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Flashcards in Theory/ Patho Week 1 Deck (82)
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1

Surgery

The art and science of treating diseases, injuries, and deformities by operation and instrumentation

2

Surgery: Performed For

Diagnosis
Cure
Palliation
Prevention
Exploration
Cosmetic improvement

3

Classification of Surgery: Urgency, Phases of Surgery

Urgency
A Case‐ Emergency
B Case‐ Urgent
C Case‐ Elective
Phases of Surgery 
Preoperative
Intraoperative
Postoperative

4

Surgery: Inpatient, Outpatient

Inpatient
◦ Admitted to hospital before or after surgery
Outpatient
◦ Performed either outside or in the hospital
◦ Discharged home after surgery
◦ Under local or general anesthesia

5

Informed Consent

• Legal document required for procedures or therapeutic measures
• Protects the client, nurse, physician, health care facility
• Married minors and emancipated minors may sign consent
• Spouses, children, significant other cannot sign instead of a capable adult

6

Pre-op Client Interview: Purpose

- Obtain health information
- Determine expectations, preparations
- Provide and clarify information on procedure
- Assess emotional state and readiness
- Identify medications and herbs taken that may affect surgical outcome
- Identify, document, and communicate results of laboratory/diagnostic tests

7

Nursing Assessment: Health History

Diagnosed medical conditions
Previous surgeries and problems
Menstrual/obstetric history
Familial diseases
- Conditions
Reactions/problems to anesthesia (client or family)

8

Nursing Assessment: Current Medications

Prescription and OTC
Herbs
Vitamins
Recreational
• Drugs
• Alcohol
• Tobacco

9

Nursing Assessment: Allergies (drug and non-drug)

Screen areas:
- Risk factors
- Contact dermatitis
- Contact urticaria
- Aerosol reactions
- History of reactions suggesting latex allergy

10

Nursing Assessment

Vitals recorded preoperatively for baseline
Bleeding/clotting times
Lab reports
Possible prophylactic antibiotics
Clinical Indicators
Identify cultural and ethnic factors that may
affect surgical experience
Psychosocial assessment, fears

11

Nursing Management: Preoperative Teaching

Client has right to know what to expect and how to participate
- Increases client satisfaction
- Reduces fear, anxiety, stress, pain, and vomiting
- Time may limit teaching
- Information given according to priority
- Observe and listen to client carefully to determine how much information is enough in each instance

12

Nursing Management: Preoperative Teaching

Assess what client wants to know
• Priority to concerns
• Usually sensory, process, and procedural information desired
Teaching documented on client’s chart
Instruction on deep breathing, coughing, and moving
post‐operatively
• Teach rationale to reinforce
• Practice

13

Nursing Management

Inform clients and families if there will be tubes, drains, monitoring devices, or special equipment postoperatively
• Enable safe care of client
• Decreases client’s and family anxiety
Provide client with information
• Fluid/food restrictions
• Possible need for enema
• Need for shower preoperatively
• Remove jewelry and prosthetics prior to surgery

14

Nursing Management: Day of Surgery Preparation

Final preoperative teaching
Assessment
Communication of pertinent findings to surgical
team
Verify signed consent
Completion of all pre‐operative charting
Labs
History and physical exam
Baseline vitals
Consultation records
Nurse’s notes
Consent for surgery

15

Nursing Management: Transportation to OR

• In‐patients transported by stretcher to operating room from room
• Outpatients transported by cart, wheelchair, or may walk

16

Intraoperative Care

• Perioperative nursing care requires understanding of surgery, surgical interventions and the operating room environment
• Nurses must keep current on technologies, advancement in surgeries and current anaesthetic procedures
• Maintain asepsis in surgical environment
• Continue to be strong advocate for client

17

Physical Environment: Operating room/ suite

◦ Geographically, environmentally, bacteriologically controlled
◦ Restricted in inflow and outflow of personnel
◦ Preferred location is next to post‐ anesthesia care
unit
◦ Filters
◦ Controlled airflow
◦ Positive air pressure
◦ Materials resistant to corroding

18

Surgical Team

• Surgeon
• Assistant surgeon
• Registered nurse who circulates
• Registered nurse first assistant
• Registered nurse, licensed practical nurse, or surgical technician, who scrubs
• Anesthesia care provider
• Other specialized technical personnel

19

Classification of Anaesthesia: General/ Local anesthesia

General anesthesia
◦ Loss of sensation with loss of consciousness
◦ Skeletal muscle relaxation
◦ Analgesia
Local anesthesia
◦ Loss of sensation without loss of
consciousness
◦ Topically
◦ Intracutaneously
◦ Subcutaneously

20

Classification of Anaesthesia: Conscious Sedation, Local Anesthesia

Conscious Sedation
- Minimally depressed level of consciousness with maintenance of client’s protective airway reflexes
Local anesthesia
◦ Produces autonomic nervous system blockade
◦ Skeletal muscle paralysis in area of affected nerve

21

Classification of Anaesthesia: Regional Anaesthesia

Loss of sensation in body region without loss of consciousness when specific nerve or group of nerves is blocked with administration of local anaesthetic

22

Classification of Anaesthesia: Spinal anesthesia, Regional nerve block

Spinal anesthesia
• Injection of agent into CSF in subarachnoid space
• Usually below L2
• Autonomic, sensory, and motor blockade
• May become hypotensive from vasodilation
Regional nerve block
• Agent injected into or around specific nerve or group of nerves

23

Classification of Anaesthesia: Epidural Block

• Injection of agent into epidural space
• Does not enter CSF
• Binds to nerve roots as they enter and exit the spinal cord
• Client can remain fully conscious
• May be used for post‐operative pain control

24

Classification of Anaesthesia: IV Induction agents, Inhalation agents

IV induction agents
- Induce pleasant sleep
- Rapid onset
Inhalation agents
- Enter body through alveoli
- Rapid excretion by ventilation

25

Classification fo Anaesthesia: Complications of inhalation agents


• Coughing
• Laryngospasm
• Bronchospasm
• Increased secretions
• Respiratory depression

26

Classification of Anaesthesia: Adjuncts to general anaesthesia

- Opioids
- Benzodiazapines
- Neuromuscular blocking agents - Antiemetics

27

Classification of Anaesthesia: Controlled hypotension, Hypothermia

Controlled hypotension
- Decrease amount of expected blood loss by lowering blood pressure during administration of anesthesia
Hypothermia
- Deliberate lowering of body temperature to
decrease metabolism
- Reduces demand for O2 and anaesthesia

28

Classification of Anaesthesia: Cryoanaesthesia, Hypnoanesthesia, Acupuncture

Cryoanesthesia
- Freezing localized area to block pain impulses
Hypnoanesthesia
- Hypnosis to produce alteration in pain consciousness
Acupuncture
- Decrease sensation

29

Nursing Management: Position of client

- Accessibility of operative site
- Administration and monitoring of anesthetic agents
- Maintenance of airway
- Correct skeletal alignment
- Prevent pressure on nerves, skin over bony prominences, eyes
- Provide for adequate thoracic excursion
- Prevent occlusion of arteries and veins
- Provide modesty in exposure

30

Nursing Management: Asepsis

Scrubbing, gowning, and gloving
- Cleanse hands and arms by scrubbing with detergent and brush
Basic aseptic technique
- Centre of sterile field in surgical incision
- Only sterilized items in sterile field
- Face shields
- Caps, gloves, aprons, eyewear (as appropriate)