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68WM6 Phase II Ch42
Care of the Surgical Patient
Question | Answer |
---|---|
when was anesthesia dicovered? | 1840's |
3 classifications of surgery | elective, urgent, emergent |
surgery not necessary to preserve life and may be preformed when the patient chooses | elective surgery |
surgery required to keep additional health problems from occuring | urgent surgery |
surgery performed immediateley to save the individual's life or preserve the function of a body part | emergency surgery |
what are the two ways that surgeries are also labled? | minor or major |
an amputation or excision of any part of the body or removal of a growth or harmful substance | alation |
therapy designed to relieve or reduce intensity or uncomfortable symptoms without cure | palliative |
reasons that surgeries are preformed? | diagnostic studies, ablation, palliative, reconstructive, transplant, constructive |
role of the nurse during preoperative, intraoperative, and postoperative care | perioperative |
before surgery | properative |
during surgery | intraoperative |
following surgery | postoperative |
what is a nurse's major responsibility in surgical care? | consistent effective nursign intervention during each phase of surgery |
what patient factors influence a surgical procedure? | age, physical condition, nutritional factors, psychosocial needs, socioeconomic/cultural needs, medications, education and experience |
concurrent use of multiple medications | polypharmacy |
how many medications do patients age 65 and older generally take? | 2-6 prescribed, 1-3 OTC |
what does using multiple medications put a patient at risk for? | adverse drug reactions and interactions |
what non prescription should we always ask about? | use of herbals and supplements |
act like medications and may interact or potentiate other medications or interfere with surgical procedures | herbs |
herbal commonly used for migrane prevention, but has anicoagulant factors, and should be d/c before surgery? | Feverfew |
herbal taken for motion sickness, cough, menstrual cramps, intestinal gas, causes risk of prolonged clotting times, and should be d/c before surgery | Ginger |
herbal that has antidepressant, antiviral, antiinflammatory action and should not be used with psych meds | St John's wart |
herb that has sedative or tranquilizer effects, sleep aid, should not be used with sedatives or anxiolytics, may increase effects of CNS depressants | Valerian root |
what types of allergies do we enquire about presurgery? | food, chemicals, pollen, antiseptics, latex, rubber |
what has been shown to influence levels of anesthesia, pain meds and speed of recovery? | properative anxiety levels |
what does smoking do to put surgical pt's at risk? | alveoli may be impaired and the pts lung capacity reduced. muccus and anesthesia by products may be trapped in the lung causing atelectasis and pneumonia |
preoperative questions? | allergies, past surgeries, infection, disease hx, prescription drugs, otc drugs, record baseline vitals, height and weight |
when is preoperative teaching preformed? | 1-2 days before surgery |
how often will vital signs, tubes, and dressing be assessed post op? | every 15-30 min until the pt is awake and stable |
what does preoperative preparation consist of? | age, physical, nutritional status, type of surgery, and preference of the surgeon |
what labratory test are preformed prior to surgery? | depends on institution and physicians preference: urinalysis, CBC, blood chem, |
what systems are evaluated pre op? | endocrine, hepatic, renal, cardiovascular, adn serum electrolytes |
what essential electrolyte is monitored closley perioperativley? | potassium |
why is potassium monitored? | if not avalailable in adequate amount, dysrhythmias can occur during anesthesia |
what is used to identify disease process or prevent cardiac damage pre op? | chest roentgenogram, electrocardiogram |
what tests verify hepatic functioning? | LDH, gamma GT, alkaline phosphate, total bilirubin, urine bilirubin |
permission obtained from the patient to preform a specific test or procedure | informed consent |
procedure in which a device is used at the bedside in regular intervals to encourage the patient to breathe deeply | insentive spirometer |
resting tidal capacity | 500ml |
tidal capacity | 4300ml |
an accumulation of platlets, fibrin, clotting factors, and cellular elements of the blood attatched to the anterior wall of a vessel, sometiem occluding the lumen of the vessel | thrombus |
dislodged thrombus that has potential to travel to the lungs, heart, or brain, where a vessel may be occluded | embolus |
localized area of necrosis caused by a thrombus or embolus | infarct |
cuts produced by a surgically sharp instrument to create an opening into an organ or body cavity | incision |
means the absence of pain | anesthesia |
results in an immobile, quiet pt who does not recall the surgical procedure | general anesthesia |
stage that begins with the pt awak until they lose consciousness | Stage I anesthesia |
stage that begins with the loc and ends with the onset of regular breathing and and loss of eyelid reflexes | Stage II anesthesia |
stage that begins with the onset of regular breathing and ends with the cessation of respirations. aka operative or surgical phase | Stage III anesthesia |
stage that begins with the cessation of respirations and must be avoided or cardiopulmonary resusitation mut occur | Stage IV anesthesia |
phase in which anesthetics are administered to endotracheal intubation | induction phase |
phase in which the pt is positioned, skin is prepped for incision, and the surgical procedure | maintenance phase |
phase in which anesthetics are decreased, and the patient begins to awaken | emergence phase |
results in the loss of sensation an the area of the body | regional anesthesia |
local anesthetic is injected into a nerve, blocking the nerve supply to the operative site | nerve block |
anesthesiologist performs a lumbar puncture and introduces local anesthetic into the csf of the subarachnoid space | spinal anesthesia |
a safer procedure than spinal anesthesia, where the anesthetic is injected into the epidural space outside the dura mater and the depth of anesthesia is not as great as spinal anesthesia | epidural anesthesia |
local anesthesia is injected via IV into an extremity below the level of the tourniquet after blood has been withdrawn | intravenous regional anesthesia (Bier block) |
involves the loss of sensation at the desired site, inhibits nerve conduction until the drug diffuses into circulation | local anesthesia |
administration of cns depressants or analgesia to relieve anxiety | conscious sedation |
what must a patient undergoing conscious sedation maintain? | a patent airway, airway reflexes, and able to respond appropriatley to physical and verbal stimuli |
an artificial replacement for a missing body part | prosthesis |
holding area outside of the operating room | preanesthesia unit |
protection against infection before, during and after surgery by the use of sterile technique | surgical asepsis |
the removal of fluids from a body cavity, wound, or other source of discharge | drainage |
all substance that have seeped from cells or blood vessels through small pore breaks in the cell membrane | exudate |
the separation of a surgical incision or rupture of a wound closure | dehiscence |
ill health, malnutrition, and wasting as a result of chronic disease | cachexia |
protrusion of an internal organ through a wound or surgical incision | evisceration |
an abnormal condition characterized by a collapsed lung | atalectasis |
the way the pain is affecting the patient emotionally | suffering |
how long does it take for bowel activity to return post op? | 3 to 4 days |
normal peristalsis? | 5 to 30 gurgles per one minute |
a decease in or absence of intestinal peristalsis that may occur after abdominal surgery, peritoneal trauma, and severe metabolic disease and other conditions | paralytic ileus |
hiccup | singultus |
an involuntary contraction of the diaphragm followed by a rapid closure of the glottis | hiccup |
loss of potassium after tissue breakdown, especially after severe trauma or crush injury | catabolism |