Intro to Surgery (lec 2) Flashcards by Wendy Pitts

Preop Nurse duties? (3)

Pt prep
Signatures of surg/anesthesia staff
Start IV w/ ordered meds

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Anesthesiologist duties? (3)

Preop pt consult
Appropriate anesth type
Sleep, analgesia, airway, breathing, circulation

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Circulating Nurse duties? (5)

Gets supplies, sterile equip
Pt ID, positioning
Sterility of suite
OR manager
Final counts

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Scrub Nurse duties? (2)

(Sterile staff member)
Supply setup
Hands off sterile instruments/supplies

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Surgeon duties?

Attending physician while pt in OR

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First Assistant duties?

Knowledge requirements?

Assist surgeon

Anatomy/phys
Surgical procedures
Surgical handling of tissue/instruments

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Retraction purposes?

1) provide counterforce

2) help w/ visualization

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Laparoscopy is?

Inflation of peritoneum w/ CO2 gas,
Small incisions for instrument ports,
Camera guidance

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Why CO2 gas for laparoscopy?

soluble in blood

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Laparoscopy advantages? (5)

1) shorter hospitalization
2) less pain
3) less scarring
4) lower cost
5) lower risk of ileus (obstruction)

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Laparoscopy Veress Needle used for?

CO2 insufflation (blown into gut) how?

Blind entrance

thru needle

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Hasson technique for Laparoscopy?

Cut down/place trocar (tube) using direct visualization

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Typical Laparoscopy procedures?

Cholecystectomy
Appendectomy
Inguinal hernia repair
Ventral hernia repair
Nissen fundoplication

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Laparoscopy post-op shoulder pain caused by?

referred pain from CO2 stretch of diaphragm

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Laparoscopic camera driving rules? (6)

1) Watch all trochars enter and exit
2) Watch all instruments enter/exit trochars
3) Ensure camera orientation
4) FRED (de-fog solution) lens
5) No contact w/ large bowel
6) Keep action centered

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Laparotomy/Celiotomy is?

surgical incision into abdominal cavity

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Exploratory Laparotomy performed when?

Acute, unexplained abd pain/pathology

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Surgical Risk Assessment includes?

1) Prior hx (traditional risk factors)
2) Fxnl capacity
3) Procedural risk
4) ECG?? slide 28

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Procedural Risk Mortality percentages:

High?

Intermediate?

Low?

High > 5%

Interm 1-5%

Low < 1%

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Post Op considerations when managing meds?

Heightened SNS response ∆s metabolism, gut motility, absorption

With surgery, what type of meds should be continued? (4)

1) Meds w/ significant w/drawal sxs that do not affect anesthesia (esp alcohol)
2) CV meds
3) Statins
4) Meds that control glycemic levels

With surgery, what meds should be d/c’d?

Antiplatelets

7-10 days preop

SCIP is?

Surgical Care Improvement Project:

standards for abx use to ↓ surgical infections

SCIP rules for prophylactic use?

1) Prophy abx given w/i one hr PRE-incision

2) Prophy abx d/c’d w/i 24 hrs of surgery completion

Positioning Patient, purpose?

protect pt

Positioning Patient: Supine? Use?

flat, face up palms down U for general surgery

Positioning Patient: Trendelenburg? Use?

supine w/ head lowered below feet ↑ exposure to pelvic organs placing central lines

Positioning Patient: Reverse Trendelenburg? Use?

supine w/ head raised above feet ↑ exposure to abdominal viscera

Positioning Patient: Sitting? Use?

Legs extended, hands in lap craniotomies cervical spine surgery

Positioning Patient: Lithotomy? Use?

supine w/ knees raised in stirrups Uro, gyn, rectal procedures

Positioning Patient: Prone? Use?

face down w/ arms bent 90°, feet propped w/ knees bent spinal surg

Positioning Patient: Lateral? Use?

on side w/ hips/legs lowered ~ -30° thoracotomies, nephrectomies, retroperitoneal procedures

-otomy is?

incision into

-ectomy is?

removal of

-ostomy is?

new opening

-plasty is?

repair

-plexy is?

fixation

-rrhaphy is?

suturing

Situational Awareness includes? (3)

1) perception of environment 2) comprehension of current situation 3) projection of future status

Degraded Situational Awareness caused by?

Precursors (lack of data/systems) Humans (lack of judgement, training, skill or misinterpretation, distraction)

Intraoperative Improvement Initiative goal?

Effect outcomes | ↓ morbidity/mortality

Intraoperative Improvement Initiative purposes? (3)

1) capture near misses 2) fix holes in system 3) ↓ chances of adverse events

Intraoperative Improvement Initiative categories of events? (9)

1) pt instability 2) physical injury to pt 3) communication failure 4) ∆ of plan 5) meds 6) blood products 7) equipment misuse or fail 8) access 9) everything else

Crew Resource Mgt/Mismgt due to? (5)

1) communication 2) personal readiness 3) supervision 4) organization culture/resources/process 5) safety vs cost

Structured Communication: Briefings purpose?

formulate and share op plan | U w/ checklist

Structured Communication: Sterile Cockpit is? Reviewed when?

High risk period needing absolute team concentration during debriefing

Structured Communication: Debriefings purpose?

(done immediately) Eval performance of system/people/procedure etc Identify areas for improvement Sustain/grow improvements

Risks of surgery?

``` Wound/line infection UTI DVT/PE PNA GI ulcers Decubitus (bed sore) MI Arrhy Stroke Bleeding ```

VTE Prevention: low risk surg? Mod - high risk surg?

mechanical prophy anticoag prophy