Week 2- Perioperative Care and Assessment Flashcards
3 components of periop
preop
intra op
post op
Seriousness classification of surgery
- major
- minor
- involves extensive reconstruction or alteration in body parts, poses great risk to wellbeing
- involves minimal alteration in body parts; often designed to correct deformities; involves minimal risks compared with major procedures
examples of major surgeries
CABG
colon resection
removal of larynx
resection of lung lobe
example of minor surgery
cataract extraction
facial plastic surgery
tooth extraction
types of urgency surgeries
elective
urgent
emergency
elective surgery
- usually is optional
- may not be necessary for health
ex: bunionectomy, facial plastic surgery, breast reconstruction, removal of wart
urgent surgery
- is necessary for patient health
- may prevent additional problems from developing (tissue destruction or impaired organ function) not necessarily emergency
ex; excision of cancerous tumour, removal of gallbladder for stones, vascular repair for obstructed artery (CABG)
emergency
must be done immediately to save a persons life or preserve function of body part
ex: repair of perforated appendix, repair of traumatic amputation, control of internal hemorrhaging
diagnostic purpose of surgery
surgical exploration that allows physician to confirm diagnosis may involve removal of tissue for further diagnostic testing
ex: exploratory laparotomy (incision into peritoneal cavity to inspect abdominal organs)
breast biopsy
ablative surgery
excision or removal of diseased body part
amputation, removal of appendix, cholecystectomy
palliative surgery
relieves or reduces intensity of disease symptoms will not cure
ex: colostomy, debridement of necrotic tissue, removal of brain tumor
reconstructive or restorative surgery
restores function or appearance to traumatized or malfunctioning tissues
ex: internal fixation of fractures, scar revision
procurement for transplant
Removal of organs, tissues, or both from a person pronounced dead for purpose of transplantation into another person.
Sometimes there are living donors such as one person donating a kidney to another.
ex: kidney, heart or liver
purpose of constructive
Restores function lost or reduced as a result of congenital anomalies
repair of cleft palate, closure of atrial septal defect
cosmetic surgery purpose
performed to improve personal appearance
ex: rhinoplasty
purpose of pre op assessment
more than HTT
baseline information
want them to be safe
might be specific based on surgery
Older adult considerations
Are more likely to experience perioperative complications than younger adults because they
- more likely to have chronic illness
- have lower % of body water- so more likely to experience fluid and electrolyte disturbances
- Tend to have reduced liver and kidney function – so they metabolize and excrete drugs slower, increasing the risks for toxic effect
- May be poorly nourished – which can impair healing
review _____ with patients to confirm accuracy
BPMH
always check
surgical PPOs and written pre op orders
meds to check pre op day of procedure
- Glucocorticoid (e.g. prednisone, dexamethasone)
- Anti-Diabetics - patient is NPO so watch for hypoglycemia and check pre-operative orders. The MRP may have changed orders for the day of surgery and the patient may not require insulin or oral hypoglycemics
- Cardiac medications- Check orders
Betablockers – typically given but check orders
ACE inhibitors and ARBs have been associated with hypotension during surgery & can impair renal function -check
Diuretics may lead to postoperative hypovolemia and hypotension -check - Blood thinners – Usually held - Heparin, Warfarin, LMWH (Should they be stopped a certain amount of time prior to surgery?); ASA(? dosage dependent) & NSAIDS & Plavix are sometimes held because of bleeding properties
herbs and supplements that cause complications
Echinacea
Feverfew
Garlic
Ginger
Gingko biloba
Ginseng
Goldenseal
Licorice
Saw palmetto
St John’s wort
Valerian
Vitamin E
Kava