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Fundamentals > Care of Surgical Pts. - EX4 > Flashcards

Care of Surgical Pts. - EX4 Flashcards

1
Q

How are surgeries classified?

A

Based on:
Seriousness
Urgency
Purpose

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2
Q

What are the levels of seriousness

A

Major + Minor

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3
Q

What are the categories of urgency

A

Elective, Emergent, Urgent

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4
Q

Classifications of surgery

A

DIagnostic, Ablative, Palliative, Reconstructive or Restorative, Constructive, Cosmetic

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5
Q

What is considered a major surgery

A

extensive reconstruction/alteration in body parts; poses great risk to well being

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6
Q

What is considered a minor surgery

A

involves minimal alteration in body parts; designed to correct deformities; minimal risk to well being

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7
Q

What is considered an elective surgery

A

performed in basis of patient’s choice; is not essential and is not always necessary ofr health

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8
Q

What is considered an emergent surgery

A

must be done immediately to save life or preserve function of body part

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9
Q

What is considered an urgent surgery

A

necessary for patient’s heath; prevents development of additional problems

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10
Q

define diagnostic

A

surgical exploration performs to confirm diagnosis; often involves removal of tissue for further diagnostic testing

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11
Q

define ablative

A

excision/removal of diseased body part

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12
Q

define palliative

A

relieves or reduces intensity of disease symptoms; does not produce cure

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13
Q

define reconstructive

A

restores function or appearance to traumatized or malfunctioning tissues

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14
Q

define constructive

A

resotres function to lost or reduced as result of congenital anomalies

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15
Q

define cosmetic

A

performed to improve person appearance

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16
Q

What is the difference between laparoscopic or a laparotomy

A
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17
Q

What are some surgical risk factors

A

increase in WBCs
very young or old d/t fraily status
nutrition - vitamin A, C and Zinc
obese (bad nutrition - lack of protein and vits
obstructive sleep apnea - careful screening important
hypovolemic
PONV
smoking
immunosuppression
fluid/electrolyte imbalance

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18
Q

What are preoperative assessments

A

patient’s expectations of surgery and recovery
nursing history
medical history
surgical history
risk factor knowledge
medications
allergies
smoking habits/alcohol
pregnancy
pain
emotional health

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19
Q

What are the preop labs

A

BMP
CBC
Clotting studies
LFTs
CXR
ECG

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20
Q

What are the normal lab values of BMP

A

K+ 3.5-5.1 mEq/L
Glucose<120mg/dL
BUN 10-20 mg/dL
Creatinine 0.5-1.2
WBC 3.7-11 K/uL

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21
Q

What do BMP values indicate?

A

cardiac and hemodynamic stability, kidney function, and drug elimination, infection

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22
Q

What are the normal lab values of CBC

A

Hgb 12-16 g/dL (F) or 13-18 g/dL (M)
Hct 36-48% (F) or 40-54% (M)

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23
Q

What do CBC lab values indictate

A

volume status,
O2 carrying capacity,
and hemodynamic stability

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24
Q

What are the normal lab values of clotting studies

A

Platelets 150-300 K/uL

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25
Q

what doe clotting studies indicate

A

liver function and possible bleeding difficulties

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26
Q

What are the normal lab values of LFTs

A

AST < 48 units/L
ALT < 55 units/L

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27
Q

what doe LFT lab values indicate

A

drug metabolism, clotting

28
Q

What are the normal lab findings of CXR

A

clear lungs, no cardiomyopathy, no atelectasis

29
Q

What do CXR values indicate

A

ID potential significant risks for complications

30
Q

What are the normal lab findings of ECG

A

NSR, no concerning dysrhythmias, ischemia, or underlying cardiac disease

31
Q

What do ECG values indicate

A

ID potentially significant risks for complication

32
Q

What is important in preoperative education

A

NPO status prior to procedure
Routines to stop/start procedure
length of stay
when to call/follow up
Med when to stop and which to continue

33
Q

Who explains the procedure, risks, benefits, alternatives, and prognosis if not surgery?

