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Week 4: Care of Surgical Patient Flashcards

1
Q

what is pre-operative care

A
  • same day surgery
  • elective or emergency
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2
Q

what is intra-operative care

A
  • in operating room or ambulatory
  • begins when we enter procedure room and ends when they enter recovery area
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3
Q

what is post-operative care

A
  • post-anesthesia recovery (PACU)
  • ambulatory (in and out)
  • admission to hospital
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4
Q

what are the 6 surgical indications and examples

A
  1. diagnosis: determine absence/presence of abnormality - ex. biopsy
  2. cure or repair: ex. hip replacement
  3. palliation: increase quality of life and comfort - ex. jejunostomy
  4. prevention: ex. mastectomy
  5. exploration: exploring what is going on - ex. colonoscopy
  6. cosmetic improvement: ex. rhinoplasty
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5
Q

what are the 4 pre-operative assessments

A
  1. consult / diagnostic testing
  2. assess medical regime, emotional status, physical assessments if indicated
  3. review past medical diagnoses and surgical procedures - helps decrease post-op complications
  4. review prescribed meds

all of this is extremely individualized

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6
Q

what are the 6 education pre-operative topics?

A
  1. protocol for routine meds before surgery
  2. which medications to stop before surgery
  3. NPO instructions
  4. pain management options
  5. infection prevention and wound care
  6. post-operative discharge and care

majority of education begins in pre-op stage!

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7
Q

what is the typical pre-operative day surgery assessment? (8 things)

A
  1. pre-operative checklist (standardized)
  2. establish baseline data (vital signs, violence risk)
  3. consider cultural considerations
  4. confirm consultations are completed
  5. review preoperative diagnostic tests
  6. consent ability
  7. identify any changes in physical assessment
  8. review medications
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8
Q

what are the 5 important preoperative considerations

A
  1. allergies
  2. systems assessment
  3. fluid and electrolyte status
  4. nutritional status
  5. labs and diagnostic tests
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9
Q

what is the ASA physical status classification system?

A

standardized score anesthesiologists use to determine risks of the person

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10
Q

what are the 6 ASA physical status levels?

A

ASA 1: healthy individual

ASA 2: patient with mild systemic disease (ex. smoking, pregnancy, obesity)

ASA 3: patient with severe systemic disease (uncontrolled diabetes, MI)

ASA 4: patient with severe systemic disease (recent <3 months, MI, sepsis, resp disease)

ASA 5: moribund patient not expected to survive without surgery (ex. ruptured abdominal aortic aneurysm, massive trauma, ischemic bowels)

ASA 6: brain-dead patient (organ removal)

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11
Q

what are the 2 surgical approaches

A
  1. open (-otomy)
  2. minimally invasive (laparoscopic -oscopy, robotic)
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12
Q

what are the benefits of laproscopic and robotic surgeries

A
  • less invasive
  • shorter recovery time
  • less pain and cosmetically beneficial
  • decrease infection risks
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13
Q

what is the intraoperative team

A

RN: circulating nurse, scrub nurse
RPN: scrub nurse
RNFA (first assist) - cardiac and orthopedic
Anaesthesiologist
Surgeon

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14
Q

how do we give general anesthesia and provide example. what are some complications?

A
  • IV or inhalation
  • opioids, benzodiazepines, and antiemetics, paralytics

complications
- risk of not fully ventilating leading to pneumothorax (collapse), alveolar collapse (atelectasis), and pneumonia

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15
Q

how do we give local anesthesia

A

variety of routes
- nerve block that blocks initiation and nerve transmission/impulse

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16
Q

how we do give regional anesthesia

A
  • spinal, epidural nerve
  • local injection INTO a nerve
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17
Q

how do we give procedural anesthesia

A

sedatives with or without analgesia
- ex. nitrous oxide

18
Q

what are the 3 critical events in the operating room

A
  1. anaphylactic reactions
    - no subjective indications, no way of us really knowing
  2. malignant hyperthermia
    - metabolic disease with rigidity of muscles
    - genetically susceptible
    - triggered by succinylcholine that relaxes muscles
    - can result in cardiac death
  3. excess blood loss
19
Q

what are the aspects of postoperative care

A

protect patient placed at physiologic risk during surgery

prevent complications

PACU - recovery room

3 phases of recovery

20
Q

what are the 3 phases of recovery

A

phase 1: care during immediate post-operative period
- focused on life sustaining needs with constant monitoring
- goal: prepare patient for safe transfer to phase 2/inpatient unit

phase 2: patient is ambulatory
- goal: prep patient for transfer to extended-care environment or home with discharge teaching

phase 3: extended observation

21
Q

Explain the PACU initial assessment

A
  • anaesthesiologist and perioperative nurse gives report to PCU nurse
  • priority of care is monitoring and managing airway and circulation, pain, temp, surgical site, and response to anaesthesia reversal

assessment includes:
- ABCs
- pulse oximetry
- telemetry or arterial BP monitoring
- temp, skin colour, condition assessment
- LOC, orientation, sensory and motor assessment, pupillary response
- assessing incision, drains, etc.

22
Q

what is the Aldrete Scale

A

determines if patient is stable enough to leave the PACU
- need a score of 9+ to leave

23
Q

what are the immediate postoperative respiratory complications? (6) what is it influenced by?

