Flashcards in TEST #1 - Pre-Post Op Deck (31):
What are some surgical classifications under anatomy?
Orthopedic - Bones &/Or Muscle
GI - Esophagus, Stomach, Intestines, etc
ENT - Ears, nose or throat
Other - Cardiac, Vascular, Neuro
Another way you can classify surgeries is by their purpose, there are 7 different ones, what are they?
Aesthetic - Improve "normal" physical feature
Constructive - Repair congenital defect
Doesn't matter how surgery is classified, it represents a major life ____ or life ______ for all clients!
Doesn't matter how surgery is classified, it represents a major life EVENT or life STRESSOR for all clients!
You can classify a surgery based on location, what are the three locations?
Free-standing Surgery Center
When doing a Pre/Post-Op assessment what do you want to find out the history of the present illnesses?
The course of events and the signs and symptoms that necessitate surgery
During Pre-Op What do you want to find out about their medical history?
Previous surgeries and Anesthesia
Includes family members' untoward reactions
Serious Illness or Trauma
-A - Allergies
-B - Bleeding Tendencies (or meds that affect)
-C - Cortisone or steroid use
-D - Diabetes
-E - Emboli (Any previous events)
Alcohol, Nicotine, & Recreational Drugs
-Prescription, OTC, and herbals
-Last Doses (Vital meds w/sips of water)
-May affect positioning
-May affect pain levels
May influence outcomes (Renal Failure)
-May affect perceptions
-May influence teaching/learning
You need to find out about the patient's cultural beliefs and practices, what do you want to ask or know?
Rituals, candles, herbs or healers
Who makes decisions within the family group
Native Americans want body part for burial
You also want to find out about spiritual beliefs and practices, like what?
Desire for prayer, rituals or spiritual leaders
Some groups oppose blood Transfusion (Jehovah's Witness)
You want to assess the pt social situation, what do you need to find out?
You want to do a cognitive assessment, What do you want to find out?
Ability to read, write or speak nurse's language
Part of the pre-op assessment is to do a physical ____-__-___ exam
Part of the pre-op assessment is to do a physical HEAD-TO-TOE exam
You want to also assess their nutrition status, what data are you wanting?
General Appearance: Hair, skin
Factors Influencing-Teeth, finances, health, and functional limitations
-Post-Op Infection, hernias, dehiscence, or evisceration
-Mobility during Post-Op
-Serum Albumin, prealbumin, hemoglobin, hematocrit, BUN, &Creatinine
What are 4 things that must be done for INFORMED CONSENT?
Doctor must explain procedure
Nurse can answer questions/clarify or redirect concerns to doctor
Requirements for them to sign:
-Done prior to any mind-altering med
-Adult >18 or emancipated
-Competent and Conscious
May be provided by parent or legal serrogate
During Pre-Op teaching what do you want to teach?
Explain what to expect
Explain what will be expected of them Pre-Op:
-NPO after MN (8-10 hrs prior to surgery)
-Tests &/or procedures
Explain what will be accepted of them Post-Op:
-Fluids and meals
-Pain and comfort management
-Activity-Leg exercises, mobility, etc
-Respiratory Hygiene-TCDB, incentive spirometry
-Anticipated equipment-Dressings, drains, devices, etc
What 5 items do you need for the Pre-Op Checklist?
Consent (Surgical & Blood)
Identification (ID band, blood band, allergy band, site marked)
Paperwork on chart (H&P, diagnostic & lab reports, med sheets)
Preps Done (Bath, skin preps, hair clipping, pre-op meds)
Clinital data Posted (VS, allergies, IV's, tubes, etc)
You must always give a ________ _________ to OR nurse when bringing patient for surgery.
You must always give a VERBAL REPORT to OR nurse when bringing patient for surgery.
There are 3 basic types of wounds, what are they?
-Edges well approx
-left open to heal from the inside out
-contaminated wounds that are closed later, then they appear free of debris.
What are some factors that affect the healing of wounds?
Corticosteroids (Impair tissue healing & mask infection)
Foreign Body (interferes with healing)
Infection (Any source delays healing)
Weight (Obesity-increased stress on suture or staples, Atepos tissue doesn't have same tissue as muscle so the blood flow is diminished)
Nutrition (Need protein and energy to rebuild tissue, Vit C&B for collagen formation and tissue development, Zinc vital mineral for tissue repairment and immunity)
Age (Older age usually takes longer to heal)
Circulation (Decreased blood flow slows down healing - Diabetes can cause circulation issues)
During Post-Op care you will receive report from PACU nurse, you then will do a post-op assessment, What would you do during the assessment?
Heat-to-toe exam compared to pre-op
Frequent VS per policy (Circulatory, Respiratory, Neurological)
IV's, tubes, dresings and drains
Pain and discomforts
Another thing you want to do during Post-Op care is to monitor and prevent complications, What do you want to do?
Focus on Respiratory Hygeine
TCDB, incentive spirometer
Activity as Ordered - Promotes Venous Return
Leg Exercises, mobility, etc - Pg 255
May be anxiety, fear or grieving
Surgery may have spiritual significance Ie: Hysterectomy pt may perceive she is being punished for a previous abortion
Morning after surgery and then every 24 hrs if no sig changes
Our ultimate goal post-op is to discharge the patient to a ______ _____. May be with self, family, or community resource.
Our ultimate goal post-op is to discharge the patient to a SAFE HOME. May be with self, family, or community resource.
Post-Op Complications can include Airway & breathing, such as decrease LOC or laryngospasm, what are some Interventions?
Position on Side
Positive pressure ventilation for laryngospasm
DB & C (Deep Breathe & Cough)
During Post-op there can be circulation complications such as Hypotension or Hypertension, What are some interventions?
(To help get adequate oxygen to brain)
(Help regulate circulating blood volume)
Medications to support
(Bring BP up or down)
May require blood transfusion
(Do a CBC to determine if needed)
Diuretic may be required
(If Hypertensive and have cardiac history to help get excess fluid off)
There are 4W's for post-op, the first is wind, what are some common wind problems and within what amount of time?
Pneumonia, Atelectasis, Pulmonary Emboli
Usually during the fir 1-2 days
There are 4W's to post-op, Wound is one and what are some problems and within what amount of time?
Infection, Dehiscence, Evisceration
Usually 5-7 days post-op
Normal Progression of Drainage:
Sanguineous - Bloody
Serosanguineous- Serum with blood
Serous- Clear to yellow
What are some signs and symptoms of infection post-op?
What are some signs and symptoms of dehiscence post-op?
Leaking of pinkish drainage
Client states "I think something popped"
What are some interventions for dehiscence post-op?
Lay client down
Check VS & Wound
Place pressure & sterile NS dressing on suture line
Call doctor STAT
What is a sign & symptom of evisceration?
Organs protruding from wound
What are some interventions for evisceration?
Lay client down
Check VS & wound
Sterile towels or dressings with NS over organs
Do not push organ back into wound
Call doctor STAT
REMAIN WITH CLIENT