a method and technique of making potentially uncomfortable interventions tolerable and safe
anesthesia
collapse of lung
atelectasis
separation of the layers of a surgical wound
dehiscence
protusion of viscera through an incision
evisceration
to insert a tube into a hollow organ or body passage
intubation
nonmechanical obstruction of the bowel from paralysis of the bowel wall, usually as a result of localized or generalized periotonitis or shock
paralytic ileus
method of controlling pain that involes an infusion pump that holds a vial of an IV analgesic that the patient controls and self-administers in small doses
Patient-controlled analgesia (PCA)
recovery room
postanesthesia care unit (PACU)
the process of joining two surfaces or edges together along a line by or as if by sewing
suture
Famotidine/Pepcid
Pre-op antacids: H-2 receptor antagonist
- Healing and prevention of ulcers.
- ? symptoms of gastroesphageal reflux.
- ?secretion of gastric acid.
Pantoprazole/Protonix
Pre-op antacids: Proton-pump inhibitors
- Diminished accumulation of acid in the gastric lumen, with lessened acid reflux.
- Healing of duodenal ulcers and esophagitis.
- Decreased acid secretion in hypersecretory conditions.
Fentanyl/Sublimaze
Morphine Sulfate/Morphine
Hydromorphone/Dilaudid
Meperidine /Demerol
Analgesics: Opioid agonist analgesic
- Decrease in severity of pain.
Ondansetron/Zofran
Dolasetron /Anzemet
Antiemetics: Serotonin 5HT3 receptor blocker
Decreased incidence and severity of nausea and vomiting following chemotherapy or surgery
Promethazine/Phenergan
Prochlorperazine/Compazine
-Antiemetics: Block H1 and dopamine receptors
- Diminished nausea and vomiting.
- Diminished signs and symptoms of psychoses or anxiety
metoclopramide/Reglan
Antiemetics: Dopaminergic blocker GI motility stimulant
- Decreased nausea and vomiting.
- Decreased symptoms of gastric stasis.
- Easier passage of nasogastric tube into small bowel.
Scopalomine hydrobromide/Transderm Scop
Antiemetics: Anticholinergic
- Reduction of nausea and vomiting.
- Preoperative amnesia and decreased secretions.
- Reduction of spams.
Midazolam/Versed
Lorazepam/Ativan
Diazepam/Valium
Antianxiety: Benzodiazepine
Short-term sedation. Postoperative amnesia.
Surgery: who needs it?
1. Diagnostic/explorative: ex. Biopsy determines origin of presenting symptoms and extent of disease process
2. Reconst/cosmetic: ex: correct a disease process or improve cosmetic appearance such as arthroplasty, rhinoplasty, mammoplasty
3. Curative: repa
Methods to classify surgery.
Urgency
-Emergency means immediately
-Urgent usually within 24-48 hours
-Elective usually scheduled by choice
Degree of risk
-Major usually to preserve life, restore function, improve/maintain health
-Minor usually elective, may be to restore function, co
What does the 'perioperative period' include?
1. Preoperative phase
Begins with decision to have surgery, last until patient is transferred to operating room
2. Intraoperative phase
Extends from admission to surgical department to transfer to recovery room
3. Postoperative phase
Last from admission t
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What's included in the health history?
**
Looking for information specific to surgical experience
1. Developmental: infants/elderly greater risk of having complications; more fragile. Infants less blood volume, difficulty keeping warm, renal/hepatic systems not fully developed...decreased metabol
Included in a health history....
3. Herbs
Dan shen - antibacterial may cause bleeding
- Echinacea Tx cold may interferes with immunosuppressant and impair wound healing - Ephedra wt loss - causes sinus congestion may cause cardiovascular problems - Ginko may cause bleeding
4. ETOH, smoke
Pre-surgical screening/tests
U/A
CBC
BMP
PT/PTT
CXR
EKG
hCG
Baseline VS
HT/WT
For healthy patients undergoing elective surgery, require a complete history and physical examination, but no routine preoperative tests unless they fall into the following categories
Obtain hemoglobin leve
For patients that have underlying health problems usual laboratory and diagnostic tests order include:
-Electrolytes, creatinine, blood sugar, liver enzymes, urinalysis, fecal occult blood, EKG, CXR, coagulation studies, blood type and screen or crossmatch
-These tests will vary according to the patients underlying disorder
Pre-op Teaching: Why do we do it?
1. Patient education and emotional support have a positive effect on patient outcomes physically and psychologically
2. Surgical patients receiving preoperative education and/or supportive intervention resulted in:
- decreased pain and anxiety
- experienc
What is included in the pre-op teaching?
Diagnostic tests
Limitations on eating/drinking before surgery
List allergies and medications currently taking
Instruct to stop any meds per MD...ex. Coumadin
Notify surgeon of infection/cold before surgery
Bowel preps, betadine scrubs
Instruct pt. to lea
What do we teach for the preoperative teaching?
1.What to expect when going to sleep and waking up: questions the patient should prepare for the anesthesiologist
2. Anticipated postoperative routine, devices such as drains or equipment, oxygen, dressings, splints, special positioning, restrictions, amb
A nurse is reviewing results of preoperative screening test and notes the patient's PT (prothrombin time) is very elevated. What should the nurse do next?
A. Nothing; an elevated PT is not going to affect the surgical outcome.
B. Document the data and not
B. Document the data and notify the physician who will do the surgery
Which of the following interventions is of major importance during preoperative teaching?
