WK1: Surgical Nursing Flashcards
1
Q
What is the meaning of -ectomy?
A
Excision or removal of
2
Q
What is the meaning of -lysis?
A
Destruction of
3
Q
What is the meaning of -orrhaphy?
A
Repair or suture of
4
Q
What is the meaning of -oscopy?
A
Looking into
5
Q
What is the meaning of -ostomy?
A
Creation of an opening to
6
Q
What is the meaning of -otomy?
A
Cutting into/incision of
7
Q
What is the meaning of -plasty?
A
Repair/Reconstruction of
8
Q
What is the true name for “keyhole surgery”?
A
Laparoscopic surgery
9
Q
What are the 6 components of a pre operative nursing assessment?
A
- Pt identification
- Past history e.g. medical history/comorbidities
- Social history e.g. lives with/smoking/alcohol
- Medications e.g. allergies/prescriptions
- Physical assessment e.g. Baseline VS/Height/weight
- Diagnostics e.g. Urinalysis/BGL/ECG
10
Q
What will a patient’s stress response for surgery be influenced by?
A
Age
Past experiences
Current health
Family support
11
Q
What are 3 nursing interventions to provide support to an anxious preoperative patient?
A
- Use appropriate language
- Communicate concerns with inter professional team
- Provide education
12
Q
What are the 3 components of preoperative education?
A
- Sensory info e.g. expected noise, odour, lights
- Procedural info e.g. what to wear/bring/arrive at
- Process info e.g. admission/PACU
13
Q
What are the fluid requirements for NBM preoperatively?
A
Max. 200mls clear, unsweetened fluids 2 hours prior
14
Q
Outline the importance of the metal prothesis
A
Diathermy is used in theatre, (to seal blood vessels) if grounding plate (attached to skin) makes contact with metal it will cause an electrical arc = burn
15
Q
What are the 11 components of the preoperative checklist?
A
- Pt identification
- Consent
- Allergies
- Pt preparation
- Pt alerts
- Prothesis
- Dental
- Communication aids
- Belongings
- Charts
- Diagnostics
16
Q
What are the 7 requirements of the nursing handover intra-operatively?
A
- Confirms pt identification
- Determines if pt has allergies
- Confirms planned procedure
- Confirms consent is signed
- Reviews pt assessment
- Pre meds administered?
- Determines how long pt has been fasting
17
Q
What are 2 examples of some pre medications?
A
Benzodiazepines (Decrease anxiety)
Antiemetics (Increase gastric emptying)
18
Q
What is the role of the scout nurse?
A
Coordinates all activities in OR, documents care
19
Q
What is the role of the instrument nurse?
A
Setting up/Handing sterile supplies to team, monitor aseptic status
20
Q
What is the role of the anaesthetic nurse?
A
Assistant to the anaethesist, prepares all equipment and ensures patient comfort
21
Q
What are 3 common intraoperative complications?
A
Cardiac arrythmias
Unknown allergy
Aspiration of stomach contents
22
Q
What determines a patients readiness for discharge from PACU?
A
Pt must be stable and vital signs must be within normal limits. Must meet discharge criteria
23
Q
What is the frequency of vital signs assessments post-operatively?
A
Every 30 mins until stable
Every hour for 4 hours
Every 4 hours for 24 hours
24
Q
What are some nursing interventions to encourage post-operatively?
A
Deep breathing and coughing exercises (Pneumonia) Early mobilisation (DVT) TED stockings (VTE prophylaxis)
25
What 7 medications need to be stopped prior to surgery?
Combined oral contraceptives (major surgery)
Hormone replacement therapy
Antidepressants (MAOI/TCA)
Lithium
Potassium sparing drugs (ACE inhibitors/ARB)
Antiplatelet/Oral anticoagulants
Diabetes medications (Switch to insulin)
26
Describe a general anaesthetic
Loss of sensation with loss of consciousness (Sedation, analgesia, muscle relaxant e.g. Surgery
27
Describe a regional anaesthetic
Loss of sensation to a region of the body without loss of consciousness e.g. invasive procedures
28
What is the dermatome?
