Care of Surgical Patient Flashcards
(132 cards)
1
Q
Needed to be done Immediately; life threatening situation
A
Emergency
2
Q
Preserve life, a body part, or function
A
Emergency
3
Q
Example of emergency surgery
A
Gallbladder surgery, appendectomy, bowel upstruction, coronary bypass
4
Q
Not an emergency; requires prompt intervention
A
Urgent
5
Q
Within a reasonably short time frame—24-48 hours
A
Urgent
6
Q
Preserve health
A
Urgent
7
Q
Example of Urgent Surgery
A
Simple hernia repair,
8
Q
Non-urgent, non-acute problem, not life threatening but surgery is preferred
treatment
A
Elective
9
Q
Pre-planned
A
Elective
10
Q
Patient’s choice; must have versus should have
A
Elective
11
Q
Not critical to survival or function. Personal preference. Cosmetic.
A
Optional
12
Q
to make or confirm diagnosis
A
Diagnostic Surgery
13
Q
Biopsy, colonoscopy
A
Diagnostic Surgery
14
Q
To remove diseased body part
A
Ablative Surgery
15
Q
removal of limb, thyroidectomy, tonsilectomy
A
Ablative surgery
16
Q
: To restore function to a traumatized or malfunctioning
tissue.
A
Restorative (reconstructive) Surgery
17
Q
Facial reconstruction, skin grafts, post-mastectomy breast reconstructive.
A
Restorative surgery
18
Q
To relieve or reduce intensity of an illness; is not curative. Relieve
symptoms without curing
A
Palliative surgery
19
Q
Removal of mass, removal of bowel obstruction.
A
Palliative surgery
20
Q
To restore function in congenital anomalies
A
Constructive surgery
21
Q
To replace organs or structures that are diseased or malfunctioning.
A
Transplantation surgery
22
Q
Two degrees of risk
A
Minor, major
23
Q
Low risk to patient; fewer complications; often same day surgery
A
Minor Risk
24
Q
High risk to patient; more complicated; increased blood loss; vital organ
involved; increased risk of post-operative complications.
A
Major Risk
25
Surgical settings
Ambulatory, Hospital
26
Advantages of Same Day Surgeries
Lower cost, less risk for hospital acquired infections, decrease in stress and anxiety, faster
27
Disadvantages of Same Day Surgeries
May encounter more complications, limited time for preoperative education, must social support
28
Inpatient surgeries are more complicated, emergency, urgent and some elective.
Decreasing length of stay is a priority now.
Hospital Setting
29
Preoperative Medical + Nursing Assessment
1) Identify patient risk factors
2) Collect data
3) Educate patient and family
30
CBC
Complete Blood Count
31
Surgical clinics, Doctor's office, outpatient surgery in hospital.
Ambulatory Surgeries
32
UA
Urinalysis
33
BMP
Basic Metabolic Panel
34
Presurgical Testing
1) CBC
2) UA
3) BMP
4) Chest x-ray
5) EKG
6) Type +Cross Matching
35
Performed by MD, PA, NP. Identifies potential problems and establishes baseline. Patient must be cleared for OR, done in office or on admission.
History + Physical
36
Components of History + Physical
1) Respiratory Status
2) Cardiovascular Status
3) Renal Status
4) Musculoskeletal status
5) Neurological Status
6) Nutritional + Hydration Status
37
Urinalysis is used to identify...
Kidney Function
38
BMP looks at
Electrolytes (sodium, potassium, etc.)
39
Nursing Assessment
1) Current Problem
2) Vital Signs
3) Height + Weight
4) Allergies
5) Health Habits
6) Chronic Health Problems
7) Previous Surgery
8) Medications
9) Support System, sociocultural needs
10) Physical Assessment
40
-Mycins, potentiate muscle relaxants
Antibiotics
41
Increase bleeding time, problem with clotting, should be stopped several days before surgery.
