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78 Cards in this Set
- Front
- Back
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Surgery is...
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The branch of medicine concerned with diseases and trauma requiring operative procedures
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In regards to the classification of surgical procedures, Seriousness is separated into...
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major and minor
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Major Surgical Procedures Involve...
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Extensive reconstruction of or alteration in body parts
Examples: Coronary artery bypass, gastric resection |
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Minor Surgical Procedures involve...
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Minimal alteration in body parts
Examples: Cataracts, tooth extraction |
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In regards to the classification of surgical procedures, Urgency
is separated into.. |
Elective, Urgent, Emergency
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Elective surgical procedures involve...
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Patient’s choice
Example: Plastic surgery |
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Urgent Surgical procedures involve...
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Necessary for patient’s health
Examples: Excision of tumor, gallstones |
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Emergency Surgical procedures involve...
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Must be done immediately to save life or preserve function
Example: Control of hemorrhage |
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The 6 purposes of Surgical procedures are...
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diagnostic, ablation, pallative, reconstructive, transplant, constructive
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In regards to the purposes of surgical procedures, diagnostic purpose involves.
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Confirm diagnosis
Example: Exploratory laparotomy |
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In regards to the purposes of surgical procedures, Ablation
purpose involves... |
Excision or removal of diseased body part or removal of a growth or harmful substance
Examples: Amputation, cholecystectomy |
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In regards to the purposes of surgical procedures, palliative
purpose involves... |
Relieves or reduces intensity of disease symptoms
Example: Colostomy |
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In regards to the purposes of surgical procedures, reconstructive
purpose involves... |
Restores function or appearance to traumatized or malfunctioning tissue
Example: Internal fixation of fractures |
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In regards to the purposes of surgical procedures, transplant
purpose involves... |
Replaces malfunctioning organs or structures
Examples: Kidney, cornea |
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In regards to the purposes of surgical procedures, constructive
purpose involves... |
Restores function lost or reduced as result of congenital anomalies
Example: Repair of cleft palate ( Table 42-1, page 1263 shows classification for surgical procedures w/ descriptions & examples) |
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ORIF stands for...
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Open Reduction Internal fixation
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Perioperative Nursing is...
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Entire operative process which includes:
Preoperative Intraoperative Postoperative |
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What are influencing factors with Perioperative Nursing?
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Age, Physical condition, Nutritional factors,
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In regards to influencing factors with perioperative nursing, what does age involve?
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Young and older patients’ metabolic needs such as temperature changes, cardiovascular shifts, respiratory needs, and renal function, may not respond to physiological changes quickly (page 1265…older adult considerations)
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In regards to influencing factors with perioperative nursing, what does Physical condition involve?
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Healthy patients
Coexisting health problems |
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In regards to influencing factors with perioperative nursing, what does Nutritional Factors involve?
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Carbohydrates and fat—energy producers
Proteins—build and repair (Page 1265, Box 42-3 – ABCDE Mnemonic device to ascertain serious illness or trauma in the preoperative patient) |
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In regards to perioperative nursing, what are the Psychosocial needs?
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Fear of loss of control (anesthesia)
Fear of the unknown (outcome, lack of knowledge) Fear of anesthesia (waking up) Fear of pain (pain control) Fear of death (surgery, anesthesia) Fear of separation (support group) Fear of disruption of life patterns (ADLs, work) Fear of detection of cancer |
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In regards to perioperative nursing, what are the Socioeconomic and cultural needs?
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Social
Economic Religious Ethnic Cultural (page 1266…cultural & ethnic considerations) |
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In regards to perioperative nursing, what is involved in Education and experience?
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Age
Life experiences Educational level (page 1267, Table 42-3…preoperative considerations for commonly ingested herbs |
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In regards to the Preoperative phase, what is involved with Preoperative teaching?
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Include patient and family
1-2 days before surgery Clarify preoperative and postoperative events Surgical procedure Informed consent Skin preparation Gastrointestinal cleanser Time of surgery Area to be transferred, if applicable Frequent vital signs Dressings, equipment, etc. Turning, coughing, and deep-breathing exercises Pain medication (prn) |
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In regards to preoperative preparation, what do Laboratory tests involve?
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Urinalysis
Complete blood count Blood chemistry profile Endocrine, hepatic, renal, and cardiovascular function Electrolytes |
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In regards to preoperative preparation, what does diagnostic imaging involve?
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Chest x-ray
Electrocardiogram |
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In regards to the preoperative phase, what does obtaining an informed consent involve?
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Competent
Mentally able to understand Should not be under the influence of pain medications Agrees to the procedure Information clear Risks explained Benefits identified Consequences understood Alternatives discussed Ability to understand (language, disabilities) |
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In regards to Gastrointestinal Preparation during the preoperative phase, what may be considered when NPO after midnight?
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Sign on door and over bed
May have oral care Moist cloth to lips |
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In regards to Gastrointestinal Preparation during the preoperative phase, what may be used as a bowel cleanser?