A
  • airway obstruction (most common by tongue)
  • atelectasis
  • aspiration
  • bronchospasm
  • hypoventilation
  • respiratory depression (opioids and sedation)

influenced by past medical history

24
Q

what are the immediate post-operative CVS complications? (3) what are they caused by?

A
  • hypotension: fluid loss, worried about cerebral and renal perfusion
  • hypertension: overstimulation of CNS
  • dysrhythmias: hypokalemia, hypoxia, acid base changes
25
when would we notify anaesthesia regarding CVS complications?
- SBP <90 or >160 - heart rate <60 or >120bpm - BP gradually decreases over consecutive readings - irregular rhythm develops - significant change from pre-operative readings
26
what are the immediate neuro complications in PACU? (2) what are they caused by?
- emergence delirium: hypoxia, anaesthesia agents, bladder distension, immobility, sensory and cognitive impairments, inadequate pain control, polypharmacy, dehydration, malnutrition - delayed awakening: over administration of anaesthesia - biggest cause of delirium
27
what do we assess regarding pain and discomfort?
- assess for anxiety related to pain - assess via pain scale, observations, vitals - assess effectiveness of pain modalities
28
what is a temperature alteration in the PACU? what causes it?
hypothermia - heat loss from surgery - cold fluids in OR - anaesthesia agents
29
what are the GI complications in PACU? (2) what are the risk factors for these?
- nausea - vomiting risk factors: over 50 y/o female, history of motion sickness, being non-smoker
30
what are the GU complications in the PACU?
- low urine output (looking for 30mL/h) - acute urinary retention (swelling causing issues passing urine from kidneys down)
31
what are the 3 common skin alterations we assess
- surgical wounds and/or dressings: monitor drainage amount/colour - drains: consider why patient has this, what is the expected output - surgical site infections
32
what are the emotional considerations in PACU? what are potential causes?
anxiety and depression - radial surgery - poor diagnosis post-op - grief, loss - changes to independence
33
what is the most common delayed post-op complication? what is it? what are the symptoms? how do we treat?
paralytic ileus - delayed gastric emptying, decreased peristalsis - symptoms: no bowel movement, bloating, and distended abdomen, persistence nausea/vomiting - treatment: walking around, antiemetics, conservative management (NPA and then NG to see if we can have slow return of bowel function)
34
what is general surgery
anything to do with GI tract - esophagus - small and large bowel - rectum - stomach (gastric) - liver - pancreas - gallbladder
35
Esophagectomy: - indication - surgical approach - surgical length - length of stay - post-operative considerations
- indication: esophageal cancer - surgical approach: thoracotomy or minimally invasive (thoracoscopy or robotic) - surgical length: 8-10h - length of stay: 4-7 days, ICU for 1-2 days for close monitoring - post operative considerations: jackson pratt drain, epidural/pain control, chest tubes, wound care, J-tube feeding, strict NPO
36
Small bowel resection: - indication - surgical approach - surgical length - length of stay - post-operative considerations
- indication: bowel cancer, Crohn's, scar tissue/adhesions causing small bowel obstruction, bowel perforation - surgical approach: laparoscopy, robotic, or laparotomy - surgical length: 2-4h - length of stay: if minimally invasive could be same day to 2 days, open 3-5 days - post-operative considerations: jackson pratt drain, epidural/pain control, ileostomy (high output), wound care
37
Colectomy (large bowel resection) - indication - surgical approach - surgical length - length of stay - post-operative considerations
- indication: bowel cancer, IBD (crohn's), diverticulitis, bowel perforation - surgical approach: laparoscopy, robotic, or laparotomy - surgical length: 2-4h - length of stay: if minimally invasive same day or 2 days, if open 3-5 days - post-operative considerations: jackson pratt drain, epidural or pain control, ileostomy OR colostomy, wound care, changes to output or bowel movements?
38
appendectomy - indication - surgical approach - surgical length - length of stay - post-operative considerations
- indication: appendicitis, very rarely appendiceal cancer - surgical approach: laparoscopy, rarely open - surgical length: 1-2h - length of stay: can go home post-op, or 1-2 days - post-operative considerations: pain from laparoscopy air, infection
39
cholecystectomy - indication - surgical approach - surgical length - length of stay - post-operative considerations
removal of gallbladder - indication: gall stones - surgical approach: laparoscopy, rarely open - surgical length 1-2h - length of stay: usually go home post-op, or 1-2 days - post-operative considerations: pain from laparoscopy air, retained gall stones
40
Pancreaticoduodenectomy (whipples) - indication - surgical approach - surgical length - length of stay - post-operative considerations
- indication: pancreatic or bile duct cancer - surgical approach: laparotomy - surgical length: 6-8h - length of stay: 4-7 days - post-operative considerations: pain modalities, wound care, drains, nutritional support
41
key considerations of caring for a surgical patient (post med history, discharge info, minimizing complications)
post med history - How does this influence length of stay? What considerations for post-operative management? discharge info - Education on new appliances, drains or ostomies - Education on potential complications & when to seek medical attention (Teach-back method) - Follow up information minimizing complications - pain control - ambulation - nutrition

NURS305 (6 decks)

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