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MED SURG > Week 7: Surgery > Flashcards

Week 7: Surgery Flashcards

(87 cards)

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1
Q

What are the 6 reasons for getting surgery?

A

Diagnosis
Cure/Repair
Palliation (improves comfort)
Prevention
Exploration
Cosmetic

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2
Q

What is an emergency/urgent surgery?

A

Unexpected , requires immediate action

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3
Q

What is an elective surgery?

A

Planned in advanced
Allows for optimization for patients condition

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4
Q

What is inpatient same day admission surgery?

A

Admitted on the same day as the surgery

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5
Q

What is ambulatory care/same day surgery?

A

Less than 23 hour cases, procedures typically taking less than 2 hours

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6
Q

What is the PACU rule of thumb?

A

Patient will stay at least 1 hour or half of the operating time

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7
Q

When is the pre op assessment done?

A

Weeks before surgery

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8
Q

How are meds a part of the pre op assessment?

A

Anticoagulant should be stopped

Herbal preps like St. Johns wort can affect bleeding

Aspirin stopped 4 days prior

Coumadin should be stopped well in advance, and replaced with subQ anticoagulants

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9
Q

NPO is a part of the pre op assessment?

A

as clear fluids are allowed up to 4 hours before surgery

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10
Q

Pain management and Infection prevention/wound care is also included in pre op assessment?

A

Discuss PCA or epidural options
Assess current pain med use
Discuss incision type and care

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11
Q

Discharge should also be included in pre op assessment, but why?

A

Start it early to ensure a smooth transition
Verify appropriate discharge location

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12
Q

What information must the nurse ensure is available the day before surgery?

A

Baseline data and vitals
Medication adherence (stopped)
Verify pre op labs
Cross match blood if significant blood loss is expected
Pt has signed consent

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13
Q

What are pre op patient considerations?

A

Age, ability to manage at home
Previous hospital experiences
Current health conditions
Need for equipment or financial aid

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14
Q

How can a nurse reduce anxiety in a patient pre op?

A

Use common, simple language
Use hospital interpreters
Explore and address stressors/fears

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15
Q

What should be included in the comprehensive pre op assessment?

A

Past health history
Anesthesia problems
Medications (All kinds)
Lifestyle (vitamins, rec drugs)

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16
Q

how long should patients abstain from alcohol before surgery ?

A

at least 24 hours before

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17
Q

What happens if a pt doesn’t disclose their opioid addiction?

A

Leads to inadequate pain management after surgery

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18
Q

What happens if patients are not narcotic naive

A

They have little to no exposure to opioid drugs meaning standard doses may be ineffective

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19
Q

What is included in the neurological assessment pre op?

A

Check if pt is alert/orientated
Assess pupils (only use PERRLA FOR ACCOMMODATION)
Look for any neurological deficits
Note any assistive devices used

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20
Q

What is included in the cardiac assessment pre op?

A

Ensure baseline vitals are documented
Ensure bleeding and clotting times are available in lab reports

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21
Q

What is included in the respiratory assessment pre op?

A

Note upper respiratory issues, meds, coughing, smoking history in packs
Inquire about sleep apnea
Asthmatic pts are more prone to bronchospasm and laryngospasm
Encourage smokers to quit 6 weeks prior to surgery

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22
Q

What is included in the renal assessment pre op?

A

Note history of urinary disorders, or problems voiding as most pts go into retention during surgery

Note renal function tests

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23
Q

What is included in the integumentary assessment pre op?

A

Note pre existing skin tears, ensure padding on boney prominences and that their body is in proper alignment

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24
Q

What kind of padding is used during surgery to prevent pressure injuries?

A

Big egg crate mattress (cardiac)

Moon boots or QB socks for long procedures to protect ankles

If pt has Kyphosis (excessive outward curve of spine) a doomer pad will protect their back

