Flashcards in Exam # 1 Pre-Operative Phase Deck (85)
Define Ambulatory Surgery Centers (ASC)
Includes centers that provide outpatient surgical services not requiring an overnight stay, independent diagnostic and testing facilities, and health provider's offices.
What are the 6 reasons surgeries are performed?
1) Diagnosis - i.e., lymph node biopsy
2) Curative - i.e., excision of a tumor or inflamed appendix
3) Palliative - i.e., cutting nerve root to relieve pain, colostomy to bypass obstruction.
4) Cosmetic - i.e., scar revision
5) Prevention - i.e., removal of pre malignant mole, mastectomy if strong family Hx of breast cancer exists.
6) Exploratory - i.e., exploratory laparotomy (ostomies & otomies)
What are the 5 classifications of surgery?
1) Emergent - PT requires immediate attention without delay.
2) Urgent - PT requires prompt attention within 24-48 hours.
3) Planned/Required -PT needs to have surgery within a few weeks or months.
4) Elective - PT should have surgery but failure to have surgery will not be catastrophic.
5) Optional - PT decides wether or not to have the surgery base on personal preference.
Give 6 examples of circumstances that require Emergency Surgeries?
1) Severe bleeding
2) Bladder or intestinal obstruction
3) Fractured skull
4) Extensive burns
5) Gunshot or stab wounds
6) Abdominal Aortic Aneurism
Give 2 examples of circumstances that require Urgent Surgery?
1) Acute gallbladder infection
2) Kidney or ureteral stones
Give 4 examples of circumstances that necessitates Planned/Required Surgeries?
1) Prostatic hyperplasia without bladder obstruction
2) Thyroid disorders
4) Tumor removal
Give 4 examples of circumstances that require Elective Surgery?
1) Repair of scars
2) Simple hernia
3) Vaginal repair
Give an example of an optional surgery?
When does the Preoperative Phase begin and end?
The Preoperative Phase begins when the decision to proceed with the surgical intervention is made, and ends with the transfer of the patient onto the OR table.
In which 4 circumstances are informed consent necessary?
1) Invasive Procedures - Such as surgical incisions, biopsies, cystoscopy, or paracentesis.
2) Procedures requiring sedation/anesthesia.
3) Non surgical procedures such as arteriography that carries more than slight risk to the patient.
4) Procedures involving radiation.
What are the 4 BMI categories?
1) Underweight - < 18.5
2) Normal - 18.5 - 24.9
3) Overweight - 25 - 30
4) Obese - > 30
When does the Intraoperative Phase of surgery begin and end?
The Intraoperative begins when the patient is transferred into the OR table and ends with admission to the PACU
What are the 3 areas of the surgical area?
1) Unrestricted Zone - Where street clothes can be worn.
2) Semi-restricted Zone - Scrub clothes and caps.
3) Restricted Zone - Scrub clothes, shoe covers, caps and masks.
Define the following:
1) Ectomy - To take out
2) Lysis - To breakdown
3) Orrhaphy - To to repair or suture
4) Scopy - To look/view
5) Ostomy - To make an opening
6) Otomy - To cut into or make an incision
7) Plasty - To repair or rebuild
What can cause an Abdominal Aortic Aneurism
Can be caused by old age or trauma
What is the difference between the 2 following surgical settings:
2) Ambulatory Care (Outpatient)
1) Inpatient - Includes same day admission and patients are admitted (meaning they stay for an extended time).
2) Ambulatory Care (Outpatient) - Cheaper, typically uses regional anesthesia, and only does minor surgery.
What are the 9 things that should be included in a complete preoperative nursing assessment ?
1) Psychological Status - Fear, anxiety, etc.
2) Physiological Factors - Individual risk factors
3) Baseline Data - Used for comparison
4) Documentation - Surgical site and side
5) Medication - Includes OTC meds, herbs, alcohol, tobacco and recreational drugs.
6) Lab and Diagnostic Tests
7) Cultural/Ethnic Factors - JWs and Muslims
8) Consent Signed
Which electrolyte is the most important to monitor perioperatively and why?
Potassium, because it can cause arrhythmias
Who's responsible for explaining the procedure to the patient Nd who signs the informed consent?
The Surgeon is responsible for explaining the procedure and the nurse is responsible for making sure the patient understands the procedure.
Informed Consent is signed by both the Surgeon and the patient.
How can you assess for latex allergy in a patient?
Ask the patient if they Re allergic to stone fruits, i.e., Kiwi, bananas etc.
What is the effect of recreational drug when the patient is in the hospital setting?
Medication administration (i.e., opioids) may not be as effective because the have built up a tolerance.
What are the 8 common fears patients generally have of surgery?
1) Fear of the unknown
2) Loss of control
7) Financial ramifications
8) Irrational fears
What are two ways to promote psychological readiness before surgery?
1) Active Listening - Ask open ended questions
2) PreOp Teaching - May include I/S, C&DB, early ambulation, and pain control after surgery.
Give 4 examples of teaching that can be done preoperatively?
1) Post-op equipment and dressings (i.e., tubes, sore throat from ET).
2) Elastic Compression Stockings
3) Intermittent Compression Devices
4) Family Teaching (i.e., visiting, OR communication, PACU)
Name 3 postop exercises a patient can be taught to do in bed that will help return blood to the heart.
1) Isometric quads
2) Gluteal squeeze
3) Ankle pumps
What are the 5 components of the nursing assessment for the cardiovascular system?
1) Baseline vitals should be recorded
2) Bleeding and clotting times
3) Lab reports
4) Prophylactic antibiotics
Your patient has a productive cough with green sputum. Who should you report this to and what might he or she order?
Report it to the surgeon who may order a culture and sensitivity
What should be involved in a preoperative nursing assessment of the respiratory system?
1) Inquire about recent airway infections - procedure may be cancelled because of increased risk of Laryngotracheobronchitis/bronchospasm or ⬇ SaO2
2) Inquire if patient smokes
Who can sign the consent form on behalf of the patient?
Anyone noted on the power of attorney