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61 Cards in this Set

  • Front
  • Back
Surgical procedures are chategorized by:
Reason of surgery
Urgency of procedure
Degree of risk
Anatomical location
Extent of Surgery
Reasons for Surgery
Diagnostic, curative, restorative, palliative, cosmetic
Diagnostic surgery
determining the origin and cause of disorder or cell type
Breast biopsy; exploratory laparotomy; arthroscopy are examples of what type of surgery
diagnostic surgery
laparoscopy cholesytectomy, mastectomy, hysterectomy are examples of:
curative
colostomy, ileostomy, nerve root resectioning, tumor debulking
palliative surgery
total knee rerplacement, finger implantation
restorative surgery
liposuction, revisionn of scars, rhinoplasty
cosmetic surgery
Urgency of Surgery is categorized by
elective
urgent
emergency
planned surgery or correction of non-acute problem
Elective
Requires prompt intervention; life-threatening if delayed longer than 24-48 hrs
Urgent
Requires immediate intervention; life threatening
Emergent
Urgent Surgeries include
intestinal obstruction; bladder obstruction; kidney or uretral stones; bone fracture; eye injury; acute cholecystitis
What type of surgery are done for gunshot/stab wounds, severe bleeding, abdominal aortic aneurysm, appendectomy
Emergency Surgyer
Degree of Risk of Surgery
Minor
Major
Major surgeries
high risk; its longer and more extensive than minor surgeries
Minor Surgeries
w/o significant risk; often can be done w/ local anesthetics
Minor Surgeries include:
incision and drainage, implantation of a venous access device (VAD, muscle biopsy
Major Surgeries include:
mitral valve replacement, pancreas replacement, lymph node dissectiton
Extent of Surgery
Simple: only the most overtly affected is involve in the surgery
Radical: extensive and goes beyond areas involved; directed at finding the cause
Ambulatory Surgery
Outpatient, surgical centers, less invasive surgeries are done
r/t better diagnosis (endoscopy, CAT, MRI)
What is the Problem with Ambulatory Surgery?
The need to teach patient alot in little time
Benefits of Ambulatory Surgery
Anesthetics metabolize fast with fewer s/e allowing shorter operative times
recognize early ambulation
ENC to assume active role in recovery
cost savings in hospital stay
decrease rease for nosocomial infection
return home same day
New Challenges of Ambulatory Surgery
problem with patient that has no support system
Assessments
Hx and PE
Assessment of History
Age
Drug/substance abuse
Medical Problems
Cardiac Problems
Pulmonary Hx
Previous Surgeries
Blood Donations
Planning for Bloodless Surgery
Discharge Planning
Physical Assessment/Clinical Manifestation Before Surgery:
CV system
Respiratory system
Renal/Urinary System
Neurological System
MS System
Nutritional Status
Psychosocial Assessment
determine level of anxiety, coping ability, support systems
Laboratory Assessment
CBC, urinalysis, H&H, creatinine, blood type and crossmatch, clotting studies, electrolyte imbalance, ABGs
Reason for urinalysis
detect presence of protein, glucose, blood and bacteria
Radiographic Assessment
check size and shape of heart, lungs and major blood vessels
data is used by anesthesiologist to determine type of anesthetics used
base on client needs, medical history and surgical procedure
Other Diagnostic Assessment
ECG for pt greater than 40 y/o receiving general anesthesia; for pt with cardial hx, or at risk for cardiac complication;
What are prophylactic drugs given to pt with cardiac problem
nitroglycerine and antibiotics
Focused Assessments
Cardiopulmonary, s/s of infections, s/s that could contraindicate surgery, assess for and report other clinical conditions that may need to eval by md/np b4 surgery
clinical conditions that may need to be eval by md/np b4 surgery
change in mental status, vomiting, rash, recent admin of anticoagulant meds
Drugs commonly allowed with a sip of water
drugs for cardiac disease, respiratory disease, seizures and antihypertensives
Preoperative Interventions
Teaching
Signed informed concent
Dietary restrictions/NPO
check regularly scheduled meds
Intestinal prep
Skin prep (1st step in preventing surgical wound infection)
Prep client for tubes, drains and vascular access
teaching about postop procedures
Skin Prep during preop
1st step in preventing surgical wound infection; 1-2 days b4 surgery surgeon may order for client to shower using antiseptic soap
reduces contamination of surgical site
then covered w/ sterile towel or drapes
Shaving surgical site-controversial
Why shaving is contraversial
predisposed to wound contamination f/ bacteria found in hair follicles; disruption of normal flora, nicks in skin
Prepare client for Tubes, drains and vascular access
prepare client to reduce anxiety
tubes-foley catheters, NG
Drains-not painful but may cause discomfort
Vascular Access-IV access
Postoperative Procedure teachings
