Week 1= periop care Flashcards
pre and intra operative (54 cards)
3 phases of surgical procedures
1- preop
2- intaop
3- post op
reasons for surgery
6
1- diagnosis (biopsy)
2. cure or repair ( fracture, pacemaker, appendix removal)
3. palliative (debulking, colostomy, shunt) prolong time not a cure
4. prevention (mole removal, breast removal)
5. exploratory (laparotomy)
6. cosmetic improvement (scar repair, breast reconstruction )
two types of surgeries
- elective (planned)
- emergency
most common surgery in canada
c section
other common surgeries in canada
4
knee replacement
fractures
coronary artery angioplasty (stent of intervention)
hip replacement
why more surgeries being completed
NDP says we need to
GCS less than 8 then
intubate
catagories of GCS
Eyes – spontaneous =4
verbal= 3
pain/touch= 2
nothing= 1
Verbal - orientated= 5
confused = 4
inappropriate words = 3
sounds = 2
none = 1
Motor obeys commands= 6
localizes to pain= 5
withdraw from pain (body away from
pain)= 4
flexion (go inwards, not as good as
withdraw) = 3
extension = 2 (can mean brainstem
injury)
none = 1
What preoperative diagnostic tests should be ordered?
for snowmobile accident with open tibial facture GCS of 7
4
- heat ct
- labs (lactate, CBC, ABGs, group and screen, electrolytes)
- x ray
- BGM
What preoperative diagnostic tests should be ordered?
penetrating chest wound
4
- CT
- US good for abdomen
- labs (g+s, CBC, lytes, lactate(how far in shock they are), ABG, HCG
- Heat CT
Who is responsible for obtaining consent?
The professional performing the procedure
Most often surgeon
Who is responsible for confirming consent
Nurse can
Confirming understanding and is there any questions
Teach back method ( have them tell you what’s going to happen)
If they don’t know call the surgeon
3 elements for consent
1-voluntary
2- mental capacity to consent
3- well informed
what if pt cant consent
is there an advanced directive
Advanced Directive
“… a capable adult may make an advance directive.
An advance directive is a written instruction that gives or refuses consent to health care in the event the adult later becomes incapable of giving the instruction at the time the health care is required
An advanced directive is typically done
ahead of time (ie. ADVANCED), usually when someone knows they are aging or a progressing mental illness (dementia, brain tumour, etc.)
Temporary Substitute Decision-Maker order
9
(a) the adult’s spouse;
(b) the adult’s child;
(c) the adult’s parent;
(d) the adult’s brother or sister;
(d.1) the adult’s grandparent;
(d.2) the adult’s grandchild;
(e) anyone else related by birth or adoption to the adult;
(f) a close friend of the adult;
(g) a person immediately related to the adult by marriage.
What to do if you cant get a hold of anyone
falls under Implied consent as long as they don’t have an advanced directive or DNR
waiting for a surgery depends on
- stability of patient and their availability
diagnostics for total knee arthroplasty
5
Labs (renal, liver, G+S, coagulation, CBC, Lytes, BG)
Chest X-ray (heart size, lungs clear?)
ECG (want to know before
MRI of knee
PMHx (maybe urine sample if they have a history)
What are some pre-surgical screening questions?
Allergies, previous surgery’s, anesthetic, dental work, medications or supplements, substance use
preparing for surgery
subjective (5)
objective (2)
Psychosocial (what is their frame of mind)
PMHx
Meds
Allergies
Alcohol/Drug use
Physical
Diagnostics
special consideration for older adult 65+
7
↑ sx site infection
Normothermia
Confusion, falls
Skin breakdown (poorer nutrition and thin skin)
VTE
↑ risk for pneumonia (more COPD or asthma)
Preexisting conditions
general surgery information
other info
What the surgery is + risks (consent)
DB&C ( prevent atelectasis, opioids and anesthetic can cause actelectesis)
Movement (restrictions) gets blood flowing, GI movement, urinary retention, resp
Splinting
Equipment (drains, monitoring)
Special prep closer to the surgery)
Shower
NPO
Pre-op meds (to give or to hold)
