Unit 5 Pre-op Flashcards Preview

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Flashcards in Unit 5 Pre-op Deck (79):
1

Phases of Surgery

• Preoperative
• Intra-operative
• Post-operative

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Preoperative

time decision is made to have surgery until transported to the OR

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Intra-operative

administration of anesthesia through completion of surgery

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Post-operative

Post-anesthesia care unit until recovery is complete

Can be years!

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Surgery

planned anatomical alteration of the human organism designed to arrest, alleviate, or eradicate some pathological process

anatomical alteration of the body

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Palliation/ Palliative

Does NOT cure; Alleviates symptoms
relieves symptoms without curing disease

Think Hospice

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Perioperative period

(encompasses 3 phases)—around the surgery

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Perioperative Nurse

allows nurse to function in variety of roles within the surgical process--> CONTINUITY OF CARE

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Inpatient

patient admitted and surgery performed in the hospital surgical suite

must stay in hospital at least over night

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Ambulatory Surgery

Outpatient
~70-90% of surgeries are not outpatient

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Free Standing

not affiliated w/ hospital; independently owned & operated

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Hospital affiliated facility

• Sep. department (for all 3 phases)
• Located w/in hosp complex or satellite office

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Minor Surgery

simple surgery that presents little risk to life (may not be minor to patient!)

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Major Surgery

involves extensive reconstruction or alteration in body part

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Diagnostic/Exploratory

to determine cause of symptoms or verify diagnosis

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Curvative

removal of diseased part, repair damaged or malformed area, removal of early stage tumors

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Ablative

removal of diseased part **** total !!!

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Restorative

strengthen a weakened area

bone pinning, herniorrophy (suture repair of hernia), mitral, valve replacement

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Constructive/reconstructive

repair malformations or improve function/appearance.

Plastic, cleft palate, plastic surgery, breast reconstruction

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-ECTOMY

removal of an organ or gland

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-lysis

destructive

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-orrhaphy

suturing or stitching

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-ostomy

providing an opening

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-otomy

cutting into

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-plasty

formation or plastic repair

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-scopy

looking into

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Emergency Surgery

unplanned – preformed immediately to save life***
- to save life or body part

Performed due to major trauma or hemorrhage of internal organs.

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Informed Consent

-Prior to any non-emergency surgery
-Must Have: clear understanding of the surgery, risks, and benefits w/ clear judgment –no impairments *
-Surgery cannot legally be performed until patient understands and signs consent
-protects: patient, hospital, staff, & surgeon
-valid for 60 days
-must be witnessed

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Urgent Surgery

Unplanned. Requires surgical intervention within 24-48 hrs

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Required Surgery

Planned; Required
Indicated for health problems but not immediate

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full explanation of the procedure in terms the patient can understand prior to signing is performed by

the physician

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Elective

-planned; desired
-Scheduled weeks or months in advance

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AORN

Asc. Of Operating Room Nurses
Purpose: gain new knowledge and improve nursing care in the OR; Develop standards of practice for the OR

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Subjective Data

Pt level of understanding/perceptions

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Subjective Data Assessments

• Site/ type of surgery/ reason for surgery
• extent of hospitalization, limitations
• pre-op/ post-op routines/ tests required
• surgical experiences/ specific concerns about present surgery
• religion or cultural beliefs
• family/significant other source of support

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WBC

Total White Blood Cell Count
Fight Infection
4,000-10,000 (4-10 on lab print out)

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Neutrophils

2nd line of defense

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Lymphocytes

1st line of defense

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Potassium

Major Cation within cells
3.5-5.0
**Minor Changes have significant consequences
Abnormal Ranges increase risk of cardia arrhythmia
• Excreted by the kidneys

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Sodium (Na+)

maj determinant of extracellular osmolality
Norm: 136-145

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Carbon Dioxide

• Norm: 23-30 mEq
• pH status of pt and other electrolytes

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Cl-

• 98-106 MeQ
• → indication of acid-base balance
• Maintain electrical neutrality with Na+

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Ca+

7.6-10.4 mg/dl
parathyroid funx, ca+ metabolism, monitor renal funx

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Collection of subjective & objective data provides

baseline information (DAY 2)
• identify & correct any risk factors
• establish baseline data for comparison
• plan & institute pre-op care
• select anesthesia

