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CMT-dos > Surgery tools > Flashcards

Surgery tools Flashcards

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staples
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5
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tissue flap
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tram flap
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6
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FREE FLAP
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8
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SKIN GRAFTING

harvest site

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Harvest site:
Hair/hairless
Color
Elasticity
Size requirements

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11
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POST-ANESTHESIA CARE UNIT (PACU)

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“PACU, Recovery room, RR”
Monitor patients following surgery
One nurse to one patient
Frequent assessment
Monitor vital signs

Anesthesia has primary responsibility for cardiopulmonary function
Any items related to anesthesia
Surgery team oversees surgical site and other non-anesthesia issues

15-30 minutes up to 3-4 hours

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12
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PACU

Monitoring

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Blood pressure – frequently (5 -15 minutes) to continuously (Arterial line)
Pulse – frequently to continuous
Pulse oximeter – continuous
EKG – continuous
Temp – initial and prior to discharge

Acute changes communicated immediately

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13
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PACU

Dressing/wound and IVF/urine output

A

Assess for drainage
Bleeding
Dehiscence
Cast/brace – ’fit’

IVF and urine output
Foley or “void prior to discharge” or collect in urinal

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14
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POST-OPERATIVE CHECK

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PACU (if going home)
Prior to D/C
Communicate with patient/Family

Floor/Unit
Check 4-6 hours after discharge
Communicate with patient/family
Check wound, fluids, vitals since surgery, PULSE
Assess pain control, diet, activity, drainage

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15
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OPERATIVE NOTE

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Communicates essential information

Acute change in recovery room
For ‘on-call’ coverage
For billing/coding
Legal defense
Surgery, surgeon, assistant, anesthesia
Fluids, blood loss, implants, complications, prep, dressing
Disposition

THINK: 4 weeks, 6 months, 3 years later??
Anyone should be able decipher what was done and why with all details

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16
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OPERATIVE NOTE

Written/EHR

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Done immediately – prior to leaving OR
Essential communication for PACU/On-call/Anesthesia

17
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OPERATIVE NOTE

Dictation

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Complete operative report
Billing/Legal/Informative

18
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OPERATIVE NOTE

what needs to be included

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Patient, DOB, ID number/MR#
Operation performed +/- indication
Preoperative diagnosis
Post-operative diagnosis
Anesthesia
Surgeon
Assisting surgeon/Assistant

Surgical findings
Basic prep, position, findings
Unusual issues, findings or outcomes
Specifics of approach, drains, dressing, closures

Estimated Blood Loss (EBL)
Intravenous fluids (IVF)
Drains
Specimen

Complications

Disposition
Awake
Intubated
To RR, PACU, ICU
Continued under anesthesia for next portion
Discharged home

(Follow-up)

19
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OPERATIVE NOTE

Don’t forget:

A

Who is dictating/writing
Why done
Specific Surgery
Complications (major)
Be appropriate
Mention what matters and could have an effect
No one cares that a knot had to be redone- as long as it is fine now

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21
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POST-OPERATIVE ORDERS

general

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Order sets versus written orders
Determine status
Inpatient
Recovery room or Extended recovery
Observation
Medications, pain control, antibiotics
Nursing and ancillary instructions and orders
Discharge instructions, diet, activity, dressing, follow-up

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24
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ADMIT

Where is the patient going to end up that day?

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Most go to PACU – but then where
Extended recovery – up to 24 hours
Observation – Medicare status up to 24-72 hours
Floor - which floor
ICU/Step-down
Home – discharge
Same day surgery unit – planning to discharge

25
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DIAGNOSIS

Admitting diagnosis

A

Used for billing, bundling
Generally don’t use “status-post” as primary diagnosis
S/P Lap chole
Use: ‘Cholelethiasis’ or ‘cholecystitis’
S/P left knee replacement – ‘Osteoarthritis with knee pain and disability”
Must justify level of admission and location

26
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CONDITION

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One-word description of status
Good, fair, poor, guarded, grave
“stable” – not a good descriptor

27
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VITALS

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Frequency of vitals
Note any special vitals
Understand what are “routine vitals” at your institution
BP, Pulse, Temp, Resp, Pain
Daily weights?
Arterial line?
CVP/Swan
Continuous pulse ox
EKG/Telemetry

28
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ALLERGIES

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All medication allergies
Relevant allergies
Latex
Peanut – if significant and life threatening
Seasonal allergies? – NO!

29
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NURSING

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Specific orders for nursing
Dressing changes, wound check
Drains to handle, record, remove
Foley, urinal, strain urine
Ins/Outs (I/O’s)
Monitoring
Positioning in bed

30
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DIET

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Dietary orders
Not just oral intake
TPN, tube feeds, supplements

Remember co-morbid conditions
Diabetes – ADA +/- cal
CAD
Gluten, lactose, soft mechanical,

NPO
‘Regular’

31
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ACTIVITY

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Stay in bed/out of bed
Up to chair
Ambulation?
Be aware of number of tubes/drains/poles required to ambulate

32
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LABS

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Which labs to draw and when
Call with results?
Alert levels outside of normal range?
Frequency (if applicable)
Only order if needed – avoid routine daily labs unless truly indicated

33
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IV

A

List which IVF
Rate
Indications to stop?
Number of total fluids
Hours
When taking PO
‘SLIV’ = saline lock IV

34
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SPECIAL STUDIES

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X-ray, CT, MRI
Swallowing studies, stress test, Echo
Telemetry could go here, EKG on arrival or in AM

35
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MEDICATIONS

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Home meds
Only what is needed or harmful to stop
Be conscious of intake and route
Does it matter if they skip a dose of a vitamin or supplement?

Specific for surgery
Antibiotics
Pain medications
Regional blocks
Nausea/vomiting

Prophylaxis
Gastric acid suppression
DVT

Comfort/Hospital specific
Sedatives
Sleep
Laxatives/Softeners

36
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POST-OPERATIVE PAIN

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Each patient is different

Each surgery is different – EVEN IF IT IS THE SAME SURGERY
Patient perception
Severity of surgery
Complications, length, involvement

37
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POST-OPERATIVE PAIN MEDICATION

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Intravenous
Morphine
Dilaudid (hydromorphone)
Demerol (meperidine) – not used much due to risk

Patient Controlled Analgesia
Type of drug
Frequency
Dose
Basal Rate (continuous infusion)

Oral
Narcotic based (Lortab, Percocet, Tylox, Vicodin, Darvocet, Percodan)
Codeine, Oxycodone, hydrocodone
Tramadol
Non-narcotic (NSAID – Ketorolac, Ibuprofen, Tylenol)
ASA – bleeding properties

Be aware of all components of medications
Tylenol in Lortab/Percocet
NSAIDs, ASA

38
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POST-OPERATIVE PAIN MEDICATION

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Scheduled
PRN
IV or Oral or PCA
Regional pain control
Block, epidural, spinal

Antispasmodics
Muscle spasms
Neuropathic
Sedation

“Reasonable control”
“Tolerable”
Surgical patients will have pain
Addiction worries are over-inflated acutely
Longer term pain control
Switch to non-narcotic when feasible
Expect pain, just control it

39
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ACUTE RETURN TO OR

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Bleeding – internal or external
Wound dehiscence
Abnormal drainage/output
Vascular, lymphatic, CSF

Possible collateral injury
Ureter, bowel, bladder, esophagus perforation
Nerve injury, compartment syndrome
Pneumothorax

Retained objects – instruments, sponge, sharps

CMT-dos (95 decks)

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