Area of skin that is supplied by a single spinal nerve
29
What are dermatome levels used for?
Assessed by e.g. ice test
| Assess the patient to determine the "level of block" the regional anaesthetic has
30
What is a bromage score?
Assesses a patients ability to move their arms and legs, used to assess movement of lower extremities after regional anaesthetic
31
What is the bromage score scale?
BS 3: Unable to move feet or knees
BS 2: Able to move feet only
BS 1: Just able to move knees
BS 0: Full flexion of knees and feet
32
Describe a local anaesthetic
Loss of sensation without loss of consciousness e.g. removal of skin cancer
33
Describe a procedural anaesthetic
(Similar to general), sedative or anxiolytic, patient usually maintains own airway e.g. eye surgery
34
Describe the 4 stages of anaesthesia
1. Analgesia: Beginning of induction - Loss of consciousness
2. Excitement: Loss of consciousness - Beginning of regular respirations
3. Surgical anaesthesia: (4 different planes)
4. Medullary paralysis/Overdose: Fixed, dilated pupils, death
35
What are the 4 planes of Surgical anaesthesia?
Plane 1- Light anaesthesia
Plane 2- Reflex like responses to pain
Plane 3- Deep anaesthesia, no movement
Plane 4- Diaphragmatic respiration and assistance
36
What is the benefit of a multimodal approach?
Uses two or more classes of an analgesic to take advantage of differing mechanisms
37
List 3 advantages of a multimodal approach
1. Minimises potential side effects due to decreased reliance on one drug
2. Reduces the need for opioids by 20-30%
3. Reduces risk of over-sedation and resp depression compared to narcotics
38
What are 3 principles of post-operative pain management?
1. Evaluate effectiveness of interventions
2. Use non pharmacological and pharmacological interventions
3. Educate patient/family and reassurance
39
What is the advantage of using a PCA?
Prompt management of pain, Constant level so skips the analgesic peaks and troughs
40
List 5 post operative complications
1. Nausea and vomiting
2. Hypoxaemia/Pneumonia
3. Abdominal distension
4. Infection
5. DVT
41
When is the FLACC pain management tool used?
When the patient is non verbal or has an ALOC
42
What does FLACC stand for?
Face: Exprressions
Legs: Relaxed, restless
Activity: Lying quietly, tense, squirming
Cry: No crying, complaints, screams
Consolability: Content, difficult to console
43
What does PQRSTU stand for?
```
Precipitating Factor
Quality/Quantity
Region/Radiation
Severity
Time/Treatment
Underlying factors
```
44
Precipitating Factor?
How did it start? What makes it better? What makes it worse?
45
Quality/Quantity?
Describe the pain (Stabbing, Aching, Crushing), Is it continuous? Does it come and go? How often?
46
Region/Radiation?
Where is the pain? Does it radiate anywhere in your body?
47
Severity?
Rate your pain from 0-10
48
Timing/Treatment?
How long has it been happening? Have you done anything/meds to try help?
49
Underlying factors?
Has it happened to you before? past history?
50
What is the WONG BAKER scale used for?
Used for paediatric patients unable to verbalise their pain or patients with intellectual dysfunction (Facial expressions)
51
What are 5 nursing management interventions of PCA's?
1. Vital signs hourly assessment
2. Assess for CNS side effects of overdose
3. IVC assessment
4. Pain assessment
5. Fully cognitive ?
52
Outline the components of a wound assessment
1. Inspect skin for swelling and bruising
2. Lightly palpate skin for pain/tenderness
3. Analgesia required for pain? Infection?
4. Pt education on wound care
5. Monitor for infection
6. Document drainage/dressings etc.
53
What are the signs and symptoms of infection?
```
Increased Pain
Tachycardia
Fever
Purulent discharge
Erythema (redness)
```
54
What is the difference between primary and secondary dressings?