Deep breathing exercise; cough and splinting; incentive spirometer, leg procedure & exercises, early ambulation, ROM exercises
Risk factors for DVT
age greater than 40
obese
cancer
decreased mobility or immobile
hx of DVT, PE and vericose veins or edema
taking oral contraceptives
smoke
decrease CO
fracture
undergoing pelvic surgery
Anxiety Interventions
teaching, communicating w/ clt before surgery, enabling the clit to use previosly successful coping mechanism, admin antianxiety meds, incorporate available support system in plan of care; preop teaching, enc communication, promote rest, using distraction, teaching family and significant others
Client Chart Review
ensure all documentation, preop procedures and orders are completed
check:
signed inform consent w/ 2 signatures
schedule procedure
ID of left vs right
have client mark the correct area
allergies
ht and wt
lab/diagnostic test/x-ray/ECG
autologous blood donor/direct blood donor
current VS
significant physical/psychosocial observation
special needs (Advance direct)
Preoperative Client Preparation
hospital gown in OR
underwear may be worn in above the waist surgery
socks unless foot/leg surgery
AE hose if prescribed
personal belonging given to family or held in hospital safe
ID band
allergy band
blood type band
remove dentures, prosthetics, hairpins and clips
ask client to empty bladder
Preop Medications
meds to:
reduce anxiety and promote relaxation
reduce pharyngeal secretions
decrease amount of anesthetic needed for induction and maintenance of anesthesia
Drug selection for preop meds is base on
clients age, physical and physiological condition, ht&wt, routine drugs
Typical combination preop meds
sedative/tranquilizer, opioid analgesic and anticholinergic
Med admin of preop meds
preop drugs are often given "on call" commonly given after the clt is transfered to OR;
after check for ID and admin
advise pt to stay in bed
side rails up and call light w/in reach
Evaluated Outcomes for preop
pt state understanding of informed consent and preop procedures
demonstrate postop exercise and techniques to prevent complication
pt has reduce anxiety
Preop Medications
meds to:
reduce anxiety and promote relaxation
reduce pharyngeal secretions
decrease amount of anesthetic needed for induction and maintenance of anesthesia
Drug selection for preop meds is base on
clients age, physical and physiological condition, ht&wt, routine drugs
Typical combination preop meds
sedative/tranquilizer, opioid analgesic and anticholinergic
Med admin of preop meds
preop drugs are often given "on call" commonly given after the clt is transfered to OR;
after check for ID and admin
advise pt to stay in bed
side rails up and call light w/in reach
Evaluated Outcomes for preop
pt state understanding of informed consent and preop procedures
demonstrate postop exercise and techniques to prevent complication
pt has reduce anxiety
Facilitating preadmission diagnostic testing and preparatio of surgical client includes:
review planned surgery
obt client hx
complete PE
describe and explain preadmissioni tx and diagnostic test
Interpret diagnostic test result as appropriate
determin client's expectation about the surgery
Provide the time for the cliet and significant other to ask questions
discuss postop DC plans
determine ability of caretakers
Preoperative Teaching Checklist:
fears and anxieties; surgical procedures; preop routines(NPO, enemas, blood samples, showering); invasive procedures(tubes, drains, lines); postop procedures (deep-breathing, IS, leg exercises,splinting, early ambulation, pain mgmt)
Special Considerations for Older Preop Client
greater incidence of chronic illness, malnutrition, more allergies, impaired self-care capabilities, inadequate support system, decrease ability to withstand stress of surgery and anesthesia, increased risk for cardiopulmonary complications; risk for change in mental status when admitted; risk for fall and resultant injury
Facilitating preadmission diagnostic testing and preparatio of surgical client includes:
review planned surgery
obt client hx
complete PE
describe and explain preadmissioni tx and diagnostic test
Interpret diagnostic test result as appropriate
determin client's expectation about the surgery
Provide the time for the cliet and significant other to ask questions
discuss postop DC plans
determine ability of caretakers
Preoperative Teaching Checklist:
fears and anxieties; surgical procedures; preop routines(NPO, enemas, blood samples, showering); invasive procedures(tubes, drains, lines); postop procedures (deep-breathing, IS, leg exercises,splinting, early ambulation, pain mgmt)
Special Considerations for Older Preop Client
greater incidence of chronic illness, malnutrition, more allergies, impaired self-care capabilities, inadequate support system, decrease ability to withstand stress of surgery and anesthesia, increased risk for cardiopulmonary complications; risk for change in mental status when admitted; risk for fall and resultant injury