Week 7: Surgery Flashcards
What are the 6 reasons for getting surgery?
Diagnosis
Cure/Repair
Palliation (improves comfort)
Prevention
Exploration
Cosmetic
What is an emergency/urgent surgery?
Unexpected , requires immediate action
What is an elective surgery?
Planned in advanced
Allows for optimization for patients condition
What is inpatient same day admission surgery?
Admitted on the same day as the surgery
What is ambulatory care/same day surgery?
Less than 23 hour cases, procedures typically taking less than 2 hours
What is the PACU rule of thumb?
Patient will stay at least 1 hour or half of the operating time
When is the pre op assessment done?
Weeks before surgery
How are meds a part of the pre op assessment?
Anticoagulant should be stopped
Herbal preps like St. Johns wort can affect bleeding
Aspirin stopped 4 days prior
Coumadin should be stopped well in advance, and replaced with subQ anticoagulants
NPO is a part of the pre op assessment?
as clear fluids are allowed up to 4 hours before surgery
Pain management and Infection prevention/wound care is also included in pre op assessment?
Discuss PCA or epidural options
Assess current pain med use
Discuss incision type and care
Discharge should also be included in pre op assessment, but why?
Start it early to ensure a smooth transition
Verify appropriate discharge location
What information must the nurse ensure is available the day before surgery?
Baseline data and vitals
Medication adherence (stopped)
Verify pre op labs
Cross match blood if significant blood loss is expected
Pt has signed consent
What are pre op patient considerations?
Age, ability to manage at home
Previous hospital experiences
Current health conditions
Need for equipment or financial aid
How can a nurse reduce anxiety in a patient pre op?
Use common, simple language
Use hospital interpreters
Explore and address stressors/fears
What should be included in the comprehensive pre op assessment?
Past health history
Anesthesia problems
Medications (All kinds)
Lifestyle (vitamins, rec drugs)
how long should patients abstain from alcohol before surgery ?
at least 24 hours before
What happens if a pt doesn’t disclose their opioid addiction?
Leads to inadequate pain management after surgery
What happens if patients are not narcotic naive
They have little to no exposure to opioid drugs meaning standard doses may be ineffective
What is included in the neurological assessment pre op?
Check if pt is alert/orientated
Assess pupils (only use PERRLA FOR ACCOMMODATION)
Look for any neurological deficits
Note any assistive devices used
What is included in the cardiac assessment pre op?
Ensure baseline vitals are documented
Ensure bleeding and clotting times are available in lab reports
What is included in the respiratory assessment pre op?
Note upper respiratory issues, meds, coughing, smoking history in packs
Inquire about sleep apnea
Asthmatic pts are more prone to bronchospasm and laryngospasm
Encourage smokers to quit 6 weeks prior to surgery
What is included in the renal assessment pre op?
Note history of urinary disorders, or problems voiding as most pts go into retention during surgery
Note renal function tests
What is included in the integumentary assessment pre op?
Note pre existing skin tears, ensure padding on boney prominences and that their body is in proper alignment
What kind of padding is used during surgery to prevent pressure injuries?
Big egg crate mattress (cardiac)
Moon boots or QB socks for long procedures to protect ankles
If pt has Kyphosis (excessive outward curve of spine) a doomer pad will protect their back
What labs and tests should be done pre op?
Labs should be current within 2 weeks, may be extended if pt condition hasn’t changed
Blood type and checks for antibodies
Blood should be available if needed
How often should the nurse teach the pt to deep breathe and cough pre op?
every hour or 2
When should pt take a shower before their surgery?
The night before and morning of work hibiclens (chlorhexdine gluconate) to remove bacteria from skin
What is included in the legal preparations in pre op?
Consent form
Consent for blood transfusion
Advanced directives (DNR)
Who is responsible for obtaining the patients signature on consent form, can nurses be apart of this
The surgeon is responsible
Nurses can only be a witness
If the patient has more questions or is confused during prep what happens?
Prep will be stopped, and surgeon must be notified
In a medical emergency, what happens to consent?
Only the doctor can override the need for consent
Can a minor sign their own consent form?
Yes if the minor understands the treatment and its complications
What should the patient wear on the day of surgery?
Only a gown with no underwear unless there’s an exception with proper documentation
What needs to be removed on the day of surgery, and where does it go?
Valuables go to hospital safe or with a family member
Dentures are placed in a labelled denture cup
Contacts, makeup , and nail polish are removed
What needs to be included in prep on the day of the surgery?
Patient needs identification and allergy bands on
Pt should void right before surgery
Ordered pre op meds should be administered
Benzodiazepines
Such as Ativan are commonly given pre op
Why are Atropine and Scopolamine given pre op?
To dry up oral secretions
Why are Morphine and Fentanyl given pre op?
For pain relief
If pt has history of vomiting during surgery what can be given pre op?
Antimetics like gravol or Odansetron
For GI surgery what med might have to be given pre op?
Antacid or Proton pump inhibitor
Can patients take their routine medications pre op?
