Week 1 Operative Patient Flashcards
Reasons for Surgery
-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
Basic Surgery Info
-Urgency: Elective, Urgent, and Emergent
- Degree of risk: Minor and Major
-Extent: Simple, Radical, and Minimally Invasive (MIS)
History and Data Collection
-Age
-Drugs and substance use
-Medical History
-Complementary/Alternative practices
-Previous Surgical Procedures
-Discharge Planning
Physical Assessment
-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
System Assessment
-Cardiovascular
- Respiratory
-Renal/Urinary
-Neurologic
-Musculoskeletal Status
-Nutritional Status
-Psychosocial
Laboratory Assessment
-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
Planning and Implementation
-Providing Information
-Ensuring Informed Consent
-Implementing Dietary Restrictions
-Preventing Respiratory Complications
-Preventing Cardiovascular Complications
-Minimizing Anxiety
NPO
-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
Skin Preparation
-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
Prevention of Respiratory Complications
-Breathing Exercises
-Incentive Spirometry
-Coughing and splinting
Prevention of Cardiovascular Complications
-leg exercises
-Mobility
Why are older people at high risk for surgery?
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
Patients at risk for VTE (venous thromboembolism)
-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
Preoperative Patients
-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
Stages of General Anesthesia
- Stage 1: Analgesia and sedation, relaxation
-Stage 2: Excitement, delirium
-Stage 3: Operative anesthesia, surgical anesthesia
-Stage 4: Danger
-Emergence: Recovery from anesthesia
Complications from General Anesthesia
-Malignant Hyperthermia
-Overdose
-Unrecognized Hypoventilation
-Problems with specific anesthetic agents
-Intubation Problems
Malignant Hyperthermia
-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
Symptoms of Hyperthermia
-Tachycardia
-Skin Mottling
-Cyanosis
-Myoglobinuria
-Rise in end tidal carbon dioxide
-Elevated temperature
Preventing Injury
-Proper body position
-Prevent pressure ulcer formation
-Prevent obstruction of circulation, respiration, nerve conduction
Preventing Infection
-Plastic adhesive drape
-Skin closures, sutures and staples, nonabsorbable sutures
-Insertion of drains
-Application of dressing
-Patient transfer from OR table to stretcher
Preventing Hypoventilation
Continuous monitoring of breathing, circulation, cardiac rhythms, blood pressure, and heart rate
Respiratory System Assessment
-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
Respiratory and Cardiovascular Assessment
-Respiratory: rate, pattern, and depth
-Cardiovascular: vital signs, heart sounds, cardiac monitoring, peripheral vascular assessment
General Assessment
-Intake and Output
-Hydration status
-IV fluids
-Acid-base balance (wound drainage and nasogastric tube drainage)
Renal/Urinary System
-Check for Urine retention
-Consider other sources of output (sweat, vomitus, diarrhea stools)
-Report urine output of <30 mL/hr
Gastrointestinal System
-Postoperative nausea/vomiting common
-Peristalsis may be delayed up to 24hrs
-Monitor for bowel sounds
-Medications to reduced nausea/vomiting
Dehiscence vs Evisceration
-Dehiscence: wound opens
-Evisceration: Organs exits out of the body through the wound
NG Tube Drainage
-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
Skin Assessment
-Normal wound healing: assess tissue integrity frequently
-Impaired wound healing: Seen most often between 5 to 10 days after surgery
Psychosocial Assessment
-Increased pulse and blood pressure
-Increased respiratory rate
-Profuse sweating
-Restlessness
-Confusion (older adults)
-Wincing, moaning, and crying
Laboratory Assessment
-Analysis of electrolytes
-CBC
-Specimens for C&S
-ABGS
-Urine and renal laboratory tests
- Glucose (Diabetics)
-Serum Amylase
Hypoxemia Interventions
-Highest incidence on 2nd postoperative day
-Interventions: airway maintenance, monitor SPO2, Semi-Fowlers position, oxygen therapy, breathing exercises, mobilization as soon as possible
Preventing Wound Infection
-Frequent Dressing and Drain changes
-Drug Therapy
-Debridement
Managing Pain
- Drug Therapy
-Positioning
-Massage
-Relaxation/Diversion techniques
