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Med Surg Exam 1 > Week 1 Operative Patient > Flashcards

Week 1 Operative Patient Flashcards

1
Q

Reasons for Surgery

A

-Diagnostic: Determines origin and cause of disorder
-Curative: Resolves health problem by repairing or removing cause
-Restorative: Improves patient’s functional ability
-Palliative: Relieves symptoms of disease process, but does not cure
-Cosmetic: Alters/enhances personal appearances

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2
Q

Basic Surgery Info

A

-Urgency: Elective, Urgent, and Emergent
- Degree of risk: Minor and Major
-Extent: Simple, Radical, and Minimally Invasive (MIS)

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3
Q

History and Data Collection

A

-Age
-Drugs and substance use
-Medical History
-Complementary/Alternative practices
-Previous Surgical Procedures
-Discharge Planning

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4
Q

Physical Assessment

A

-Obtain: Obtain baseline vital signs
-Focus on: Focus on problem areas identified in history; all body symptoms affected by surgical procedure
-Report: Report abnormal assessment findings to surgeon/anesthesiology personnel

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5
Q

System Assessment

A

-Cardiovascular
- Respiratory
-Renal/Urinary
-Neurologic
-Musculoskeletal Status
-Nutritional Status
-Psychosocial

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6
Q

Laboratory Assessment

A

-Urinalysis
-Blood Type and Screen
-CBC, Hemoglobin Level, and Hematocrit
-Clotting Studies (PT, INR, aPTT)
-Electrolyte Levels
- Serum Creatinine Level
-Pregnancy Test
-Chest X-ray
-ECG

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7
Q

Planning and Implementation

A

-Providing Information
-Ensuring Informed Consent
-Implementing Dietary Restrictions
-Preventing Respiratory Complications
-Preventing Cardiovascular Complications
-Minimizing Anxiety

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8
Q

NPO

A

-Patient CANNOT ingest anything by mouth for 6 to 8hrs before surgery
- Some medications require a SIP of water like seizures, hypertension, cardiac/respiratory disease

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9
Q

Skin Preparation

A

-Breaks in the skin increases risk for infection
-Patient may be asked to shower using antiseptic solution
-Hair removal by electric clippers
-Shaving of hair creates risk for infection

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10
Q

Prevention of Respiratory Complications

A

-Breathing Exercises
-Incentive Spirometry
-Coughing and splinting

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11
Q

Prevention of Cardiovascular Complications

A

-leg exercises
-Mobility

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12
Q

Why are older people at high risk for surgery?

A

Decreased: -cardiac output, peripheral circulation
-vital capacity, blood oxygenation
-Blood flow to kidneys, glomerular filtration rate

Increased: -Blood Pressure
-Risk for skin damage, infection
- Sensory deficits
-Deformities related to osteoporosis/arthritis

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13
Q

Patients at risk for VTE (venous thromboembolism)

A

-Obese Patients
-Age of 40 or older
-History of cancer or decreased cardiac output
-Decreased mobility, immobile, spinal cord injury
-History of VTE, PE, Varicose veins, Edema
-Oral Contraceptives
-Smoking
-Hip fracture, total hip/knee surgery

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14
Q

Preoperative Patients

A

-Remove most clothing; provide down
-Leave valuables with family or lock up
-Tape rings in place if cannot be removed
-ensure patient is wearing ID band
-Remove: Dentures, Prosthetic, Hearing aids, Contact lenses, Fingernail polish, Artificial nails, and all jewelry

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15
Q

Stages of General Anesthesia

A
  • Stage 1: Analgesia and sedation, relaxation
    -Stage 2: Excitement, delirium
    -Stage 3: Operative anesthesia, surgical anesthesia
    -Stage 4: Danger
    -Emergence: Recovery from anesthesia
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16
Q

Complications from General Anesthesia

A

-Malignant Hyperthermia
-Overdose
-Unrecognized Hypoventilation
-Problems with specific anesthetic agents
-Intubation Problems

17
Q

Malignant Hyperthermia

A

-Acute, life-threating complication
-May be genetic
-Begins with skeletal muscle exposed to specific agent
-Causes increased metabolism, calcium levels in muscle cells
-Leads to acidosis, high temperatures, dysrhythmias

18
Q

Symptoms of Hyperthermia

A

-Tachycardia
-Skin Mottling
-Cyanosis
-Myoglobinuria
-Rise in end tidal carbon dioxide
-Elevated temperature

19
Q

Preventing Injury

A

-Proper body position
-Prevent pressure ulcer formation
-Prevent obstruction of circulation, respiration, nerve conduction

20
Q

Preventing Infection

A

-Plastic adhesive drape
-Skin closures, sutures and staples, nonabsorbable sutures
-Insertion of drains
-Application of dressing
-Patient transfer from OR table to stretcher

21
Q

Preventing Hypoventilation

A

Continuous monitoring of breathing, circulation, cardiac rhythms, blood pressure, and heart rate

22
Q

Respiratory System Assessment

A

-Patent airway, adequate gas exchange
-Note artificial airway when applicable
-Rate, pattern, depth of breathing
-Breath sounds
-Accessory muscle use
-Snoring and Stridor
-Respiratory depression or hypoexmia

23
Q

Respiratory and Cardiovascular Assessment

A

-Respiratory: rate, pattern, and depth

-Cardiovascular: vital signs, heart sounds, cardiac monitoring, peripheral vascular assessment

23
Q

General Assessment

A

-Intake and Output
-Hydration status
-IV fluids
-Acid-base balance (wound drainage and nasogastric tube drainage)

23
Q

Renal/Urinary System

A

-Check for Urine retention
-Consider other sources of output (sweat, vomitus, diarrhea stools)
-Report urine output of <30 mL/hr

23
Q

Gastrointestinal System

A

-Postoperative nausea/vomiting common
-Peristalsis may be delayed up to 24hrs
-Monitor for bowel sounds
-Medications to reduced nausea/vomiting

24
Q

Dehiscence vs Evisceration

A

-Dehiscence: wound opens
-Evisceration: Organs exits out of the body through the wound

24
Q

NG Tube Drainage

A

-Inserted during surgery to decompress and train stomach, promote GI rest, allow lower GI rest, provide enteral feeding route, monitor any gastric bleeding, and prevent intestinal obstruction
-Assess drained material every 8hr

25
Q

Skin Assessment

A

-Normal wound healing: assess tissue integrity frequently
-Impaired wound healing: Seen most often between 5 to 10 days after surgery

26
Q

Psychosocial Assessment

A

-Increased pulse and blood pressure
-Increased respiratory rate
-Profuse sweating
-Restlessness
-Confusion (older adults)
-Wincing, moaning, and crying

27
Q

Laboratory Assessment

A

-Analysis of electrolytes
-CBC
-Specimens for C&S
-ABGS
-Urine and renal laboratory tests
- Glucose (Diabetics)
-Serum Amylase

28
Q

Hypoxemia Interventions

A

-Highest incidence on 2nd postoperative day
-Interventions: airway maintenance, monitor SPO2, Semi-Fowlers position, oxygen therapy, breathing exercises, mobilization as soon as possible

29
Q

Preventing Wound Infection

A

-Frequent Dressing and Drain changes
-Drug Therapy
-Debridement

30
Q

Managing Pain

A
  • Drug Therapy
    -Positioning
    -Massage
    -Relaxation/Diversion techniques

Med Surg Exam 1 (3 decks)

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