Surgical Client

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Perioperative nursing: includes nuring care given before, during and after sx
postoperative care: care after sx
preoperative care: care before sx
intraoperative care: care during sx
outpatient: minor sx, enter hosp, have sx and leave same day
What are surgical procedures classified under?: seriousness, urgency and purpose of sx
What are the 6 main risk factors used to anticipate care?: age 60+, impaired preop cog. funct, smoker, BMI > 27, hx or cancer, midline abd incision site
what do normal tissue repair and resistance to infection depend on?: adequate nutrition
how many kilocalories a day does a pt need to maintain energy reserves?: 1500
Major surgery: involves extensive reconstruction or alteration in body parts, poses great risks to well-being
minor sx: involves minimal alteration in body parts, often designed to correct deformities, invloves min risks
urgency elective: performed on basis of cts choice, may not be necessary for health
urgent: necessary for cts health, may prevent additional problems from developing, not nec. emergency
Emergency: must be done immediately to save life or preserve function of body parts
Purpose diagnostic: surgical exploration that allows physician to confirm dx, may involve removal of tissue for further testing
Ablative: excision or removal of diseased body part
palliative: relieves or reduces intensity of disease symptoms, will not produce cure
reconstructive/restorative: restores function or appearance to traumatized of malfunctioning tissues
procurement for transplant: removal of organs and/or tissues from a person pronoun. brain dead for transpl. into another person
constructive: restores function lost or reduced as a result of congenital anormalies
cosmetic: performed to improve personal appearance
How long should sx be delayed after radiology treatments?: 4-6wks
How does the body respond to sx?: as a form of trauma
why does a pregnant person make sx more complex?: uterus displaces abd organs and distorts landmarks
When do anesthetic and medication cause fetal abnormalities?: first trimester
What is the major responsibility or a perioperative nurse?: safe, consistent, effective nursing care during all phases of treatment
when does preoperative teaching start so its most effective?: when you first assess cts and families readiness and ability to learn
what is one of our principal roles as a perioperative nurse.: ct. advocate
how can a latex allergy manifest?: contact dermitis, contact uticaria, hay fever
What is a smoker more at risk for after sx than a non-smoker is?: pulmonary complications
Does past hx of sx and how they went affect a ct?: yes
How do bleeding disorder increas the risks of sx?: increase risk of hemorrhage
How does DM increase the risks of sx?: ups susceptibility to infection, impair wound healing, cause CNS malfunction,
How does heart disease increase the risks of sx?: stress causes uped demands on heart to maintain cardiac output,
What does general anesthesia do to the heart?: depresses cardiac function
how does a URI increase the risks of sx?: increases risk of resp. complication during anesthesia
How does liver disease increase risk of sx?: alters metabolism and elimination or drugs, impairs wound healing and clotting time
How does fever increase risk of sx?: predisposes ct to fluid and electrolyte imbalances and may indicate an infection
How does chronic resp disease increase risk of sx?: reduces cts means to compensate for acid-base alterations, anesthesia reduces resp functi
How do immunological disorders increase risk of sx?: increase risk of infection and delay wound healing
How does abuse of street drugs increase risk of sx?: may have underlying disease
How does chronic pain increase risk of sx?: have higher tolerance may need higher doses to control pain
What do antibiotics do?: potentiate action of anesthetic agents, can cause mild resp depression
What do antidysrhythmics react with sx ct?: reduce cardiac contractility and impari cardiac conduction during anesthesia
How do anticoagulants affect pts who are having sx?: alter normal clotting factors and increase risk oh hemmorrage.
When should anticoagulants be d/cd prior to sx?: at least 48 hours
What type of drug is aspirin?: anticoagulants
anticonvulsants and sx?: long-term use of certain anticonvulsants can alter metabolism or anesthetic agents
antihypertensives and sx?: cause bradycardia, hypotension ad impaired circulation
corticosteroids and sx?: cause adrenal atrophy which reduces bodies ability to handle stress
insulin and sx?: diabetics need is down during sx
diuretics and sx: potentiate electrolyte imbalances
Nonsteroidal antiinflammatory drugs: inhibit platelet aggregation and my prolong bleeding time,
symptoms of a fearful ct?: asks alot of questions, be very quiet, seem uneasy when strangers enter room, actively seek company
Why may asian cts remain quiet?: out of respect
What reaveals level of hydration?: condition of oral mucous membranes
What do you always do if ct has heart disease?: assess apical pulse
How long may bowel sounds be diminished if general anesthesia is used?: up to several days
Can a cts LOC change the result of general anesthesia?: yes
What does spinal or epidural anesthesia cause?: temporary paralysis of lower extremities
When does the plan of care begin?: preoperative phase
When is a plan of care modified?: intraoperative and postoperative phases
What does a low HgB indicate?: anemia
What does a hight HgB indicate?: polycythemia
Normal HgB for female?: 12-16
Normal HgB for male: 14-18
Normal Hct for female?: 37-47%
Normal hct for male?: 42-52%
Low hct indicate?: fluid overload
high hct indicate?: dehydration
Normal whaite blood cell ct?: 5000-10000
normal platelet count: 150000-400000
If the ct has signed all the forms to allow sx, can he/she still decline?: yes
