Care of Surgical Patient Flashcards
(106 cards)
1
Q
Ablation
A
amputation or excision of any part of body; removal of a growth or harmful substance
2
Q
Anesthesia
A
absence of sensation (an-without and - esthesia feeling/sensation)
3
Q
Atelectasis
A
Collapse of lung tissues, preventing respiratory exchange of carbon dioxide and oxygen
4
Q
Cachexia
A
General illl health and malnutrition marked by weakness and emaciation; usually associated with a serious disease such as cancer
5
Q
Catabolism
A
breakdown or destructive phase of metabolism, occurs when complex body substance are broken down to simpler ones; opposite of anabolism
6
Q
Conscious Sedation
A
administration of central nervous system depressant drugs and/or analgesia to relieve anxiety and/ or provide amnesia during surgical, diagnostic, or interventional procedures
7
Q
Dehiscence
A
partial or complete separation of a surgical incision or rupture of a wound closure
8
Q
Drainage
A
free flow or withdrawal of fluids from a wound or cavity by some sort of system (such as urinary catheter or t-tube)
9
Q
embolus
A
foreign object, quantity of air or gas, bit of tissue or tumor, or a piece of thrombus that circulates in bloodstream until it becomes lodged in a vessel
10
Q
Evisceration
A
protrusion of an internal organ through a disrupted wound or surgical incision
11
Q
Extubate
A
to remove an endotracheal tube from airway
12
Q
Exudate
A
fluid, cells, or other substances that have been slowly exuded or discharged from body cells or blood vessels through small pores or breaks in cell membrane
13
Q
Incentive Spirometry
A
procedure in which a device (spirometer) is used at beside at regular intervals to encourage a patient to breathe deeply
14
Q
Incisions
A
surgical cut produced by a sharp instrument to create an opening into an organ or space in body
15
Q
Infarct
A
localized area of necrosis in tissue, a vessel, or an organ resulting from tissue anoxia; caused by an interruption in blood supply to an area
16
Q
Informed Consent
A
permission obtained from patient to perform a specific test or procedure
17
Q
Intraoperative
A
pertaining to period of time during a surgical procedure
18
Q
Palliative
A
designed to relieve pain and distress and to control signs and symptoms of disease; not designed to produce a cure
19
Q
Paralytic Ileus
A
most common type of intestinal obstruction; a decrease in or absence of intestinal peristalsis and bowel sounds that may occur after abdominal surgery
20
Q
Perioperative
A
entire surgical inpatient period occurring immediately before, during, and immediately after surgery
21
Q
Postoperative
A
pertaining to a period of time after surgery
22
Q
Preoperative
A
pertaining to period of time before surgery
23
Q
Prosthesis
A
artificial replacement of a missing body part
24
Q
Singultus
A
hiccup
25
Surgery
branch of medicine concerned with diseases and trauma requiring operative procedures
26
Surgical Asepsis
group of techniques that destroy all microorganisms and their spores (sterile technique)
27
Thrombus
of or pertaining to a clot
28
BENZODIAZEPINES
- Mindazolam (Versed, Valium, Ativan)
- Diazepam
- Lorazepam
- dose dependes on amount of adequate sedation necessary for surgery
- decreases anxiety and produces sedation
- induces amnesia
- monitor for respiratory depression, hypotension, drowsiness, and lack of coordination
29
OPIOID ANALGESICS
- Morphine
- Fentanyl Citrate (sublimaze)
- decreases anxiety
- allows decreased anesthetics
- monitor for respiratory depression, nausea, vomiting, orthostatic hypotension, pruritus
30
H2 RECEPTOR ANTAGONISTS
- Famotidine (Pepcid)
- Ranitidine (Zantac)
- reduces gastric acid volume and concentration
| - monitor for confusion and dizziness in older adults
31
ANTIEMETICS
- Metoclopramide (Reglan)
- Droperidol (inapsine)
- Ondansetron HCI (5-HT3 receptor antagonist) (Zofran)
- enhances gastric emptying
- tranquilizer
- prevents postoperative nausea and vomiting
- monitor for sedation and extrapyramidal reaction (involuntary movement, muscle tone changes, and abnormal posture)
- instruct patient to report any difficulty breathing
32
ANTICHOLINERGICS
- atropine sulfate (atropine sulfate)
- Glycopyrrolate (Robinul)
- reduces oral and respiratory secretions to decrease risk of aspiration
- decreases vomiting and laryngospasm
- monitor for confusion, restlessness, and tachycardia
- prepare patient to expect dry mouth
33
ANTIBIOTICS
- Cefazolin Sodium (Ancef)
- Cefotaxime Sodium (claforan)
- Ceftriaxone (Recephin)
- bactericidal
