Exam 1 Ch 30

phases of perioperative period

preoperative, intraoperative, postoperative

preoperative

begins with decision to have surgery and lasts until patients is tranfserred to operating room

intraoperative

extends from admission to surgical dept to transfer to recovery room,

postoperative

lasts from admission to recovery room to complete recovery from surger and last follow-up physician visit

AORN

association of operating room nurses

classification of surgical procedures

urgency, risk, purpose

elective surgery

(ex: tonsilectomy) delay of surgery has no ill effects; can be scheduled in advance based on patient's choice

emergency surgery

done immediately (ex: control of hemorrhage)

minor risk surgery

primarily elective (ex: tooth extraction)

ablative surgery

remove diseased body part (ex: appendectomy)

diagnostic surgery

to make or confirm diagnosis (ex: biopsy)

palliative surgery

to relieve or reduce intensity of illnes but not curative (ex: colostomy)

constructive surgery

restore function in congenital anomalies (ex: cleft palate)

reconstrucitve surgery

to restore function to traumatized or malfunctioning tissue (ex: breast augmentation)

urgent surgery

usually done within 24-48 hrs (exL removal of gallbladder)

transplantation surgery

to replace organs or structures that are diseased or malfunctioning (ex: heart, kidney)

types of anesthesia

general, regional, topical and local, moderate sedation/analgesia

general anesthesia

administration of drugs by inhalation or intravenous route, patient needs respiratory/intravenous support

regional anesthesia

anesthetic agent injected near a nerve or nerve pathway or around operative site, patient is awake (ex: epidural)

topical and local anesthesia

used on mucous membranes, open skin, wounds, burns

moderate sedation/analgesia

used for short term, minimally invasive procedures

3 phases of general anesthesia

induction, maintenance, emergence

induction phase

from administration of anesthesia to ready for incision

maintenence phase

from incision to near completion of procedure

emergence phase

starts when patient emerges from anesthesia and is ready to leave operating room

states of anesthesia

loss of consciousness, analgesia, relaxation, loss of reflexes

types of regional anesthesia

nerve blocks, spinal anesthesia, caudal and epidural anesthesia

informed consent info

description of procedure & alternative therapies, underlying disease process & natural course, name & qualification of person performing procedure, explanation of risks and how often they occur, explanation that patient has right to refuse treatment or wi

advance directives

living wills, durable power of attorney for healthcare

outpatient/same-day surgery

reduces length of hospital stay, cut costs, reduces stress for patient, may acquire additonal teaching and home care services

outcomes for surgical patient

be free from injury, be free from infection & DVT, maintain fluid and electrolyte balance, skin integrity, normal temperature, have pain managed, participate in rehab process, demonstrate understanding of physiologic and psychologic responses to surgery

DVT

deep vein thrombosis- blood clot

patient risk factors and strengths

age, medical history, medications, previous surgeries, nutritional status, use of alcohol/illicit drugs/nicotine, activities of daily living and occupation, coping patterns and support systems, sociocultural needs

anticoagulants

precipitate hemorrhage

diuretics

electrolyte imbalance, respiratory depression from anesthesia

tranquilizers

increase hypointensive effects of anesthetic agents

adrenal steroids

abrupt withdrawal may cause cardiovascular collapse

antibiotics in mycin group

respiratory paralysis when combined with certain muscle relaxants

oral antidiabetic medications

may react with radiologic iodinized contrast dyes and causes acute renal failure

presurgical screening tests

chest x-ray, electrocardiopgraphy, complete white blood count, electrolyte levels, urinalysis

nurse role in presurgical testing

ensure tests are explained to patient, ensure results are recorded in patient records, ensure abnormal results are reported

nurse preparing patient through teaching

surgical events and sensations, pain management, phys activities, deep breathing, coughing, incentive spirometry, leg exercises, turning in bed- explained to patient

nursing interventions for surgical patients

hygiene and skin prep, elimination, nutrition and fluids, rest and sleep

typical preopoperative meds

sedatives, anticholinergics, narcotic analgesics, neuroleptanalgesic agents, histamine receptor antihistamines

anticholinergics

pulmonary drying, prevent or dry secretions

narcotic analgesics

facilitate anesthesia

neuroleptanalgesic agents

calmness in patient

histamine recpetor antihistamines

decrease gastric/reflux activity

post-op assessments

vital signs, oxygen saturation, color & temp of skin, level of consciousness, IV fluids, surgical site, other tubes, comfort, position and safety

A and O x3

do they know who they are, where they are, and time?

return of consciousness

unconscious, response to touch and sounds, drowsiness, awake but not oriented, awake and oriented

cardiovascular complications

hemorrhage, shock, DVT, pulmonary embolus (clot in lungs)

interventions to prevent respiratory complications

monitor vital signs, implement deep breathing, coughing, incentive spirometry, turning in bed every 2 hrs, ambulating, maintaining hydration, avoid positioning that decreases ventilation, monitoring responses to narcotic analgesics