Anticoagulants, Aspirins, NSAIDS
42
When used with anesthetics can cause hypotension
Antihypertensives
43
Loss of K. Hypokalemia will cause cardiac problems, arrhythmias
Diuretics
44
steroids—when stopped suddenly will cause CV collapse; Also
| steroids are anti-inflammatory and will delay wound healing
Corticosteroids
45
potentiate narcotics and barbiturates which will decrease BP and
cause CNS depression
Tranquilizers
46
Nursing Diagnoses
1. Knowledge Deficit:
2. Fear R/T
3. Powerlessness R/T
4. Anticipatory Grieving R/T
5. Anxiety R/T
47
Respiratory Equipment
1. Incentive Spirometer
| 2. Positive Expiratory Pressure (PEP) Cough Support Device
48
Postoperative Exercises + Activities
1. Anti-embolism stockings (TED’s)
2. Sequential Compression Device (SCD’s)
3. Leg exercises
4. Turning in bed; OOB
49
to empty bladder; may return with one or may need one after if does
not void usually within 8-12 hours post op. When in place patient may still feel the urge to
urinate.
Foley Catheter
50
to keep stomach empty; rests the GI tract; attached to LIWS-low intermittent
wall suction. Placed in surgery or after. Irrigate only if ordered.
NG Tube
51
Postoperative Equipment
1) Foley Catheter
2) NG Tube
3) Drains
4) IV Access; PCA
5) Ventilator
6) CPM Machine, Abduction Pillow, Dressings, Ostomies
52
Knee surgery
CPM Machine
53
Hip Surgery
Abduction Pillow
54
Ordered by anesthesiologist
| Given at scheduled time, on call, or in the holding area
Preoperative Medications
55
such as diazepam (Valium); midazolam (Versed); or lorazepam (Ativan) to
alleviate anxiety and decrease recall of events related to surgery
Sedatives
56
such as atropine and glycopyrrolate (Robinul) to decrease pulmonary
and oral secretions and prevent laryngospasm
Anticholinergics
57
such as morphine to facilitate patient sedation and relaxation and to
decrease the amount of anesthetic agent needed
Narcotic analgesics
58
such as fentanyl citrate-droperidol (Innovar) to cause ageneral state of calmness and sleepiness
Neuroleptanalgesic agents
59
such as cimetidine (Tagamet) and ranitidine
| (Zantac), to decrease gastric acidity and volume
H2-histamine receptor antagonist
60
Post medication administration safety:
Patient should be on bedrest, in bed or on stretcher, with siderails up, and safety
belt on prn
61
IMMEDIATE PRE OP NURSING CARE NURSING RESPONSIBILITIES
A. Preoperative check List
B. Assess NPO Status and Vital Signs
C. Informed Consent – Physician is responsible for providing appropriate information
62
Preoperative informed consent should include:
- Nature and intention of the surgery
- Name of the person performing the surgery
- Risks, including tissue damage, disfigurement, or even death
- Chances of success
- Possible alternative measures
- The right of the patient to refuse consent or later withdraw consent
63
Nursing Responsibilities regarding informed consent
-Ensure that consent is signed
-Witness patient’s signature
-Nurse’s signature does not indicate that the patient is informed
-Surgeon must be contacted and requested to see the patient if the patient needs
any clarification of information.
-Consent must be signed before any preop medication is administered.
-Must call MD if pre-op medication has been given.
64
Criteria for a Consent to be Valid
1. Consent is voluntary
2. Informed subject
3. Competent subject—Legal age and mentally competent
65
consent is signed by next of kin usually spouse, adult child, parent, sibling.
Incapable Adults
66
Who signs for minor (under 18)?
Parent or legal Guardian
67
consent is signed by next of kin usually spouse, adult child, parent, sibling.
Emergency Consent
68
Blind patients can sign the consent with...
two witnesses
69
Certain procedures require additional consents:
Blood Transfusion
70
performs surgery, manages patient care before and after
Surgeon
71
works under the supervision of the surgeon.
Responsibilities include: handling tissue, suturing, providing visualization of the
operative area, maintaining homeostasis
Registered Nurse First Assistant
72
administers anesthesia and other drugs, monitors
patient’s response throughout procedure, manages any technical problems, intubates
patient.
Anesthesiologist or Anesthetist
73
Has graduated from an accredited nurse anesthetist program,
| passed exams to become a Certified Nurse Anesthetist.
Nurse Anesthetist
74
RN who coordinates activities and environment in OR, is patient
advocate by assessing and monitoring the patient’s safety, monitoring surgical asepsis, is
responsible for counts, assists with patient positioning, preparing the patient’s skin,
managing surgical specimens, and documenting events.