- wound infection
- minimize risk of wound infection
- bactericidal
- bactericidal as perioperative prophylaxis
- if large doses are given, therapy is prolonged or pt is at high risk, monitor for signs and symptoms of superinfection, including abdominal pain, moderate to severe diarrhea, severe anal or genital pruritus and severe mouth soreness
- determine pt's history of allergies
- if dosing continues, space drug evenly around clock
- advise pt to complete therapy
34
ADRENOCOTRICAL STEROID
-Methylprednisolone (Depo-Medrol, Solu-Medrol)
- adults: 10-250 mg (succinate) IV q 4-6hr
- Oral 2-60 mg in 4 divided doses
- IM 10-80 mg (acetate)
- decreases inflammation
- determine whether patient has hypersensitivity to drug
- determine whether patient has diabetes mellitus, and anticipate an increase in antidiabetic drug regimen because raised blood glucose level
35
NONSTEROIDAL ANTINFLAMMATORY DRUG (NSAID)
-Ketorolac (toradol)
- 50 mg/mL IM; 30 mg/mL IV push over at least 15 sec
- reduces intensity of pain
- reduces inflammation
- assess duration, location, onset, and types of pain patient is having
- evaluate patient for therapeutic response
36
ANTICOAGULANTS
-Enxoaparin Sodium (lovenox)
- produces anticoagulation
- prevents new clot formation or secondary embolic complications
- don't give IM, but give subQ
- tell patient not to take aspirin or similar over-counter drugs
37
Heparin Sodium (Heparin)
- 10 units/mL to 15,000 units/500 mL subQ
- Heparin sodium flush syringes: 10 units/mL, 100 units/mL; vials (most use saline for flush)
- 10 units/mL greater than/equal to 100 units/mL; vials 10-100 units/mL
- cross-check heparin dose with another nurse before administering
- use constant rate IV infusion pump
- monitor patient's partial thromboplastin time diligently
- assess patient's gums for erythema and gingival bleeding; skin for bruises or petechiae; and urine for heamturia
38
Warfarin Sodium (Coumadin)
- 5 mg vials IM; 1-10 mg PO tablets or IV
- observe patient for evidence of hemorrhage such as abdominal or back pain, decreased blood pressure, increased pulse rate, and severe headache
- urge patient to not ingest alcohol or make drastic dietary changes
- if administration continues, urge patient to notify physician if he/she experiences block stools; bleeding; brown, dark, or red urine; coffee-ground vomitus; or red-speckled mucus from a cough
39
Effect of antibiotics during surgery
-antibiotics potentiate action of anesthetic agents. If taken within 2 weeks before surgery, aminoglycosides (gentamicin, tobramycin, neomycin) may cause mild respiratory depression from depressed neuromuscular transmission
40
Effect of antidysrhythmics during surgery?
antidysrhythmics can reduce cardiac contractility and impair cardiac conduction during anesthesia
41
Effect of anticoagulants during surgery
anticoagulants alter normal clotting factors and thus increase risk of hemorrhaging. they should be discontinued at least 48 hours before surgery. aspirin is commonly used medication that can alter clotting mechanisms
42
Effect of anticonvulsants during surgery
long-term use of certain anticonvulsants (e.g Phenytoin (dilantin), phenobarbital) can alter metabolism of anesthetic agents
43
Effect of Antihypertensives during surgery
antihypertensives interact w/anesthetic agents to cause bradycardia, hypotension, and impaired circulation. They inhibit synthesis and storage of norepinephrine in sympathetic nerve endings
44
Effect of Corticosteroids during surgery?
with prolonged use, corticosteroids cause adrenal atrophy, which reduces body's ability to withstand stress; before and during surgery,dosage may be temporarily increased.
45
What are the effects of insulin during surgery?
Diabetic patient's need insulin after surgery is reduced because nutritional intake is decreased. Stress response and intravenous administration of glucose solutions can increase dosage requirements of surgery.
46
What effects can diuretics have during surgery?
diuretics potentiate electrolyte imbalances (particularly potassium) after surgery.
47
What effects does Nonsteroidal Antiinflammatory drugs (NSAIDs) have on surgery?
NSAIDs inhibit platelet aggregation and may prolong bleeding, increasing susceptibility to post-operative bleeding
48
Herbal Therapies (ginger, ginkgo, ginseng) effect surgery in what ways?
These herbal therapies can affect platelet activity and increase susceptibility to postoperative bleeding. Ginseng may increase hypoglycemia with insulin therapy.
