Chapter 3 - The Surgical Patient

Front 1

An individual who has special education and training in a given field and who meets certain competency based and ethical criteria in the vocational arena.

Back 1

ST

Front 2

ST was also described as

Back 2

A paramedical field

Front 3

The primary role of ST in rendering care to the surgical pt is:

Back 3

Related to assistance provided for a physician, establishment and protection of a sterile field, care and handling of instrumentation and assistance w/ technical task throughout the surgical procedure.

Front 4

When ST refers to the tasks they perform as:

Back 4

preoperative,
intraoperative and
postoperative

Front 5

TO KNOW:
- In facilities where ST assist w/ circulating, the ST does not perform any of the tasks related to nursing diagnosis or creation of a pt care plan.

Back 5

0

Front 6

The role of ST is to:

Back 6

- Maintain environmental awareness of surgical team and conditions affecting the pt.
- Allow the ST to better anticipate the surgeon's needs intraoperative.

Front 7

For the surgical pt, surgical intervention is a:

Back 7

Physical,
psychological,
social and
spiritual event.

Front 8

Definitions that make up an individuals:
a) Any need or activity related to genetics, physiological or anatomy.
b) Any need or activity to the identification and understanding of oneself

Back 8

a) Physical need
b) Psychological need

Front 9

c) Any need or activity related to one's identification or interaction w/ another individual or group

Back 9

c) Social need

Front 10

d) Any need of activity related to identification and understanding of one's place in an organized universe (expression may involve theology, philosophy, mythology and intuition)

Back 10

d) Spiritual need

Front 11

Establishes a means of prioritizing needs effective for basic understanding of individuals and for quick recognition of pt concern.

Back 11

Maslow's hierarchy of needs

Front 12

Common factors that results in surgical interventions are:
Factor - Example

Back 12

- Genetic malformation----------Cheiloschisis (cleft lip)
- Trauma---------Anterior cruciate ligament tear
- Nonmalignant neoplasm-------Uterine fibroid
- Malignant neoplasm------Colon cancer
- Disease-------------Cholecystitis
- Condition----------Kidney stone
- Psychological state-----------Rhytidectomy (facelift)

Front 13

Pt response to illness and hospitalizations, the two broad factors that apply to the majority of pt are:

Back 13

Adaptation and stress

Front 14

a) Can take form of physical, chemical or emotional phenomenon that causes tension.
b) It also can be divided into two categories

Back 14

a) Stress
b) Distress and eustress

Front 15

a) Is the most commonly referred to type of stress, the type has negative implication
b) Is a term for positive, desirable form of stress

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a) Distress
b) Eustress
Eu means "good" "well'.

Front 16

TO KNOW:
- Both type of stress can be equally taxing on the body and mind, but the outcome is different.

Back 16

- Example of eustress:
Illustrate a positive nature, including coming in first place during a race, receiving a promotion, getting married and have a baby.

Front 17

- Example of distress:
Is the result of perceived or real threat to the person and is characterized by particular physiologic and psychosocial behavior.

Back 17

- Individuals may vary in their reaction and tolerance to stress and one's reaction also depends on the intensity, type and duration of the stressor.

Front 18

Pt can manifest stress in several manners including:

Back 18

Loss of appetite and body weight, Change in body function including digestion, fluid and electrolytes.
Change in mental status, increase in blood pressure and heart rate and change in metabolism.

Front 19

As health deteriorates and treatments fail, a slow but steady shift takes place near the end of life and focus of care changes from:

Back 19

Cure to palliative treatment to comfort care.

Front 20

There are 3 accepted definition of death:
1 - The irreversible loss of cardiac and respiratory function, this is the permanent absence of heartbeat and respiration.

Back 20

1 - Cardiac death

Front 21

2 - This is the irreversible loss of high brain function, the lower brain stem continues to provide respiration, blood pressure and heartbeat without the assistance of a respirator.

Back 21

2 - High brain death

Front 22

3 - The irreversible loss of all functions of the entire brain, whole brain dead is the current law in most jurisdiction of the world and reflects the standard set by Harvard School of Medicine, it include a flat EEG, unresponsiveness, lack of pupil reflexes and low body temp.