Circulating RN
75
RN, LPN, Surgical Technician—responsible for preparation of sterile
supplies, delivery of instruments, anticipate what instruments and supplies will be needed,
assists with final counts
Scrub Person
76
Inhalation or Intravenous
Produces CNS depression, analgesia, relaxation, and reflex loss
Patients are not arousable, are unable to maintain breathing and require mechanical ventilation, and CV function may be impaired also
General Anesthesia
77
4 stages of General Anesthesia
1) Beginning Anesthesia
2) Excitement
3) Surgical Anesthesia
4) Medullary Depression
78
Local anesthetic injected around nerves
Patient is awake and aware of surroundings
Less systemic effect. Good for elderly, those with cardiac or respiratory problems,a patient who has recently eaten
Regional Anesthesia (blocks or spinal)
79
Two Types of Regional Anesthesia
Epidural
| Spinal
80
Agent is injected into the epidural space that surrounds the duramater of the spinal cord.
Epidural Anesthesia
81
Advantage of Epidural?
No headache
82
Disadvantage of Epidural?
need more precise technical administration. Can be used postoperative also for pain control.
83
Agent injected through the dura mater and into the
subarachnoid space surrounding the spinal cord.
Produces anesthesia to lower extremities, perineum, and lower abdomen. Side effects—headache and hypotension. Tx: lay flat and administer fluids.
Spinal Anesthesia
84
Used alone or with regional anesthesia. Minimal depression of LOC., patient can maintain airway,
respond to commands. Uses IV narcotic and antianxiety drugs. Used in short term surgical procedures or diagnostic procedures (colonscopy). Continuous monitoring is required
Moderate Sedation/Analgesia (previously called Conscious sedation)
85
Nursing Responsibilities in the Operating Room
1. On-going assessment – physiologic, psychosocial, physical, ethical
2. Physiological monitoring-vitals, telemetry, I+O, lab results, pulse ox.
3. Minimize anxiety – psychological support
4. Minimize risk for injury
5. Patient Advocate
86
Potential Inoperative Complications
1) Nausea + Vomiting
2) Anaphylaxis
3) Hypoxia
4) Hypothermia
5) Malignant Hyperthermia
87
Inadequate ventilation due to airway occlusion, inadvertent intubation of
esophagus instead of trachea. Other causes are respiratory depression from
medications, aspiration of secretion or vomitus, the positioning of the patient on the table.
Brain damage occurs within minutes. Patient must be monitored carefully—O2 levels,
pulse ox, peripheral circulation.
Hypoxia
88
-Intentionally done with bypass surgery. Unintentionally done
because of low room temperature, cold IV fluid, inhaling cold gases, open body cavity,
decreased muscle activity, age, medications. Re-warm gradually. Room temperature,
warm IV fluids, dry sheets. Monitor patient closely.
Hypothermia
89
-A rare inherited MS disorder chemically induced by
anesthetic agents. ID patients at risk: bulky muscles, hx of MS cramps or weakness,
unexplained increase in temperature, and unexplained death of family member during OR
with increased temperature. Recognizing symptoms early and discontinuing anesthesia
and surgery are imperative.
Malignant Hyperthermia
90
an acute allergic reaction to an antigen (e.g., a bee sting) to which the body has become hypersensitive. Life threatening.
Anaphylaxis
91
Transferring a person to PACU (Steps)
1. Patient transferred to PACU with anesthesiologist
2. Report given to PACU nurse
3. All pre-op orders cancelled – new orders must be written
92
PACU stands for...
Post Anesthesia Care Unit
93
Focus of Nursing Care in PACU
1. Physiological monitoring
2. Psychological support
3. Environmental safety
4. Comfort measures
94
Respiratory Status
1) Airway Patency
2) Hypoventilation
3) Aspiration
95
assess for return of gag reflex; look at positioning of tongue;
accumulation of secretions. Perform respiratory assessment including:
Airway Patency
96
shallow respirations and decreased gas exchange R/T anesthesia,
narcotics, muscle relaxants, pain or obesity.
Hypoventialtion
97
inhalation of gastric contents; nausea and vomiting.