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Enema
Laxative GI lavage (GoLYTELY) Medication to detoxify and sterilize bowel |
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In regards to the preoperative stage, what is involved in skin preparation?
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Removal of hair
Assess for skin impairment Infection Irritation Bruises Lesions Scrub with detergent and antiseptic solution applied (Hibiclens and Betadine |
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In regards to respiratory preparation during the preoperative phase, why is incentive spirometry used?
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Prevent or treat atelectasis
Improve lung expansion Improve oxygenation Prevent post-op pneumonia |
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In regards to respiratory preparation during the preoperative phase, what is involved during the routine Turn, cough, and deep-breathing exercises?
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At least every 2 hours
Turn from side-to-back-to-side 2-3 deep breaths Cough 2-3 times (splint abdomen if needed) Contraindicated: surgeries involving intracranial, eye, ear, nose, throat, or spinal) |
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What are Cardiovascular considerations during the preoperative phase?
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Prevents thrombus, embolus, and infarct
Leg exercises (page 1278) Antiembolism stockings (TEDS) (pages 1279-1280) Sequential compression devices (page 1281 |
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Explain vital signs during the preoperative phase.
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Blood pressure, temperature, pulse, and respiration
Frequency depends on hospital and physician protocol and stability of patient Needed for baseline to compare with postoperative vital signs |
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What are Genitourinary concerns during the preoperative phase?
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Normal bladder habits
Instruct patient about postoperative palpation of bladder (page 1281, figure 42-6) Urinary catheter may be inserted |
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In regards to Pain during the properative phase, what is Nontraditional analgesia?
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Imagery
Biofeedback Relaxation |
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In regards to Pain during the properative phase, what is Traditional analgesia?
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Intermittent injections
Patient-controlled analgesia (PCA) Epidural Oral analgesics (when oral intake allowed) |
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In the preoperative phase, what is the nurses responsibility regarding Tubes?
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Teach patient about possibility of tubes
Nasogastric tubes Wound evacuation units IV Oxygen |
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What preoperative medicine will reduce anxiety?
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Valium, Versed
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What preoperative medicine decreases anesthetic need?
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Valium
meperidine morphine |
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What preoperative medicine Reduces respiratory tract secretions?
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Anticholinergics—atropine
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What are some safety measures that should be used if properative medication is given on the nursing unit?
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Bed in low position and side rails up
Monitor every 15-30 minutes |
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Explain General anesthesia.
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Analgesia, amnesia, muscle relaxation, and unconsciousness occur
Inhalation, oral, rectal, or parenteral routes |
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Explain Regional anesthesia.
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Renders only a specific region of the body insensitive to pain
Nerve block, spinal, or epidural anesthesia |
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Explain Local anesthesia.
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Topical application or infiltration into tissues of an anesthetic agent that disrupts sensation at the level of the nerve endings
Immediate area of application |
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The Preoperative Checklist includes...
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Permits signed and on chart
Allergies ID band(s) on patient Skin prep done Removal of dentures, glasses/contacts, jewelry, nail polish, hairpins, makeup TED stockings applied Preoperative vital signs Preoperative medications Physical disabilities and/or diseases History and physical and lab reports on char |
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What is involved when transporting the patient to the operating roon?
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Compare patient’s ID bracelet to the medical record
Assist patient to stretcher Direct family to appropriate waiting area |
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Preparing for the postoperative patient involves...
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Sphygmomanometer, stethoscope, and thermometer
Emesis basin Clean gown, washcloth, towel, and tissues IV pole and pump Suction equipment Oxygen equipment Extra pillows and bed pads PCA pump, as needed |
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During the Intraoperative Phase, what is the holding area?
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Preanesthesia care unit
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What will be the preoperative preparations In the Preanesthesia care unit during the intraoperative phase?
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IV
Preoperative medications Skin prep (hair removal) |
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What are the roles of the circulating nurse during the intraoperative phase?
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Prepares equipment and supplies
Arranges supplies—sterile and non-sterile Sends for patient Visits with patient preoperatively: verifies operative permit (op) permit, identifies patient, and answers questions Performs patient assessment Checks medical record Assists in transfer of patient Positions patient on operating table Counts sponges, needles, and instruments before surgery Assists scrub nurse in arranging tables for sterile field Maintains continuous astute observations during surgery to anticipate needs of patient, scrub nurse, surgeon, and anesthesiologist Provides supplies to scrub nurse as needed Observes sterile field closely Cares for surgical specimens Documents operative record and nurse’s notes Counts sponges, needles, and instruments when closure of wound begins Transfers patient to the stretcher for transport to recovery area Must be careful to slowly change patient’s position to prevent hypotension Accompanies patient to the recovery room and provides a report |
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What are the roles of the scrub nurse during the intraoperative phase?
