Preoperative Surgery Flashcards
(42 cards)
Disadvantages of am surg
Responsible for pre-op prep, outpatient pre-op assessment, interventions carried out at sx center, patient monitored and recovered until safe to discharge
Advantages of am surg
Cheaper, more inpatient beds for sick, less separation anxiety, and decreases disruption of normal routine
Am surg criteria
Age (young adults and children >1yr), general health status, patient compliance, and insurance requirements
Psychosocial preparation
Sx is a stressor, a potential or actual threat to body integrity. Anxiety is normal, adaptive response to stress of sx (can impair cognition, decision making, and coping), providing info can decrease anxiety ( biggest fear is not waking up)
Fears related to sx
General: fear of unknown, loss of control, loss of love from partner, threat to sexuality. Specific: dx of cancer, anesthesia, dying, pain, disfigurement, permanent limitations
Assessment of pre-op subjective data:
Site-type of- reason for sx, extent of hospitalization, pre-op/post-op requirements, previous sx experiences/specific concerns, religion/cultural beliefs, support system
Assessment of pre-op objective data:
Speech patterns, degree of interaction with others, physical (vs, body language, activity level, urinary/bowel habit, perspiration), change in sleep patterns
Implementation if nursing action:
Allow patient to talk about fears, use therapeutic technique, active listening, open non-judgmental attitude, clarification, touch
Pre-op teaching:
Preparing patient for OR: reduces anxiety, enhance physical process, require less anesthesia/analgesia, decrease hormone excretion, lowers infection risk, lowers HR/BP
Level of understanding of SX:
Basic purpose of SX, assess what patient really knows (patients often tune out because of anxiety), explore patients expectations and perceptions, always provide written information, simple explanations are best. REMEMBER giving info does not mean it is perceived or understood.
Evaluation of pre-op teaching:
Performance of post-op exercises (return demo and verbalized rationale), ability to sleep, willingness to cooperate
Pre-op physical assessment includes:
Head to toe PE, pre-surgical test results, identification of risk factors
Collection of baseline information:
General health/ previous sx, allergies, current med list, smoking, ETOH, prosthesis, dentures, glasses, hearing aids, disabilities/impairments/pregnant, mobility limits, body size/structure (actual W&H), LOC, mental status,
Physical pre-op assessment:
Nutritional status, skin integrity, resp status, cardio status, renal status, endocrine, hepatic, neuro, musculoskeletal, immune system
Routine pre-surgical tests: nursing responsibilities
Check order, ensure all tests are done, and assure all results are available prior to OR/ alert MD of findings (if abnormal).
Surgical risk factors:
Degree of sx risk factors depend on: Physical/mental status, extent of pre-existing disease, severity of required sx
Surgical risk factors include:
Age, general health, use of drugs/ETOH, allergies, nutrition, fluid/electrolyte balance, mental status, radiation therapy,
Planning and interventions:
Planning=EO, provide information and instruction for optimal physiological needs, degree of pre-op physical prep, overall goal of pre-op period is to ensure patient is mentally and physically prepared for sx
Expected outcomes:
Knowledge, fear control, anxiety control, comfort level, coping, decrease complications and length of stay in hospital (overall goal)
Physical prep evening prior to sx:
Bowel prep (so will not obstruct access to organs/or get knicked), skin prep (sx bath and integrity), sleep/rest (manages stress), food/fluid (npo),
Physical prep day of SX:
OR checklist, VS, hygiene and attire (sx bath, mouth care, zero makeup/nail polish/prosthetic devices/clothing/jewelry), special orders (foley, NGT, IV)
Purpose of pre-op medication:
Reduces anxiety, analgesia, prevents nausea/vomiting, decrease amount of anesthesia, prevents post-op infection, promotes sedation/amnesia, facilitates induction, prevents autonomic reflex response, decrease resp/gi secretions
Pre-op medications:
Ordered by anesthesiologist or surgeon, abx/anti-emetics given <60 min prior to sx, and anticholinergics/benzodiazepines given just prior to OR
Transportation to OR:
OR will call when ready, chart goes with patient, allow family to say goodbye, instruct family on what to expect