Yes with 30ml of water unless a anticoagulant
How often should the nurse provide updates during surgery?
Every hour
Who transfers accountability to the OR staff?
The transferring nurse
What happens in the holding area?
Family says goodbye
Iv lines are started, pre op meds are given, catheters are inserted, and final pt identification
Circulating nurse
Records all nursing care and documentation
Supports scrub nurse and rest of the team
Scrub nurse
prepares the patient, maintains sterile asepsis, and assist surgical team
Surgeon
Performs procedure, reviews medical history, obtains consent, pt safety, and manages post op
Surgical assistant
Assist surgeon by holding retractors or equipment, general practitioner or RN
Registered nurse first assistant
advanced practice role involving handling instruments, tissues and sutures
Anesthesiologist
administers aesthetic gases, monitors vitals, manages fluids, and prescribes pre op and post op meds
What position should pt be in for hysterectomy, lobectomy, or brain surgery
Lithotomy
Lateral
High fowlers
For skin prep how should you manage pts hair?
Clip the hair instead of shaving to prevent infection
How should skin be cleansed/prepped?
Scrubbed with antimicrobial agents in a circular motion from clean to dirty
What is local anesthesia?
Interrupts nerve impulses causing loss of sensation but not loss of consciousness
Can be topical, neubulized, ophthalmic, or injectable
What is general anesthesia?
Can be inhaled or through IV
Causes loss of sensation and consciousness
Used for long duration surgeries
What is regional anesthesia
Injected into the spine causing loss of sensation in a specific body region without loss of consciousness
What are the advantages of local and regional anesthesia?
Rapid recovery
Continued post op analgesia
Suitable for pts with comorbidities
What are the disadvantages of local and regional anesthesia?
Difficult injections
Discomfort at injection site
Risk of inadvertent vascular injection leading to hypotension, dysrhythmias, and seizures
What is the initial post op period in PACU?
Begins right after surgery and lasts until patient is discharged
PACU has a high nurse to patient ratio
What are the immediate post op assessments
Prioritize ABCs
Assess respiratory effort and ensure no airway obstruction
Look our for laryngospasm
Maintain BP within 20% of pre op values
Administer low doses of pain meds slowly
What position is best for preventing aspiration?
Lateral
How should you warm up patient after surgery in PACU?
With warm blankets, avoid layering too many blankets has rapid warming can cause vasodilation & drop in BP
What does shivering increase?
Metabolic rate and blood pressure
How can treat vasodilation from rapid warming?
With fluid administration
How do you monitor surgical site in PACU?
Check for bleeding in areas like groin/chest
Also check underneath the pt for pooling of blood
Why should you apply nasal prongs in PACU?
To aid in eliminating anesthetic gases and meet increased oxygen demands
What is post anaesthetic delirium?
Combativeness or restlessness as pt emerges from anaesthesia
How should you manage anaesthetic delirium?
Rule out other causes such as airway compromise, oxygenation and BP issues first
Meds and communication can help
What is special about hearing in post op pts?
Last sense to fade and first to return
Fever is rare complication post op, how should you manage it?
Administer Acetaminophen and investigate any potential causes
For respiratory complications like aspiration and atelectasis how would you manage it?
Deep breathing and coughing for atelectasis
Sideline or recovery position for aspiration
What is Ileus complication post op?
Bowel paralysis due to anesthesia
Assess bowel sounds before administering fluids
How can should you manage hypotension?
Administer a saline bolus as per order
Consider blood transfusion if there was a significant blood loss during surgery
How often are vitals done in PACU?
every 5 mins/first 15 mins, every 15 mins for next 30-45 mins, and every 30 mins to 60 mins until discharge
How often does a mild evaluation of temp need to be monitored?
Every couple hours
What increase temperatures may indicate atelectasis?
38 degrees Celsius
What should you do when your post op pt has a low grade temperature?
37 degrees C or 99 degrees F
Report to surgeon as it can indicate pulmonary embolism
What does it mean when an elevation in temp up to 38 degrees happens after 48 hours?
Could indicate infection
What are the 5 W’s in post op fever?
They show potential causes for fever:
Wound (site infection)
Wind (Atelectasis or Pneumonia)
Water (UTI)
Walking (DVT/PE)
Waves (ECG changes, cardiac)
How long post op should you maintain NPO status?
Until bowel sounds return
What does early ambulation help with in terms of GI system?
Peristalsis and preventing ileus
What is the expected output post op?
1mL/kg/hr (30-40ml/hour)
What is target output in the first 6-8 hours post op?
at least 200ml
What is common on day 3 in regards to output post op?
Edema as fluid begins to shift
What are signs of infection in wounds?
Purelent drainage, increased temp and decreased bp
What does the floor nurse need to do immediately after receiving pt from PACU?
Vitals and assess ABCs
When pt is transferred from PACU to the floor, what is expected within 4 hours if the pt is stable?
Dangling at bedside or ambulation