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25
What labs and tests should be done pre op?
Labs should be current within 2 weeks, may be extended if pt condition hasn't changed Blood type and checks for antibodies Blood should be available if needed
26
How often should the nurse teach the pt to deep breathe and cough pre op?
every hour or 2
27
When should pt take a shower before their surgery?
The night before and morning of work hibiclens (chlorhexdine gluconate) to remove bacteria from skin
28
What is included in the legal preparations in pre op?
Consent form Consent for blood transfusion Advanced directives (DNR)
28
Who is responsible for obtaining the patients signature on consent form, can nurses be apart of this
The surgeon is responsible Nurses can only be a witness
29
If the patient has more questions or is confused during prep what happens?
Prep will be stopped, and surgeon must be notified
30
In a medical emergency, what happens to consent?
Only the doctor can override the need for consent
31
Can a minor sign their own consent form?
Yes if the minor understands the treatment and its complications
32
What should the patient wear on the day of surgery?
Only a gown with no underwear unless there's an exception with proper documentation
33
What needs to be removed on the day of surgery, and where does it go?
Valuables go to hospital safe or with a family member Dentures are placed in a labelled denture cup Contacts, makeup , and nail polish are removed
34
What needs to be included in prep on the day of the surgery?
Patient needs identification and allergy bands on Pt should void right before surgery Ordered pre op meds should be administered
35
Benzodiazepines
Such as Ativan are commonly given pre op
36
Why are Atropine and Scopolamine given pre op?
To dry up oral secretions
37
Why are Morphine and Fentanyl given pre op?
For pain relief
38
If pt has history of vomiting during surgery what can be given pre op?
Antimetics like gravol or Odansetron
39
For GI surgery what med might have to be given pre op?
Antacid or Proton pump inhibitor
40
Can patients take their routine medications pre op?
Yes with 30ml of water unless a anticoagulant
41
How often should the nurse provide updates during surgery?
Every hour
42
Who transfers accountability to the OR staff?
The transferring nurse
43
What happens in the holding area?
Family says goodbye Iv lines are started, pre op meds are given, catheters are inserted, and final pt identification
44
Circulating nurse
Records all nursing care and documentation Supports scrub nurse and rest of the team
45
Scrub nurse
prepares the patient, maintains sterile asepsis, and assist surgical team
46
Surgeon
Performs procedure, reviews medical history, obtains consent, pt safety, and manages post op
47
Surgical assistant
Assist surgeon by holding retractors or equipment, general practitioner or RN
48
Registered nurse first assistant
advanced practice role involving handling instruments, tissues and sutures
49
Anesthesiologist
administers aesthetic gases, monitors vitals, manages fluids, and prescribes pre op and post op meds
50
What position should pt be in for hysterectomy, lobectomy, or brain surgery
Lithotomy Lateral High fowlers
51
For skin prep how should you manage pts hair?
Clip the hair instead of shaving to prevent infection
52
How should skin be cleansed/prepped?
Scrubbed with antimicrobial agents in a circular motion from clean to dirty
53
What is local anesthesia?
Interrupts nerve impulses causing loss of sensation but not loss of consciousness Can be topical, neubulized, ophthalmic, or injectable
54
What is general anesthesia?
Can be inhaled or through IV Causes loss of sensation and consciousness Used for long duration surgeries
55
What is regional anesthesia
Injected into the spine causing loss of sensation in a specific body region without loss of consciousness
56
What are the advantages of local and regional anesthesia?
Rapid recovery Continued post op analgesia Suitable for pts with comorbidities
57
What are the disadvantages of local and regional anesthesia?
Difficult injections Discomfort at injection site Risk of inadvertent vascular injection leading to hypotension, dysrhythmias, and seizures
58
What is the initial post op period in PACU?
Begins right after surgery and lasts until patient is discharged PACU has a high nurse to patient ratio
59
What are the immediate post op assessments
Prioritize ABCs Assess respiratory effort and ensure no airway obstruction Look our for laryngospasm Maintain BP within 20% of pre op values Administer low doses of pain meds slowly
60
What position is best for preventing aspiration?
Lateral
61
How should you warm up patient after surgery in PACU?
With warm blankets, avoid layering too many blankets has rapid warming can cause vasodilation & drop in BP
62
What does shivering increase?
Metabolic rate and blood pressure
63
How can treat vasodilation from rapid warming?
With fluid administration
64
How do you monitor surgical site in PACU?
Check for bleeding in areas like groin/chest Also check underneath the pt for pooling of blood
65
Why should you apply nasal prongs in PACU?
To aid in eliminating anesthetic gases and meet increased oxygen demands
66
What is post anaesthetic delirium?
Combativeness or restlessness as pt emerges from anaesthesia
67
How should you manage anaesthetic delirium?
Rule out other causes such as airway compromise, oxygenation and BP issues first Meds and communication can help
68
What is special about hearing in post op pts?
Last sense to fade and first to return
69
Fever is rare complication post op, how should you manage it?
Administer Acetaminophen and investigate any potential causes
70
For respiratory complications like aspiration and atelectasis how would you manage it?
Deep breathing and coughing for atelectasis Sideline or recovery position for aspiration
71
What is Ileus complication post op?
Bowel paralysis due to anesthesia Assess bowel sounds before administering fluids
72
How can should you manage hypotension?
Administer a saline bolus as per order Consider blood transfusion if there was a significant blood loss during surgery
73
How often are vitals done in PACU?
every 5 mins/first 15 mins, every 15 mins for next 30-45 mins, and every 30 mins to 60 mins until discharge
74
How often does a mild evaluation of temp need to be monitored?
Every couple hours
75
What increase temperatures may indicate atelectasis?
38 degrees Celsius
76
What should you do when your post op pt has a low grade temperature?
37 degrees C or 99 degrees F Report to surgeon as it can indicate pulmonary embolism
77
What does it mean when an elevation in temp up to 38 degrees happens after 48 hours?
Could indicate infection
78
What are the 5 W's in post op fever?
They show potential causes for fever: Wound (site infection) Wind (Atelectasis or Pneumonia) Water (UTI) Walking (DVT/PE) Waves (ECG changes, cardiac)
79
How long post op should you maintain NPO status?
Until bowel sounds return
80
What does early ambulation help with in terms of GI system?
Peristalsis and preventing ileus
81
What is the expected output post op?
1mL/kg/hr (30-40ml/hour)
82
What is target output in the first 6-8 hours post op?
at least 200ml
83
What is common on day 3 in regards to output post op?
Edema as fluid begins to shift
84
What are signs of infection in wounds?
Purelent drainage, increased temp and decreased bp
85
What does the floor nurse need to do immediately after receiving pt from PACU?
Vitals and assess ABCs
86
When pt is transferred from PACU to the floor, what is expected within 4 hours if the pt is stable?
Dangling at bedside or ambulation

MED SURG (10 decks)

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