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Performs surgical hand scrub
Dons sterile gown and gloves aseptically Arranges sterile supplies and instruments Checks instruments for proper functioning Counts sponges, needles, and instruments with circulating nurse Gowns and gloves surgeons as they enter operating room Assists with surgical draping Maintains neat and orderly sterile field Corrects breaks in aseptic technique Observes progress of surgical procedure Hands surgeon instruments, sponges, and necessary supplies during procedure Identifies and handles surgical specimens correctly Maintains count of sponges, needles, and instruments so none will be misplaced or lost |
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What is the role of the nurse during the immediate postoperative phase in the postanesthesia care unit?
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Vital signs checked every 15 minutes
Respiratory and GI function monitored Wound evaluated for drainage and exudate Pain medication given as needed Transfer to nursing unit must be approved by the anesthesiologist or surgeon |
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What is the role of the nurse during the later postoperative phase in the nursing unit?
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Immediate assessments
Vital signs IV Incisional sites Tubes Postoperative orders Body system assessment Side rails up Call light in reach Position on side or HOB up 45 degrees Emesis basin at bedside Note amount and appearance of emesis NPO until ordered and patient is fully awake Assess for signs and symptoms of shock |
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In regards to incisions, what is the nurses role in the postoperative phase when caring for dressings?
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Reinforce for first 24 hours
Circle the drainage and write date and time |
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In regards to incisions during the postoperative phase, what is Dehiscence?
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Separation of a surgical wound
3 days to 2 weeks postoperatively Sutures pull loose |
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In regards to incisions during the postoperative phase, what is Evisceration?
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Protrusion of an internal organ through a wound or surgical incision
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In regards to incisions during the postoperative phase, what are Nursing interventions for dehiscence or evisceration?
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Cover with a sterile towel moistened with sterile saline
Have patient flex knees slightly and put in Fowler’s position Contact the physician |
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Prevention of atelectasis and pneumonia involves...
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Turn, cough, and deep-breathe every 2 hours
Analgesics Early mobility Frequent positioning |
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During the postoperative phase, nurses should monitor for signs and symptoms of pulmonary embolism which include...
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sudden chest pain, dyspnea, tachycardia, cyanosis, diaphoresis, and hypotension
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Nursing interventions for a pulmonary embolism include...
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HOB up 45 degrees, O2, notify physician
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In regards to pain during the later postoperative phase, what is the nurses role when administering analgesics?
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Offer every 3-4 hours
Acute pain—first 24-48 hours Intermittent injections Patient-controlled analgesia (PCA) Epidural Oral analgesics (when oral intake allowed) |
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What comfort measures should be taken during the postoperative phase?
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Decrease external stimuli
Reduce interruptions and eliminate odors |
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Describe pain assessment during the postoperative phase.
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Subjective: The patient’s description of discomfort (scale of 1 to 10)
Objective: Detectable signs of pain (restlessness, moaning, grimacing, diaphoresis, vital sign changes, pallor, guarding area of pain) |
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Explain TENS unit during the postoperative phase.
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Applies electrical impulses to the nerve endings and blocks transmission of pain signals
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What is the nurses role in regards to urinary function during the postoperative phase?
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Assess every 2 hours for distention
Report no urine output after 8 hours Use measures to promote urination: Monitor for accurate intake and output 30 ml per hour minimum |
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What are measures used to promote urination during the postoperative stage?
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Running water
Hands in warm water Ambulate to bathroom Males stand to void |
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What is venous stasis?
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Normal flow of blood through the vessels is slowed
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What is involved during assessment of venous stasis?
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Palpate pedal pulses and note skin color and temperature
Assess for edema, aching, cramping in the calf Homans’ sign |
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What is involved during the prevention of venous stasis?
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Leg exercises every 2 hours
Antiembolism stockings (TEDS) Sequential compression devices (SCD) |
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What are the effects of early postoperative ambulation?
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Increased circulation, rate and depth of breathing, urination, metabolism, peristalsis
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What are nursing interventions in regards to activity during the later postoperative phase?
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Encourage muscle-strengthening exercises
Dangling Two people to assist with ambulation |
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What is Paralytic ileus?
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A decrease or absence of peristalsis which can be R/L to:
Rest intestine Nasogastric tube Measure abdominal girth Encourage activity |
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How long will it take for bowel activity to return postoperation?
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3-4 days
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What are Singultus (hiccups)?
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Involuntary contraction of the diaphragm followed by rapid closure of the glottis
Irritation of the phrenic nerve Causes could be abdominal distention or internal bleeding |
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Monitoring Fluid and electrolyte loss during the postoperative phase involves...
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Fluid loss during surgery
Blood Insensible (lungs and skin) Sodium and potassium depletion Blood loss Body fluid loss (vomiting, NG tube, etc.) Catabolism (tissue breakdown from severe trauma or crush injuries) |
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What are Nursing interventions in regards to fluid and electrolyte loss during the postoperative phase?
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Monitor electrolyte values
Monitor intake and output Maintain IV therapy Assess IV for patency and rate, erythema, edema, heat, and pain When oral fluids are ordered, encourage small amounts frequently, encourage 2000-2400 ml per 24 hours, avoid iced and carbonated beverages Use antiemetics as ordered, if needed |