A. Ensure the patient has adequate breakfast the morning of surgery
B. Encouraging the patient to identify and verbalize fears
C. Discussing the site and extent of t
C. Discussing the site and extent of the surgical incision
What is informed consent?
It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.
What is included in an informed consent?
Description of procedure and alternative therapies
Underlying disease process and its natural courses
Names and qualification of person performing procedure
Explanation of the risks/benefits and how often they occur
Explanation that patient has the right
Who obtains the infomed consent?
the physician performing the procedure.
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Who can witness a patient's signature?
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Anyone.
If the nurse witnessess, the responisiblity of that nurse is to make sure the patient understands what's going on.
What is the nursing role for the day of surgery?
1. Review health hx.
3. Go over preop checklist: NPO, no dentures, hearing aids, voided, IV access, allergies (meds/latex), current VS/BS, autologus blood available...
4. Medications in pre-op area ex: Versed (midazolam), Pepcid (famotidine), Zofran (onda
What are some sociocultural factors of surgery?
1. Perception/reaction to the surgical experience influenced by cultural/ethnic background, family beliefs
2. Reaction to pain varies by culture
3. Language barriers may influence experience
4. Family dynamics may influence experience
5. Cultural variatio
A 40 year old female is having a right mastectomy. She is currently taking 1 baby Aspirin a day for prophylactic reasons and is allergic to latex; otherwise she is healthy. You observe her fidgeting with her admission papers and is expressing anxiety rega
C) Make all OR personnel aware of latex allergy and check all package labels for latex
Your patient is scheduled for liposuction surgery to reduce her weight. Based on urgency, how is this surgery classified:
A) Urgent
B) Elective
C) Emergency
D) Futile
B) Elective
A nurse has been asked to obtain informed consent for a surgical procedure. What is the role of the nurse?
A) Securing informed consent from the patient
B) Act as a patient advocate in ensuring patient questions are answered
C) Ensuring the patient does n
B) Act as a patient advocate in ensuring patient questions are answered
A patient, scheduled for open-heart surgery, tells the nurse he does not want to be "saved" if he dies during surgery. What should the nurse do next?
A) Discuss with surgeon and document the wishes of the patient and family
B) Administer the ordered oral
A) Discuss with surgeon and document the wishes of the patient and family
Who is included on the intraoperative team?
Scrub nurse
Circulating nurse
Surgeon
Anesthesiologist
Nurse anesthestist/physicians assistant
Scrub tech/anesthesia tech
What is the intraoperative nurse's role?
Meet/assess pt. just prior to surgery; review pre-op data, consent, npo status, ID pt, type of surgery, check if pt. marked, answer questions, provide reassurance, info for family
Intraoperatively: positioning to prevent skin and neuromuscular injuries (d
The Joint Commission 2011 National Patient Safety Goals
Improving patient identification: two identifiers for each pt.
Preventing surgical site infections
Performing time-out before any procedure or surgery
Marking surgical site: right procedure, right pt. right site
4 different types of anesthesia
1. General
2. Regional
3. Local
4. Conscious sedation
Drug induced state of analgesia, amnesia, muscle relaxation, and unconsciousness
general anesthesia
Blocks nerve impulse conduction to a specific area or region of the body to decrease pain, produce anesthetic field without loss of consciousness
regional anesthesia
Disrupts sensation at the nerve endings
local anesthesia
Raises the pain threshold and produces an altered mood with some degree of amnesia ("twilight sleep")
conscious sedation
What is the role of postoperative nursing care in the PACU?
Immediate postoperative care: think ABC's!
Emphasis on continuous assessment and prevention of complications
-Respiratory status
-Cardiovascular status
-CNS status
-Fluid status
-Pain management
-Wound management
-General condition
What is the post-operative assessment?
1. Vital signs, temp (may need warming), BP, pulses, capillary refill; compare to baseline
2. Effort of breathing, adventitious breath sounds
3. Color of skin, lips, mucous membranes, O2 Sat
4. Fluid status; EBL, UOP, I/O during surgery, bowel prep before
Why is it so important to manage post-op pain?
1. Controlled pain:
Reduces recuperation time
Provides for faster mobilization
Assists in returning to full activities and work
Increases patient satisfaction
2. Uncontrolled pain:
Psychological and physiological consequences: impaired healing, impaired p
After conducting a preoperative health assessment, the nurse documents that the patient has physical assessment supporting the medical diagnosis of COPD. Based on this finding, what postoperative interventions would be included on the plan of care?
A) Per
D) Thorough respiratory assessment, incentive spirometry q1 hour while awake
A nurse is teaching a surgical patient about postoperative p.r.n. pain control. Which of the following should be included?
A) "We will bring you pain medication, you do not need to ask"
B) "Even if you have pain, you may get addicted to the drugs"
C) "You
D) "You need to ask for the medication before the pain becomes severe
A nurse is providing ongoing postoperative care to a patient who has had knee surgery. He assesses the dressing and finds it saturated with blood. The patient is restless and has a rapid pulse. What should the nurse do next?
A) Document the data and apply
B) Apply a pressure dressing and report findings
What can you do to promote health and normalcy after surgery?
Meet comfort and rest needs
Meet fluid and nutritional needs
Meet elimination needs
Assist in coping
Involve family participation as much as possible as the patient wishes
Prepare the patient for discharge
An operating room nurse is preparing for a surgical procedure for an infant. His perioperative care is based on what physiologic factor that puts infants at greater risk from surgery than adults?
A )Increased vascular rigidity
B) Diminished chest expansio
C) Lower blood volume