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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
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?
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
necessary for cts health, may prevent additional problems from developing, not nec. 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
excision or removal of diseased body part
relieves or reduces intensity of disease symptoms, will not produce cure
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
restores function lost or reduced as a result of congenital anormalies
performed to improve personal appearance
How long should sx be delayed after radiology treatments?
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?
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?
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?
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?
What does a hight HgB indicate?
Normal HgB for female?
Normal HgB for male
Normal Hct for female?
Normal hct for male?
Low hct indicate?
fluid overload
high hct indicate?
Normal whaite blood cell ct?
normal platelet count
If the ct has signed all the forms to allow sx, can he/she still decline?
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?
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?
What is the favorite site of microorganism to grow and multiply?
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?
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?
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
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?
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?
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?
How long does risk for hemorrage last after sx?
several days
In a postoperative nsg unit is a sudden change of consciousness normal?
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?
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?
What is important to maintaining alertness?
orientation to environment
Do you chg the surgical dsg first w/o an order?
When do cts have the most surgical pain?
24-48 hours
What can make cts depressed during recovery?
slow recovery

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