Chapter 17 - Preoperative Care

Question 1

PERIoperative Surgery

Answer 1

total surgical episode

-includes PREoperative, INTRAoperative, POSToperative periods

Question 2

PREoperative

Answer 2

time before surgery

Question 3

INTRAoperative

Answer 3

time during actual surgical procedure

Question 4

POSToperative

Answer 4

period after surgery is over

Question 5

reasons for surgery

Answer 5

• diagnosis
• cure
• palliation (alleviate sympt w/o cure)
• prevention
• cosmetic imprvmt
• exploration (determine nature/extent of disease) (less common)

Question 6

-ectomy

Answer 6

excision or removal of

Question 7

-lysis

Answer 7

destruction of

Question 8

-orrhaphy

Answer 8

repair or suture of

Question 9

-oscopy

Answer 9

looking into

Question 10

-ostomy

Answer 10

creation of opening into

Question 11

-otomy

Answer 11

cutting into or incision of

Question 12

-plasty

Answer 12

repair or reconstruction of

Question 13

elective surgery

Answer 13

carefully planned event

Question 14

emergency surgery

Answer 14

arise w unexpected urgency

Question 15

ambulatory surgery is aka

Answer 15

same-day or outpatient surgery

Question 16

ambulatory surgery

Answer 16

minimally invasive techniques

Question 17

6 Reasons for surgery

Answer 17

1 dx
2 cure
3 palliation
4 prevention
5 cosmetic
6 exploration

Question 18

Fear in patients

Answer 18

• decrease some anxiety by giving patients info about what to expect
• reassure that drugs are avail for pain
• -teach patients to ask for med BEFORE pain becomes severe
• listen to patient’s concern w accepting attitude

Question 19

antidepressants + opioids

Answer 19

antideps can POTENTIATE effect of opiods

Question 20

Hx antihypertensive drugs predispose patients to ____

Answer 20

shock

-fr combined effect of drug (lowering BP) +vasodilating effects of anesthetics

Question 21

insulin/oral hypoglycemic drugs needs to be adjusted bc ___

Answer 21

• incr body metab
• decr oral intake
• stress
• anesthesia

Question 22

NSAIDs stands for

Answer 22

non steroidal anti inflammatory drugs

Question 23

NSAID + anti platelet drugs can ___

Answer 23

inhibit platelet aggregation > incr postop bleeding

Question 24

options for patients w long-term anti-coag therapy

Answer 24

1 cont therapy
2 withhold therapy for a time before + after surgery
3 withhold therapy + start subQ or IV heparin during periop

Question 25

herbal products that can incr BP before + during surgery

Answer 25

astralagus + ginseng

Question 26

herbal products that can incr bleeding

Answer 26

cinnamon, vit E, fish oils, 4G (ginger, garlic, ginseng, gingko)

Question 27

herbal products that can cause excessive sedation

Answer 27

kava + valerian

Question 28

allergy/anaphylactic rxn effects

Answer 28

- hives - hypotension - tachycardia - bronchospasms

Question 29

diuretic therapy will require...

Answer 29

serum K levels drawn before surgery

Question 30

hypertensive patients may require ___

Answer 30

vasoactive drugs to maintain adequate BP

Question 31

patient w prosthetic heart may require ____

Answer 31

antibiotic prophylaxis | -decr the risk for endocarditis

Question 32

upper airway infection may increase risk for

Answer 32

- bronchospasm - laryngospasm - decreased O2 sat - problems w resp secretion

Question 33

Hx of COPD is at high risk for

Answer 33

pulm complications like HYPOXEMIA + ATELACTASIS

Question 34

Smoking

Answer 34

- stop w/in 6 weeks before | - incr risk for for pulm complication during + after surgery

Question 35

Renal dysfunction

Answer 35

- fluid + electrolyte imbalance - coagulopathies - incr risk for infections - impaired wound healing - altered response to drugs - unpredictable drug elimination

Question 36

testing for renal functions

Answer 36

BUN serum creatinine urinalysis?

Question 37

what are normal liver functions?

Answer 37

- glucose homeostasis - fat metab - protein synth - drug + hormone metab - bilirubin formation + excretion

Question 38

hepatic dysfunction

Answer 38

incr risk for clotting abnormalities | adverse response to drugs

Question 39

common diabetes complications

Answer 39

hypo/hyperglycemia delayed wound healing infection

Question 40

Addisonian crisis/shock

Answer 40

occurs if patient ABRUPTLY stops taking corticosteroid

Question 41

Corticosteroid

Answer 41

used in immunosuppressive doses may be TAPERED before surgery

Question 42

high albumin

Answer 42

protein makes drugs less active | -interferes w distribution

Question 43

obesity

Answer 43

- stresses heart + resp - makes access site more difficult - predisposed to wound dehiscence - high risk for wound infection - high risk incisional herniation - slower to recover fr anesthesia bs fat absorbs + stores inhalation agents

Question 44

important substances for wound healing

Answer 44

protein, vit A B C

Question 45

American Society of Anesthesiologists [ASA] Physical Classification System

Answer 45

physical status rating for anesthesia admin

Question 46

P1 (ASA I)

Answer 46

normal healthy person

Question 47

P5 (ASA V)

Answer 47

moribund patient - NOT expected to survive without surgery

Question 48

P6 (ASA VI)

Answer 48

declared brain dead | -organs being removed for donor purposes

Question 49

importance of teaching

Answer 49

- incr patient satisfaction - reduce anxiety - decr dvlpt of complications - decr length of hospitalization - decr recovery time

Question 50

3 types of info in teachings

Answer 50

1 sensory (hear, smell, feel) 2 process info (general flow of info) 3 procedural info (detailed info)

Question 51

all patients should receive instructions about _____

Answer 51

- deep breathing - coughing - ambulation

Question 52

why do we restrict fluid + food intake

Answer 52

reduce risk for aspiration, nausea, + vomiting

Question 53

why do we encourage patients to void before preop drugs?

Answer 53

empty bladder prevents involuntary elimination during op | -reduce risk for urinary retention during early post op

Question 54

preop med + purpose

Answer 54

``` 1 benzo> sedative + amnesic 2 anticholinergic> reduce secretion 3 opioid> analgesic/pain 4 antiemetics> decr n/v 5 B-adrenergic blockers> control BP, prevent MI/cardiac arrest ```

Question 55

patients w known hypertension or coronary artery disease (CAD) may receive ___

Answer 55

B-adrenergic blockers - controls BP - reduce chance of MI or cardiac arrest