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Pre-op physical assessment includes

• physical assessment
• pre-surgical test results
• identification of surgical risk factors

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Baseline Data Includes

• General health/previous surgeries
• Allergic responses
• Medications/smoking/ETOH
• prosthesis: dentures, glasses, etc
• disabilities/impairments
• mobility limitations
• body size & structure
• level of consciousness
• mental status/ coping/support
• pregnant
• Body surface area

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smoking history -->

↓ ciliary action to remove secretions
irritating to tracheobronchial passages →lyringo spasms

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Hepatic

detoxifies drugs - primary concern for anesthesia

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malnutrition

state of impaired functional ability of essential nutrients & calories within cells

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obesity

excessive accumulation of fat ↑surgical risk
• Adipose tissue is avascular
• More adipose tissue, more technical difficulty
– longer anesthesia time
– higher risk of intraop complications

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adrenocortical stress response

results in sodium & water retention/ potassium loss

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Radiation Therapy

• Side effects that may affect surgery/healing
• -thin skin layers
• -breaks down collagen for less healing potential
• -scars tissue-fibrotic & changes vascularity
• ****Ideally, wait 4-6 weeks after radiation to do surgery.****

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Overall goal of pre-op period

to ensure patient is mentally & physically prepared for surgery

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Purposes of Pre-op Medication

Prevents N/V, autonomic reflex response, post-op infections -- antibiotics

Decreases anesthetic requirements,respiratory & GI secretions –> prevents aspiration; anticholorgenic

Relieves apprehension & anxiety -->Promotes sedation & amnesia -->Facilitates induction of anesthesia

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Pre-op Medications:

• ordered by anesthesiologist or surgeon

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Antibiotics & anti-emetics:

given 30-60 minutes prior to surgery

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Once pre-op meds are given:

• patient to remain in bed with side rails up, call bell in reach
• DOCUMENT: explained to patient need to remain in bed

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What to expect when love one comes out of surgery

• Not awake
• Say incoherent things
• Pale
• Special Equipment
• Frequent Vital Signs

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BUN

• 10-20
• Monitors Kidney Function

60

• Creatine

• 0.5-11
• Monitors Kidney Fun

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Urinalysis

• UTI, renal function, diabetes

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• Type & Cross Match

• High risk for blood loss, sufficient blood for pt during surgery

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ABG's

arterial blood gases

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• Pregnancy Test

Female pt of childbearing age

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• Clotting Factor

• PTT – Prothrombin Time
• PT/INR- Pro Time/ International Ratio – normally between 1&2

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• Bleeding Time

how long… done on “wheel”

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FBS

• Fasting Blood Sugar
• Thick blood → decrease flow → increase clot

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Albumin/Protein

important for osmotic press. w/ in vascular space
• Measure of Nutrition

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• ALT

(alanine aminotransferase)

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(alanine aminotransferase)

Norm: 4-6
Liver enzyme → indicates any damage to liver

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EKG

measures heart electrical activity
• Rate, Rhythm & other factors
• ID Pre-existing cardiac problems
• Pt >40 years/ or hist of heart disease

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PFT

pulmonary function

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Anticholinergics & benzodiazepines:

given just prior to OR

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Hematocrit

% of total red blood volume made up of RBC
• M: 42-52%
• F: 37-47%

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Platelets

essential to blood clotting
• 150,000-400,000

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Bowel Prep

empty bowel of fecal material '
Collapse or “decompress” bowel so not obstruct access to organs or be nicked during surgery; prevents incontinence & contamination of surgical; prevents post-op constipation r/t decreased peristalsis; prevents uncomfortable straining first dew days post-op → dangerous for rectal, prostate & eye surgery; PERISTALSIS DOES NOT RETURN FOR 24 HOURS

77

Objective Data: clues to anxiety level

• speech patterns -rept themes
• degree of interactions with others
• physical-pulse/ respirations,hand movements, perspiration, activity level, frequent voiding
• change in sleep patterns

78

biggest fear

will not wake up

79

a stressor, a potential or actual threat to body integrity; Always a major experience for pt

surgery