Aspiration
98
When assessing Cardiocascular status, we assess BP every _________ minutes and check for ________, _________, __________, _________ + ________ .
15 Minutes
Cardiac Rhythm, Skin Color,
Capillary Refill, All Pulses, Intake + Output.
99
When assessing wound status, we check for....
Bleeding/Hemorrhaging/Shock, check linens underneath wound, circle drainage, reinforce as needed, assess tubes and drains.
100
When assessing wound status post-op, we never...
change the dressing
101
When assessing the Central Nervous System Status, we check for:
1. LOC, responsiveness, and extremity movement and sensation
2. Naloxone (Narcan)
3. Atropine or Glycopyrrolate (Robinul) with Neostigmine
4. Hypothermia
102
Reverses Narcotics
Naloxone (Narcan)
103
Reverses Muscle Relaxers
Atropine or Glycopyrrolate (Robinul) with Neostigmine
104
Fluid imbalance can occur due to...
NPO (Nothing by mouth) status, fluid loss during surgery, wound drainage, surgical stress response.
105
Assess + treat...
Pain
106
Focus of Post Op Nursing Care for Hospitalized Patient
1. Physiological monitoring
2. Psychological support
3. Comfort measures
4. Support of family
5. Mobilization
6. Wound healing
7. Discharge planning
107
-incomplete expansion or collapse of alveoli resulting in poor gas exchange.
Atelectasis
108
Treatment of Atelectasis:
Raise head of bed, C & DB every 1-2 hours, apply O2, T & P every 2 hours
109
lung inflammation caused by bacterial or viral infection, in which the air sacs fill with pus and may become solid. Inflammation may affect both lungs, one lung, or only certain lobes.
Pneumonia
110
Treatment of Pneumonia:
Raise head of bed, C & DB every 1-2 hours, apply O2, T & P every 2 hours, administer antibiotics + hydration
111
Pulmonary Embolism
a sudden blockage in a lung artery. The blockage usually is caused by a blood clot that travels to the lung from a vein in the leg. May develop 5-10 days post op.
112
Treatment of Pulmonary Embolism:
Notify MD, apply O2, raise head of bed
113
an emergency condition in which severe blood or fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.
Hypovolemic Shock/Hemorrhage
114
Treatment of Hypovolemic Shock/Hemorrhage
Stop bleeding, replace blood volume (IV fluid and transfusion), O2, elevate legs
115
Treatment of Thrombophlebitis/Venous Thrombosis:
anti-coagulants, TEDS, bedrest, do not massage
116
Skin Prep Pre Op
Shave skin w/ electric razor, clean area with antimicrobial soap,
117
GI Prep Pre Op
Helps to prevent aspiration, depends on the surgery, helps to prevent contamination further preventing infection
118
Paralysis of intestinal smooth muscle
Paralytic ileus
119
Treatment of Paralytic Ileus:
Insert nasogastric tube, increase activity
120
Treatment of Constipation:
increase activity, administer stool softners, increase fluids and fiber
121
a condition in which there is difficulty in emptying the bowels, usually associated with hardened feces.
Constipation
122
How do we provide for a safe transfer?
Bed rails up, take all equipment, proper personnel there for transfer.
123
Treatment of Urinary Retention
: measure urine after voiding, palpate suprapubic area, use bladder scanner to
assess amount of urine in bladder, urinary catheterization
124
the inability to completely or partially empty the bladder.
Urinary Retention
125
inflammation of a vein with blood clot formation inside the vein at the site of the inflammation
Thrombophlebitis/Venous Thrombosis
126
Wound infection may not be present until post op days __-__ .
5-10
127
Treatment of Wound Infection:
Use Aseptic Technique, Administer Antibiotics
128
Treatment of Wound Dehisence + Evisceration:
cover with sterile towels soaked in sterile 0.9% normal saline, notify MD
129
Care of wound and dressing, symptoms to report, medications, activities allowed and prohibited, dietary
restrictions or modifications, follow up care, answer any other questions.
DISCHARGE INSTRUCTIONS AND PLANNING
130
anesthesia that affects a restricted area of the body.
Local Anesthesia
131
CVP assesses...
Right ventricular function
132
Swan Guaze assesses...
left ventricular function