What does ct education do?: relieves anxiety, increases self-esteem, speeds up recovery, reduces med costs, decreases amt of perceived pain
teaching and ventilary function?: improves ability and willingness to ambulate and resume ADLS
teaching and physical functional capacity?: increases understanding and willingness to ambulate and resume ADLS
When is preoperative teaching started to be most useful?: the week before admission and reinforced immed b4 sx
What is the most effective form of teaching for surgical cts?: planned to cover entire sx experience
What happpens during the use of general anesthetic?: muscles relax and gastic contents can reflux into the esophagus
Does anesthesia affect the gag reflex?: eliminates it
What is one of the cts greatest fears about sx?: pain
PCA: patient controlled anesthesia
What does diaphragmatic breathing do?: improves lung expansion and o2 delivery w/o using excess energy
What does deep breathing do in regards to anesthesia?: clear any gases from the airways
What can help to facilitate deep breathing?: incentive spirometer
What do leg exercises and turning do?: improve blood flow to the extremities and thus reduce venous stasis
is rest essential for normal healing?: yes
What is the favorite site of microorganism to grow and multiply?: skin
what does an empty bowel reduce?: risk of injury to the intestinges and minimizeds contamination of the operative wound
What type of undergarments can a ct wear when having sx?: none
Should a pt wear makeup during sx? why or why not?: no, cant assess mucous membranes to determine the cts level of oxygenation, circulation fluid balance
Jewelry in sx?: no, wedding rings can be taped
two roles of nurses in OR?: circulating nurse, scrub nurse
role of circulating nurse: cares for ct while in OR, comp. other preoperative assess, est. and implement the intraoperative plan of care provides contin of care after sx
which nurse helps the anesthesiologist?: circulating
Which nurse operates nonsterile equip: circulating nurse
Which nurse maintains written records?: circulating nurse
What type of nurse is a circulating nurse?: must be an RN
PSCU: presurgical care unit
what does the scrub nurse do?: resp for maintaining sterile field, adhere to strict sx sepsis, applies drapes, and hands surgeon instraments
What kind of nurse does a scrub nurse have to be?: may be an RN, LPN, or surgical technician
What minimizes risk of or irritation and small cuts when shaving?: clippers
Who transfers ct to operating room?: circulating nurse
General anesthesia: all sensation and consciousness are lost, muscles relax, reflexes lost, amnesia experienced
When is GA used?: major procedures, some minor procedures for children
Regional anesthesia: loss of sensation in an area of body
How is Regional anesthesia given?: infiltration and local app
Examples of regional anesthesia?: nerve, spinal, epidural and caudal blocks
Local anesthesia: loss of sensation at desired site by inhib peripheral nerve conduction
When is local anesthesia usually used?: during minor procedures or ambulatory sx
Conscious sedation: brings ct into decreased consciousness
What are some advantages to conscious sedation?: adequate sedating, deminished anxiety, pain relief, mood alteration rapid recovery
two phases of postoperative course: recovery period and convalescence
Where does convalescence occur for ambulatory sx pt?: at home
How long is recovery for ambulatory pt?: 1-2 hours
Where are pts transferred immediately after sx?: PACU
How often do you do assessments in PACU?: every 15 min
Phase 2 environment in ambulatory pts?: promotes the cts and families comfort and well-being until discharge
If pt is not ambulatory pt where do they go after recovery phase?: postoperative nursing unit
what do you do during convalescence?: consider goals of care est. earlier
In convalescence what is the direction of your nursing care?: towards pts smooth transition home
How often are assessments taken when pt is in postop nsg unit?: 15-30 min first, than hourly , and then per physicians order
Normal Pulse ox?: 92-100
How long does risk for hemorrage last after sx?: several days
In a postoperative nsg unit is a sudden change of consciousness normal?: no
what may a rash indicate?: drug sensitivity or allergy
what do abrasions or petechiae show?: inadequate padding during positioning or restraining
What is the critical time for wound healing?: 24-72 hours
What can exert physical stress on a wound?: coughing, vomiting, movement
What is evisceration?: wound seperates below fascia
Is evisceration a medical emergency?: yes
What do you put over an eviscerated site?: gauze soaked with sterile normal saline
When does a wound normally become infected?: 3-6 days after sx
How long can spinal anesthesia prevent ct from feeling bladder fullness?: 12-24 hrs
How long can you expect to have bloody urine from a pt who has had urinary sx?: 12-24 hrs
When can pain be perceived?: before full consciousness is regained
When should normal bowel sounds return after sx?: about 24 hours
goal during recovery?: returning ct to normal physiological funct
When do goals become more long term?: when ct is in surgical nursing unit
What are the priorities when pt is in PACU?: center on physiological needs
When should you begin deep breathing exercised?: as soon as ct can
What do you observe for with external hemorrage?: increased bloody drainage on dsgs and through drains
What do you observe fro with internal hemorrage?: swollen and tight operative site, hematoma
What is the cts only source of fluid intake after sx?: IV
What is important to maintaining alertness?: orientation to environment
Do you chg the surgical dsg first w/o an order?: no
When do cts have the most surgical pain?: 24-48 hours
What can make cts depressed during recovery?: slow recovery

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