Lecture 4: care of surgical pt Flashcards
(82 cards)
pre-op
- same day surgical admission (“elective”)
- emergency
intra-op
- operating rm
- ambulatory
post-op
- post anesthesia recovery (PACU)
- ambulatory
- admission to hospital
diagnostic surgical indication
just go to see what’s happening. Often written on their diagnosis, determining presence or non-presence of pathological abnormality. (endoscopy or colonoscopy). Can send a biopsy as well. Can be coupled up with exploration surgery.
cure or repair surgery
obviously to do this (appendicitis removal and whatnot, hip replacement), cleft pallet?
palliation procedure surgery
some cancers may be relieved with surgery, ostomy so you aren’t continuously vomiting is an example.
prevention surgery
Bilateral mastectomy if you are more high risk for breast cancer.
exploration surgery
going exploring to look at extent or presence of disease.
cosmetic improvement surgery
Rhinoplasty in the cosmetic sense, breast reduction also cosmetic sense, breast augmentation, liposuction, tummy tuck
pre-op assessments
- consults or diagnostic testing
- assess medical regime, emotional status & physical assessments if indicated
- review past medical diagnoses and surgical procedure
- review prescribed meds
Allergies
Call talking about what is going to happen - what the day will look like for the pt (what you can expect) and gather information regarding their medical conditions
Baseline vitals
Basic bloodwork
How they handle anesthesia
Diagnostic testing: MRI, ultrasound, x-ray, echo, ecg (baseline imaging so they can estimate what it’ll look like when u get in there)
Substances: caffeine, alcohol, etc.
Reviewing PMH and past surgeries
Knowing what medications they are on
- For ex: anticoagulants - may need to stop them up to 7 days in advance because we don’t want them to bleed out
pre-op education
- protocol for routine meds before surgery
- which meds to stop before surgery
- NPO instructions
- pain management options
- infection prevention and wound care
- post-op discharge and care
Use medical directives to figure out what the hell were doing
- Make the decisions on their own on what medications they are stopping, what they are taking, etc. the day of their surgery.
NPO before surgery -> to reduce the risk of aspiration during surgery
If stomach is full and people stick stuff down your throat you will vomit into you lungs and aspirate
People can have clear fluids up to 2 hrs before procedure -> but very surgeon dependent.
Give pt some pain reduction options, as well as infection prevention and wound care.
Give them realistic expectations for recovery. As well clear expectations of what life after their surgery will look like.
Using teach back methods.
pre-op day of surgery assessment
- pre-op checklist
- confirms consultations are completed
- identifies any changes in physical assessment
- establish baseline data
- review pre-op diagnostic tests
- review meds
- consider cultural considerations
- consent ability
pre-op considerations
- allergies
- sys assessment
- fluid and electrolyte status
- nutritional status
- labs and diagnostic tests
ASA 1 classification
healthy, non smoking no to minimal alcohol intake
ASA 2 classification
mild disease, minimal functional limitations (smoking, social alcohol intake, pregnancy, obesity, controlled diabetes)
ASA 3 classification
substantial functional limitations w one or more moderate to severe diseases (uncontrolled diabetes, MI, CVA)
ASA 4 classification
recent (<3 mo) MI, CVA, sepsis, acute resp disease
ASA 5 classification
ruptured abdominal aortic aneurysm, massive trauma, ischemic bowels
ASA 6 classification
brain-dead pt
organs being removed for donation
what is an open approaches
has incision, cutting them open (hips, knee surgeries)
- otomoy (big incision)
laparoscopy
I put little holes in you and instruments thru the holes
robotic approach
blue circle claws, almost looks like they are knitting and there’s foot peddles. Can use slicer, scope, etc. and can switch thru the robot.
less big incision perks
shorter stay, less risk of infection, less pain, better mobility (decrease risk of DVT, pneumonia, and a lot of post-op complications).
General anesthesia classifications
- IV or inhalation
- opioids, benzodiazepines, and antiemetics
General anesthesia: you have a breathing tube and are on a ventilator. Breathing on your own may be difficult afterwards Do they have respiratory issues?
Risk of underinflating his lung: alveolar collapse, atelectasis, post-op pneumonia
Overinflation: pneumothorax, lung burst
