Week 2: P and Z and the client undergoing surgical procedure Flashcards
What is preoperative?
Before surgical procedure
Intraoperative
During surgical procedure
Postoperative
After surgical procedure
Disease vs Illness
Disease: viewed from medical POV (objective)
Illness: human experience (subjective)
Multimorbidity
Simultaneous occuerence of several chronic medical conditions
Top 3 leading causes of chronic illnesses
- Cardiovasc disease
- Cancer
- Resp disease
What are the 3 models of disability?
Medical, social and biopsychosocial
Informal Caregiver
Anyone who provides care without pay
Caregiver burden
Overall physical, emotional and financial costs of caregiving
What are factors that increase caregiver burden?
- caregiver has poorer sense of well-being
- higher frequency of client dysfunctional behavior
- higher demand for assistance
- caregiver dissatisfied with outside help
Chronic: Illness Trajectories Phases
Crisis phase: period before and immediately after diagnosis, when learning to live with symptoms
Chronic phase: timespan between initial diagnosis and final time phase
Terminal phase: Marked by issues surrounding grief and death
ectomy
remove
ex; appendectomy
oscopy
look into
ex; endoscopy
ostomy
opening into
ex; colostomy
otomy
incision/ cutting into
ex; tracheotomy
plasty
repair or reconstruct
ex; mammoplasty
Purpose of preoperative nursing assessment
- determines worries/ concerns/ priorities
- physological factors
- identify cultural and ethnical factors
- establish baseline data
- post op teaching
What should you include in subjective pre-op assessment?
Fears, anxiety, hope, past health history, medications, allergies, latex allergies
What is important information to gather in pre-op for a neuro system?
- Vision and hearing
- Cognitive function
What is important information to gather in pre-op for a cardio system?
- Baseline vitals
- Bleeding/clotting times
- Lab reports
What is important information to gather in pre-op for a resp system?
- History of dyspnea, coughing, hemoptysis, COPD or Asmtha
- Smoking
- Airway infections
What is important information to gather in pre-op for a urinary system?
- Hx of urinary or renal diseases
- Renal function tests
What is important information to gather in pre-op for a hepatic system?
- Consider presence of liver disease if there is a history of jaundice, hepatitis, and alcohol abuse
What is important information to gather in pre-op for a integumentary system?
- Hx of skin and musculoskeletal problems (pressure ulcers)
Why are clients with diabetes mellitus at greater risk for complications?
- hypo/hyerglycemia
- ketosis
- cardiovascular alterations
- delayed wound healing; infections
Common preop lab tests?
Urinalysis, chest x-ray, ECG, pulmonary function, CBC (hemoglobin/hematocrit, WBC, electrolytes, oximetry, ABG, INR, blood glucose, creatinine, Renal proBUN, liver function, type, screen&crossmatch, Prothrombin (INR)
Legal preparations: what are important forms to have signed pre-op?
- Informed consent, blood transfusions, advance directives, power of attorney
Who is responsible for obtaining consent?
Surgeon
- But RN might witness patient’s signature, verify client has understanding and recognize client permission may be withdrawn any time
Describe techniques of medical asepsis
- hand hygiene 10-15 seconds lather
- hands are most contaminated
- keep hands and forearms lower than elbows
- dry with paper towel from fingers to wrists to forearms
Describe techniques of surgical asepsis
- surgical scrub
- 2-6min
- hands become cleanest
- wet hands and arms to 5cm above elbows
- keep elbows above elbows at all times
- dry with sterile towels
When can appointed family consent for client?
If they are a minor, unconscious or mentally incompetent
When is the only time that doctors may override need to obtain consent
In a true medical emergency
Nursing Preop Responsibilities
Admission history/physical exam on chart
Consultation records
Nurse’s notes
Baseline V/S
Weight
Appropriate tests (e.g. CXR, EKG) completed
Urinalysis completed
Blood Work (CBC, lytes, completed
ID and allergy bands on wrist
Valuables returned to family
Other pre op diagnostic tests
Health teaching
Signed consent in chart
Shave prep if req’d
NPO
Insert Foley if ordered
I&O
Pre-op nursing jobs day of the operation
IV
Prosthesis out
Clean hospital gown
Rings off/taped; jewelry; dentures, contacts, prostheses removed
Nail polish, makeup off
Void prior to going
Pre-op meds if ordered (sedation, antibiotics…)
Safety issues (i.e., side rails; call bell near)
Pre op check list …is charting up to date??