49
Diazepam Side Effects:
apnea, ataxia, blurred vision, bradycardia, coughing, confusion, cardiovascular, collapse, respiratory depression, decreased reflexes, dyspnea, headache, hiccups, hyperventilation, neutropenia, venous thrombosis, phlebitis at IV injection site
50
Droperidol Side Effects
abnormal EEG (electrocephalogram), chills, shivering, dizziness, hallucinations, hypotension, palpitations, tachycardia, prolonged QT, restlessness, anxiety
51
Fentanyl Citrate (Sublimaze) Side Effects:
most common w/injection: bradycardia, circulatory depression, hypotension, diaphoresis, dizziness, nausea, vomiting, chest wall/muscle rigidity, blurred vision, respiratory depression, may markedly decrease pulmonary ventilation in older adults
52
Glycopyrrolate (Robinul) Side Effects
anticholinergic psychosis, blurred vision, tachycardia, constipation, pupil dilation, mouth dryness, flushing, nausea, vomiting, postural hypotension, urinary retention, paralytic ileus, anaphlaxis, hypertension, malignant hyperthermia, muscle weakness, palpitations, photophobia, seizures, urticaria, pruritus, weakness, respiratory arrest
53
Morphine Sulfate Side Effects:
primary adverse effect is constipation; headache, pruritus w/parenteral dosing
54
Medications for Pre-OP?
Atropene, Valium, Morphine, Demerol, Versed
55
Atropene
Anticholinergic, increase heart rate
56
Splinting
provides support while coughing, fear of dehensce, encourage good lung expansion
57
Medications to decrease pt anxiety
valium, ativann, versed, morphine, zaynx, apronaolamin
58
Scrub Nurse Roles
performs surgical hand scrub, dons sterile gloves & gown, arranges sterile supplies and instruments, checks instruments for proper functioning, counts sponges, needles, and instruments w/circulating nurse; gowns & gloves surgeons as entering OR; assist w/surgical draping of patient; maintains neat and orderly sterile field; corrects breaks in aseptic technique; observes progress of surgical procedure; hands surgeon instruments, sponges, and necessary supplies during procedure; identifies and handles surgical specimens correctly; maintains count of sponges, needles, and instruments so none will be misplaced or lost in wound
59
Circulating Nurse Roles:
prepares OR w/necessary equipment and supplies and ensures that equipment is functional; arranges sterile and unsterile supplies; opens sterile supplies of scrub nurse; sends for pt at proper time; visits w/pt peroperatively; explains role, identifies pt, verifies operative permit, and answers any questions; performs pt assessment; confirms pt assessment; assists in safe transfer of pt to OR table; positions pt on OR table in accordance w/type of procedure and surgeon's preference; places conductive pad on pt if electrocautery is to be used; counts sponges, needles, and instruments w/scrub nurses before surgery; assists scrub nurse and surgeons by tying gowns; may prepare pts skin; assists scrub nurse in arranging tables to create sterile field; maintains continuous astute observations during surgery to anticipate needs of pt, scrub nurse, surgeons, and anesthesiologist; provides supplies to scrub nurse as needed; observes sterile field closely for any breaks in aseptic technique, and reports accordingly; cares for surgical specimens according to institutional policy; documents operative record and nurse's notes; counts sponges, needles, and instruments when closure of wound begins; transfers pt to gurney for transport to recovery area; accompanies pt to recovery room and provides a report
60
Post OP
prioritize based findings, assessment gave pre-op med, now assess pt situation
61
ABC's
A: airway
B: breathing
C: consciousness
S: system review
62
PACU
post anesthesia care unit, left side laying in case pt vomits
63
Jackson Pratt Hemovac
manual suction
64
Immediate Post OP phase:
assessment of ABC's, v/s, airway, LOC
65
Fluids
intake and output
66
Nursing Process
```
assessment
nursing diagnosis
planning
implementation
evaluation
```
67
Percocet
acetomenophin
68
Percodan
aspirin
69
Valium
for anxiety
70
ileus (paralytic ileus)
complication of surgery should hear bowelm musc>50 gurgles per minute
71
atelectasis
in response to airway/breathing problems course crackles vs. fine crackles, want to prevent this by performing some nursing interventions
72
Lovenox
enoxaparin
73
Thrombophlebitis (PE)
sudden onset, if you work out along sinus headache, basement 911
74
any surgical blood loss > 500 cc
requires a transfusion
75
Medications for Pre-OP?