A

The provider

34
Q

Who obtains consent for anesthesia

A

Anesthesiologist or CRNA

35
Q

who obtains consent for surgical procedures

A

surgeon

36
Q

who obtains consent for blood products

A

surgeon

37
Q

What is the role of the RN during informed consent

A

witness that informed consent was obtained and confirm with pt questions were answered

38
Q

What is involved in surgical prep

A

minimize risk for surgical site infection:

maintain normal fluid and elyte balance:

39
Q

How do you minimize risk for surgical site infection

A

skin asepsis
antibiotics
clipping instead of shaving hair

40
Q

How do you maintain normal fluid and elyte balance

A

NPO - fasting, no chewing gum
parenteral fluid administration
large gauge PIV

41
Q

What is the surgical prep immediately before surgery

A

prep hair,
safeguard valuables
prepare bowel and bladder
vital signs
prevention of DVT
preop meds
documentation/hand off
site marking

42
Q

Intraoperative phase includes

A

Time- out
verify right pt, procedure, site, side

43
Q

When is a time out performed

A

immediately prior to starting procedure

44
Q

What is the purpose of a time out

A

reconcile any discrepancies among team

45
Q

What does a circulating nurse do

A

management of pt care, skin prep, counts, movement

46
Q

What does a scrub nurse and surgery technician do

A

assist surgeon
knows the instruments
passes instruments
maintain sterile field

47
Q

What are the types of anesthesia

A

general
regional
local
moderate

48
Q

define general anesthesia

A

unconscious - loses all reflexes , can be done through IV

49
Q

general anesthesia risks

A

hypotension, changes in heart rate/rhythm, lowered temp, resp depression, emergence delirium

50
Q

define regional anesthesia

A

loss of sensation in an area of body by anesthetizing sensory pathways ; along a nerve on the pathway of spinal cord

51
Q

side effects of regional anesthesia

A

respiratory paralysis
low BP

52
Q

define local anesthesia

A

loss of sensation at desired site used in ambulatory surgery

53
Q

what are patients at risk for with local anesthesia?

A

drug interactions and allergic reactions

54
Q

define moderate sedation

A

IV moderate sedation used routinely for short term surgical, diagnostic, and therapeutic procedures that only require a depressed level of consciousness

55
Q

risks of moderate sedation

A

aspiration, hypoxemia, respiratory depression, can become over sedated and lose ability to protect and maintain airway

56
Q

what does the postoperative phase involve

A

begins when leaving OR too the PACU
Q15 of:
VS
Resp and CV
Neuro
Effects of anesthesia
Fluid status
pain management
temp control

57
Q

postoperative phase 1 begins when

A

(immediate recovery)

58
Q

postoperative phase 2

A

(intermediate recovery)

59
Q

postoperative phase 3

A

(convalescence)

60
Q

priority concepts of surgery?

A

Oxygenation
Perfusion
Fluid Volume Balance
Pain
INfection Control
Mobility
Safety
Coping

61
Q

what is Intraoperative Malignant Hyperthermia

A

severe reaction to certain anesthetic, inherited or genetic defect

62
Q

IMH s/sx

A

tachypnea, hypercapnia, high fever, muscle rigidity, spasms, tachycardia , hyperkalemia, muslce breakdown
onset 35mins to 2 hours from anesthetic induction

63
Q

IMH intervention

A

dantrolene and cooling

64
Q

what are early signs Postoperative Hemorrhage

A

resltess, increased HR and RR

65
Q

what are late signs of postoperative hemorrhage

A

lethargic, rapid decrease in HR, RR, BP, SpO2

66
Q

Interventions for postoperative hemorrhage

A

notify provider STAT, prepare for immediate transfer to OR

Fundamentals (8 decks)

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