Back 22

3 - Whole brain dead

Front 23

TO KNOW:
- It is important that the health care provider be sensitive to any religious or cultural practices that honor the pt in death. For example:

Back 23

- Roman Catholic ritual known as Anointing of the Sick may be performed on a seriously ill person.
- Muslin tradition might request that immediately after death to turn the pt's body to the east to face Mecca (their Holy City)

Front 24

- Catholic and Protestant are given the last rite before death.
- Jewish the dying pt (goses) should not be left alone and the nurses cannot touch the body until the Rabbi offers the final rites, after death the closely relative close the eyes and mouth.

Back 24

- Buddhist believe in reincarnation and that the last thoughts of a person before death determine the rebirth condition.
- Hindu feels that cremation is the best way for the soul to begins its journey.

Front 25

People deal w/ grief in distinct stages, these stages were introduced by Elizabeth Kubler - Ross and have become to known as the:

Back 25

Five Stages of Grief

Front 26

1 - Is the initial stage, pt cannot believe it is happening to them and may be saying such ad "It can't be happening to me"

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1 - Denial

Front 27

2 - When the first stage cannot be continued, it is replaced by feeling in what pt is asking "Why me?"

Back 27

2 - Anger

Front 28

3 - If a pt has been unable to face the reality and has gone though the stage of being angry, they may move to the stage of bargaining to postpone the inevitable, the pt may say " Just let me live to see my son's graduation"

Back 28

Bargaining

Front 29

4 - When a terminal ill person can no longer deny the illness as it progress his/her anger is replaced w/ a sense of great loss, the pt may think: " Please don't take me away from my family".

Back 29

Depression

Front 30

5 - When the pt has had enough time to work through the first four stage they will reach a stage where he/she is neither depressed nor angry, the statement of resolution may be: " I know I will be in the better place".

Back 30

Acceptance

Front 31

Any unexpected death is tragic, general categories of cause of death are:

Back 31

Accidental ( natural, MVA or homicide)
Terminal ( suffer from dz)
Prolonged - chronic ( condit. long - last more than 4 - 6 weeks) ex: asthma
Sudden ( death occurred without warning) ex: cardiac arrest or SIDS.

Front 32

Are intended to provide the pt w/ symptom relief, the avoidance of symptoms or relief from conditions secondary to the progressive local dz.

Back 32

Palliative procedure

Front 33

Refers to a set of therapies that preserves the pt's life when body system are not functioning sufficiently to sustain life.

Back 33

Life support

Front 34

Examples of life support:

Back 34

Feeding tubes
IV drips
Oral parenteral nutrition
Mechanical respiration
Heart/lungs bypass
dialysis

Front 35

Come from Greek "good death" and Americans have recast its meaning as "easy death" or "painless inducement of quick death".

Back 35

Euthanasia

Front 36

The 2 categories of Euthanasia are:
1 - Which is when the physician does nothing to preserve life.

Back 36

1 - Positive euthanasia

Front 37

2 - Which requires actions that speed the process of dying, eg. administration of morphine

Back 37

2 - Active euthanasia

Front 38

Active euthanasia is further divided into:
1 - Where the pt initiate facilitation of his/her death
2 - Where the pt's autonomous rights are violated

Back 38

1 - Voluntary euthanasia
2 - Involuntary euthanasia

Front 39

Is a general term that refers to one of two legal document used to speak for the pt in the event that they cannot make a decision for themselves

Back 39

Advance directives

Front 40

Allows the pt to state in writing to endure to sustain life

Back 40

Living will

Front 41

1 - DNR
2 - DRI

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1 - Do not resuscitate
2 - Do not intubate

Front 42

TO KNOW:
Prioritizing needs: Maslow's hierarchy
- The developmental stages for human progression are expressed in terms of a hierarchy.

Back 42

- The progressive steps are:
Safety
Love and belonging
Esteem

Front 43

1 - The most basic needs are biological needs like water, oxygen, food and temp regulation
2 - These needs refers to the perception on the part of the individual that his/her environment is safe.

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1 - Physiological needs
2 - Safety needs

Front 44

3 - These are basic social needs, to known and care for as an individual and to care for another
4 - This level refers to a positive evaluation of oneself and others, a need to be respected and respect others

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3 - Love and belonging needs
4 - Esteem needs

Front 45

5 - This is the need to fulfill what one believes on one's purpose

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5 - Self - actualization

Front 46

The hierarchy is especially important in the field of health care, the nature of surgery requires that the surgical team concentrate on:

Back 46

Physiological needs first - followed by:
Environmental
Affective,
Self - esteem and
Self - actualization needs