Atropene, Valium, Morphine, Demerol, Versed
76
Atropene
Anticholinergic, increase heart rate
77
Splinting
provides support while coughing, fear of dehensce, encourage good lung expansion
78
Medications to decrease pt anxiety
valium, ativann, versed, morphine, zaynx, apronaolamin
79
Scrub Nurse Roles
performs surgical hand scrub, dons sterile gloves & gown, arranges sterile supplies and instruments, checks instruments for proper functioning, counts sponges, needles, and instruments w/circulating nurse; gowns & gloves surgeons as entering OR; assist w/surgical draping of patient; maintains neat and orderly sterile field; corrects breaks in aseptic technique; observes progress of surgical procedure; hands surgeon instruments, sponges, and necessary supplies during procedure; identifies and handles surgical specimens correctly; maintains count of sponges, needles, and instruments so none will be misplaced or lost in wound
80
Circulating Nurse Roles:
prepares OR w/necessary equipment and supplies and ensures that equipment is functional; arranges sterile and unsterile supplies; opens sterile supplies of scrub nurse; sends for pt at proper time; visits w/pt peroperatively; explains role, identifies pt, verifies operative permit, and answers any questions; performs pt assessment; confirms pt assessment; assists in safe transfer of pt to OR table; positions pt on OR table in accordance w/type of procedure and surgeon's preference; places conductive pad on pt if electrocautery is to be used; counts sponges, needles, and instruments w/scrub nurses before surgery; assists scrub nurse and surgeons by tying gowns; may prepare pts skin; assists scrub nurse in arranging tables to create sterile field; maintains continuous astute observations during surgery to anticipate needs of pt, scrub nurse, surgeons, and anesthesiologist; provides supplies to scrub nurse as needed; observes sterile field closely for any breaks in aseptic technique, and reports accordingly; cares for surgical specimens according to institutional policy; documents operative record and nurse's notes; counts sponges, needles, and instruments when closure of wound begins; transfers pt to gurney for transport to recovery area; accompanies pt to recovery room and provides a report
81
Post OP
prioritize based findings, assessment gave pre-op med, now assess pt situation
82
ABC's
A: airway
B: breathing
C: consciousness
S: system review
83
PACU
post anesthesia care unit, left side laying in case pt vomits
84
Jackson Pratt Hemovac
manual suction
85
Immediate Post OP phase:
assessment of ABC's, v/s, airway, LOC
86
Fluids
intake and output
87
Nursing Process
```
assessment
nursing diagnosis
planning
implementation
evaluation
```
88
Percocet
acetomenophin
89
Percodan
aspirin
90
Valium
for anxiety
91
ileus (paralytic ileus)
complication of surgery should hear bowelm musc>50 gurgles per minute
92
atelectasis
in response to airway/breathing problems course crackles vs. fine crackles, want to prevent this by performing some nursing interventions
93
Lovenox
enoxaparin
94
Thrombophlebitis (PE)
sudden onset, if you work out along sinus headache, basement 911
95
any surgical blood loss > 500 cc
requires a transfusion
96
Echinacea
- treats cold symptoms
- possible negative impact on liver
- subsequent interference w/hepatic metabolism of certain anesthesia medications
97
Ephedra sinica
- decongestant
- weight loss
- increased risk of cardiac dysrhythmias
- may reduce effectiveness of medications used to treat hypotension
98
Feverfew
- migraine prevention
- has anticoagulation factors; potential for increased bleeding
- preoperative assessment should include clotting studies
- discontinue before surgery
99
Garlic
- Motion sickness
- cough
- menstrual cramps
- intestinal gas
- risk of prolonged clotting times
- preoperative assessment should include clotting studies
- discontinue before surgery
100
Ginkgo biloba
- brain function and alertness
- tension
- erectile dysfunction
- potential for increased bleeding
101
Ginseng
- overall well-being
- diabetes
- may increase anesthetic agent requirements
- potential for hypoglycemia in patients taking insulin or oral diabetes agents
102
Guarana
- mental alertness
- fatigue
- may reduce efficacy of warfarin
- may potentiate sympathetic nervous system stimulants, leading to cardiac complications
- may decrease cerebral blood flow
103
Kava
- sleep aid
- anxiety, tension
- may potentiate muscle relaxants
- may increase effects of certain antiemetics
- potential for serious liver damage and subsequent decreased hepatic metabolism of certain anesthetic agents
104
Licorice
- asthma, eczema, rheumatoid arthritis, expectorant, gastritis
- may cause hypertension
- potential for hypokalemia and associated cardiac dysrhythmias
105
St. John's Wort
- antidepressant
- antiviral properties
- antiinflammatory action
- should not be used w/other psychoactive drugs,monoamine oxidase inhibitors, or serotonin reuptake inhibitors
- discontinue before surgery because of possible drug interactions
106
Valerian Root
- sedative or tranquilizer effect
- sleep aid
- shouldn't be used w/sedatives or anxiolytics
- may increase effects of central nervous system depressants