Primary dressings go directly on the wound to soak up any exudate and take it away from the edge, secondary dressing is to protect wound and provide compression, placed over primary dressing
55
What is the purpose of a dressing?
To cushion/protect the wound
To support the wound
Physical comfort for patient
56
Describe the process of debridement
Removing dead and devitalised tissue from a wound
57
Describe the process of hyperbaric oxygenation
Increases the capacity for blood to carry oxygen to tissues, increased oxygenation improves leukocyte migration, phagocytosis and decreased oedema
58
Describe the process of negative pressure wound therapy
Vacuum assisted closure
| Used on complex wounds, provides an optimal increased fluid removal environment for repair
59
What is the purpose of surgical drains?
Provide an exit for air and fluids, promote healing and prevent swelling
60
What is a Penrose drain?
Soft ribbon like tube that drains onto gauze or into a pouch (open drainage)
61
What is a Jackson Pratt drain?
Closed drainage system where fluid is collected into a small soft bulb
62
What is a redivac/hemovac drain?
Closed drainage system, circular device connected to a tube that sits inside the body, creates low pressure suction
63
What are 3 nursing management skills for surgical drains?
1. Check surgeons instructions
| 2. Monitor drainage colour, amount, document!!
64
What are nursing interventions for management of sutures/staples?
Education about discomfort, pain
Good clean
Document all
65
Paracetamol
- Drug Class
- Indication
- Mechanism of Action
- Adverse effects
- Nursing consideration
- Analgesic
- Mild to moderate pain/Fever
- Prostaglandin synthesis inhibition in the CNS
- Nausea, Dyspepsia, renal dysfunction
- Consider all routes for dosage limits, caution in liver disease patients
66
Ibuprofen
- Drug Class
- Indication
- Mechanism of Action
- Adverse effects
- Nursing consideration
- Non Steroidal Anti Inflammatory Drug (NSAID)
- Mild to moderate pain/Fever
- Inhibition of COX-1 non selectively and COX-2 selectively reducing pain and inflammation
- Diarrhoea, Dyspepsia
- Caution with concurrent warfarin use (bleeding), and aspirin or other NSAIDS
67
Morphine
- Drug Class
- Indication
- Mechanism of Action
- Adverse effects
- Nursing consideration
- Opioid analgesic
- Moderate to Severe pain/Supplementary during General anaesthetic
- Binds with specific opioid receptors pre/post synaptically to decrease pain transmission
- Constipation, bradycardia
- Close monitoring for resp depression, constipation prevention
68
Fentanyl
- Drug Class
- Indication
- Mechanism of Action
- Adverse effects
- Nursing consideration
- Opioid analgesic
- Moderate to severe pain/Supplementary during general anaesthetic
- Binds with specific opioid receptors pre/post synaptically to decrease pain transmission
- Constipation, bradycardia
- Close monitoring for resp depression, constipation prevention
69
Oxycodone
- Drug Class
- Indication
- Mechanism of Action
- Adverse effects
- Nursing consideration
- Opioid analgesic
- Moderate to severe pain
- Binds with specific opioid receptors pre and post synaptically to decrease pain transmission
- Constipation, bradycardia
- Close monitoring for resp depression, constipation prevention
70
Ondansetron
- Drug Class
- Indication
- Mechanism of Action
- Adverse effects
- Nursing consideration
- 5HT3 receptor antagonist
- Control N&V
- Blocks the initiation of the vomiting reflex by activating vagal afferents via 5HT3 receptors
- Headache, constipation
- Wafers placed under tongue to dissolve then swallowed
71
Metoclopramide
- Drug Class
- Indication
- Mechanism of Action
- Adverse effects
- Nursing consideration
- Prokinetic agent
- Control nausea and vomiting
- Stimulates motility of upper GI tract without stimulating gastric, biliary or pancreatic secretions
- Dizziness, constipation
- Short term use only (tardive dyskinesia)
