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61 Cards in this Set
- Front
- Back
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Surgical procedures are chategorized by:
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Reason of surgery
Urgency of procedure Degree of risk Anatomical location Extent of Surgery |
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Reasons for Surgery
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Diagnostic, curative, restorative, palliative, cosmetic
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Diagnostic surgery
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determining the origin and cause of disorder or cell type
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Breast biopsy; exploratory laparotomy; arthroscopy are examples of what type of surgery
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diagnostic surgery
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laparoscopy cholesytectomy, mastectomy, hysterectomy are examples of:
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curative
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colostomy, ileostomy, nerve root resectioning, tumor debulking
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palliative surgery
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total knee rerplacement, finger implantation
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restorative surgery
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liposuction, revisionn of scars, rhinoplasty
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cosmetic surgery
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Urgency of Surgery is categorized by
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elective
urgent emergency |
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planned surgery or correction of non-acute problem
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Elective
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Requires prompt intervention; life-threatening if delayed longer than 24-48 hrs
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Urgent
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Requires immediate intervention; life threatening
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Emergent
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Urgent Surgeries include
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intestinal obstruction; bladder obstruction; kidney or uretral stones; bone fracture; eye injury; acute cholecystitis
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What type of surgery are done for gunshot/stab wounds, severe bleeding, abdominal aortic aneurysm, appendectomy
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Emergency Surgyer
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Degree of Risk of Surgery
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Minor
Major |
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Major surgeries
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high risk; its longer and more extensive than minor surgeries
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Minor Surgeries
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w/o significant risk; often can be done w/ local anesthetics
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Minor Surgeries include:
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incision and drainage, implantation of a venous access device (VAD, muscle biopsy
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Major Surgeries include:
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mitral valve replacement, pancreas replacement, lymph node dissectiton
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Extent of Surgery
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Simple: only the most overtly affected is involve in the surgery
Radical: extensive and goes beyond areas involved; directed at finding the cause |
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Ambulatory Surgery
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Outpatient, surgical centers, less invasive surgeries are done
r/t better diagnosis (endoscopy, CAT, MRI) |
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What is the Problem with Ambulatory Surgery?
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The need to teach patient alot in little time
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Benefits of Ambulatory Surgery
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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 |
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New Challenges of Ambulatory Surgery
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problem with patient that has no support system
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Assessments
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Hx and PE
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Assessment of History
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Age
Drug/substance abuse Medical Problems Cardiac Problems Pulmonary Hx Previous Surgeries Blood Donations Planning for Bloodless Surgery Discharge Planning |
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Physical Assessment/Clinical Manifestation Before Surgery:
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CV system
Respiratory system Renal/Urinary System Neurological System MS System Nutritional Status |
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Psychosocial Assessment
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determine level of anxiety, coping ability, support systems
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Laboratory Assessment
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CBC, urinalysis, H&H, creatinine, blood type and crossmatch, clotting studies, electrolyte imbalance, ABGs
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Reason for urinalysis
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detect presence of protein, glucose, blood and bacteria
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Radiographic Assessment
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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 |
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Other Diagnostic Assessment
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ECG for pt greater than 40 y/o receiving general anesthesia; for pt with cardial hx, or at risk for cardiac complication;
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What are prophylactic drugs given to pt with cardiac problem
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nitroglycerine and antibiotics
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Focused Assessments
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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
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clinical conditions that may need to be eval by md/np b4 surgery
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change in mental status, vomiting, rash, recent admin of anticoagulant meds
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Drugs commonly allowed with a sip of water
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drugs for cardiac disease, respiratory disease, seizures and antihypertensives
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Preoperative Interventions
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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 |
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Skin Prep during preop
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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 |
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Why shaving is contraversial
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predisposed to wound contamination f/ bacteria found in hair follicles; disruption of normal flora, nicks in skin
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Prepare client for Tubes, drains and vascular access
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prepare client to reduce anxiety
tubes-foley catheters, NG Drains-not painful but may cause discomfort Vascular Access-IV access |
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Postoperative Procedure teachings
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Deep breathing exercise; cough and splinting; incentive spirometer, leg procedure & exercises, early ambulation, ROM exercises
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Risk factors for DVT
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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 |
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Anxiety Interventions
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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
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Client Chart Review
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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) |
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Preoperative Client Preparation
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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 |
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Preop Medications
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meds to:
reduce anxiety and promote relaxation reduce pharyngeal secretions decrease amount of anesthetic needed for induction and maintenance of anesthesia |
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Drug selection for preop meds is base on
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clients age, physical and physiological condition, ht&wt, routine drugs
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Typical combination preop meds
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sedative/tranquilizer, opioid analgesic and anticholinergic
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Med admin of preop meds
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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 |
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Evaluated Outcomes for preop
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pt state understanding of informed consent and preop procedures
demonstrate postop exercise and techniques to prevent complication pt has reduce anxiety |
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Preop Medications
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meds to:
reduce anxiety and promote relaxation reduce pharyngeal secretions decrease amount of anesthetic needed for induction and maintenance of anesthesia |
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Drug selection for preop meds is base on
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clients age, physical and physiological condition, ht&wt, routine drugs
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Typical combination preop meds
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sedative/tranquilizer, opioid analgesic and anticholinergic
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Med admin of preop meds
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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 |
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Evaluated Outcomes for preop
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pt state understanding of informed consent and preop procedures
demonstrate postop exercise and techniques to prevent complication pt has reduce anxiety |
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Facilitating preadmission diagnostic testing and preparatio of surgical client includes:
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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 |
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Preoperative Teaching Checklist:
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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)
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Special Considerations for Older Preop Client
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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
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Facilitating preadmission diagnostic testing and preparatio of surgical client includes:
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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 |
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Preoperative Teaching Checklist:
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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)
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Special Considerations for Older Preop Client
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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
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