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Flashcards in TEST #1 - Pre-Post Op Deck (31):
0

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

1

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

Diagnostic

Exploratory

Reconstructive

Curative

Palliative

2

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!

3

You can classify a surgery based on location, what are the three locations?

Inpatient

Outpatient

Free-standing Surgery Center

4

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

5

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

Medications
-Prescription, OTC, and herbals
-Last Doses (Vital meds w/sips of water)

Chronic Illnesses
-May affect positioning
-May affect pain levels
May influence outcomes (Renal Failure)

Psychological Illnesses
-May affect perceptions
-May influence teaching/learning
-Includes Dementia

6

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

7

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)

8

You want to assess the pt social situation, what do you need to find out?

Support System

Financial Resources

9

You want to do a cognitive assessment, What do you want to find out?

Mental Abilities

Ability to read, write or speak nurse's language

10

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

11

You want to also assess their nutrition status, what data are you wanting?

General Appearance: Hair, skin

Height/Weight

Factors Influencing-Teeth, finances, health, and functional limitations

Obesity
-Technical difficulty
-Post-Op Infection, hernias, dehiscence, or evisceration
-Pulmonary Complications
-Mobility during Post-Op

Lab Tests
-Serum Albumin, prealbumin, hemoglobin, hematocrit, BUN, &Creatinine

12

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

13

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)
-Surgical Bath
-Surgical Prep
-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
-Visitors
-Anticipated equipment-Dressings, drains, devices, etc

14

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)

15

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.

16

There are 3 basic types of wounds, what are they?

Primary intention
-Edges well approx

Secondary intention
-left open to heal from the inside out

Tertiary intention
-contaminated wounds that are closed later, then they appear free of debris.

17

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)

18

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

I&O

Pain and discomforts

Safety Issues

19

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

Psychological Support
May be anxiety, fear or grieving

Spiritual Support
Surgery may have spiritual significance Ie: Hysterectomy pt may perceive she is being punished for a previous abortion

Lab Values
Morning after surgery and then every 24 hrs if no sig changes

20

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.

21

Post-Op Complications can include Airway & breathing, such as decrease LOC or laryngospasm, what are some Interventions?

Oral/Nasal Airway

Position on Side

Positive pressure ventilation for laryngospasm

Suctioning

Oxygen Therapy

DB & C (Deep Breathe & Cough)

22

During Post-op there can be circulation complications such as Hypotension or Hypertension, What are some interventions?

Trendelenburg
(To help get adequate oxygen to brain)

Fluids
(Help regulate circulating blood volume)

Medications to support
(Bring BP up or down)

May require blood transfusion
(Do a CBC to determine if needed)

Monitor I&O

Diuretic may be required
(If Hypertensive and have cardiac history to help get excess fluid off)

23

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

24

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

25

What are some signs and symptoms of infection post-op?

Fever

Redness

Warmth

Purulent Drainage

26

What are some signs and symptoms of dehiscence post-op?

Leaking of pinkish drainage

Client states "I think something popped"

27

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

28

What is a sign & symptom of evisceration?

Organs protruding from wound

29

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

30

What are some perioperative pharmacology?

Antianxiety
Decrease mental tension and anxiety (Xanax, Ativan)
SE: Drowsiness, Sedation

Narcotics
Used for pain control, anesthesia, per/post-op (Morphine, Demerol, Lortab)
SE: Respiratory Distress, Constipation, N/V

Sedatives
Sedation, Muscle Relaxation, & Amnesia
SE: Respiratory Depression, Hypotension, Drowsiness

Anticholinergics
Decrease oral and Respiratory secretions
SE: Urinary Retention, Muscle Weakness, Constipation, Dry Mouth

Histamine H, Recepter Antagonists
Decrease gastric acid secretions
SE: HA, Bradycardia, Abdominal Cramping