Room ready for return
Instruct family on waiting area where they can be informed of progress
Diferentiate purpose of three different areas of surgiacal suite and appropriate attire for each
Unrestricted
Semi-restricted
Restricted
The semi-restricted area is where scrub attire and hair coverings are worn, the scrub sinks are located, and clean and sterile supplies are stored; it also includes some of the areas used to process surgical instruments. The restricted area includes operating rooms, procedure rooms, and clean-core areas. This is where full surgical attire and masks are worn. The work flow of people, supplies, and equipment needs to travel from dirty to clean areas in such a way that contaminated items are separated from clean and sterile items by space, time, and traffic patterns
General Anaesthesia
- IV inductionl; inhalation agents
- Adjuncts to general-opioids, bezodiazepines, muscle relaxants
Local anesthesia
- Topical (EMLA cream)
- Regional (peripheral) nerve block
- Spinal (into CSF below L2; autonomic, sensory and motor block)
- Epidural (above dura binds to nerve root as they enter-exit spinal cord)
Epidural vs Spinal
Epidural
- dose high
- onset slow
- doesnt cause much of neuromuscular blocl
- multiple dosing possible
- various points along backbone
Spinal
- dose is low
-onset is fast
- can cause neuromuscular blocl
- single dose only
- given only at specific point to avoid damage to spinal cord
Post Op Checks upon patient’s return from PACU to Unit
- surgery done
- time of arrival
- dr. orders w primary nurse
- check ABC’s
- dressing and incision
- VS
- IV
- Catheter/draining tubes
Post Op Checks upon patient’s return from PACU to Unit
- surgery done
- time of arrival
- dr. orders w primary nurse
- check ABC’s
- dressing and incision
- VS
- IV
- Catheter/draining tubes
Hypoxemia/ atlectasis
Low oxygen levels in blood relating to collapsed lung
Illeus
A temporary lack of the normal muscle contractions of the intestines.
Hypovelemic Shock
emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body
How to prevent complications in during Post Op
Deep breathing & coughing
Incentive spirometer
Early ambulation
Turning side to side
O2 as ordered
Regular respiratory assessment
How do you prevent circulatory stasis?
- Leg exercises, early ambulation, anticoagulants, adequate fluid intake, regular C/V assessment
What is PACU?
Post-anaesthesia care unit
Existentialism
Type of philosophy; find meaning and make responsible choices
Benign
Non cancerous
Malignant
Cancerous
Circulating Nurse
Going around in and out, updates to family, where she needs.
Scrub Nurse
Handing instruments, sterile
Describe the areas of the surgical suite
Unrestricted, semi-restricted and restricted
Unrestricted area
No clothing restrictions; patients, family members and others may enter these areas for temporary business in street clothes
Semi-restricted
Authorized personnel only. Surgical attire and covering of all head and facial is required. PPE is required
Restricted
OR and procedure rooms. To enter these you must cross the red line.
- Movement of personnel in and out of room is kept to minimum
- Surgical attire, covering of all head and facial hair and appropriate footwear are required for all
- masks required where sterile supplies are open
- PPE required
What do Registered Nurse First Assistants do? (RNFA)
Assists surgeon by monitoring patient’s vital signs during surgical procedures. Helps with stabilizing patient
What do Registered Nurse Anaesthesia Assistants do?
Help monitor patient stability for anaesthesiologist. May administer meds to help keep pt. sedated.
Local vs regional vs general anesthesia
Local: temporarily stop pain in certain area of body. Can be given via injection ot site or absorbed into skin
Regional: numbs only portion of body that will undergo surgery. (Spinal and epidural anesthetic)
General: unconsciousness during surgery; either inhaled or given by IV
How to prevent post op atelectasis
Atelectasis can be prevented or treated by adequate analgesia, incentive spirometry (IS), deep breathing exercises, continuous positive airway pressure, mobilisation of secretions and early ambulation.
