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The Surgical Client*
The surgical client
| Question | Answer |
|---|---|
| Perioperative care | care that clients receive before, during, and after surgery |
| Preoperative period | time starts when client is informed surgery is necessary and ends when client is transported to operating room |
| What are the types of surgery according to urgency? | optional, elective, required, urgent, emergency |
| Optional surgery | surgery that's performed at the clients request |
| What is surgery for cosmetic purposes an example of? | optional surgery |
| Elective surgery | surgery that's planned at the clients convenience |
| What is a surgery for the removal of a superficial cyst an example of? | elective surgery |
| Required surgery | surgery that's necessary and should be done relatively promptly |
| What is a surgery for the removal of a cataract an example of? | required surgery |
| Urgent surgery | surgery that's required promptly within 1 to 2 days |
| What is a surgery for the removal of a malignant tumor an example of? | urgent surgery |
| Emergency surgery | surgery required immediately for survival |
| What is a surgery to relieve an intestinal perforation an example of? | emergency surgery |
| Inpatient surgery | procedures performed on a client who is admitted to the hospital and expected to remain at least overnight |
| What is often done to a client prior to surgery? | laboratory and diagnostic testing |
| Anesthesiologist | a physician who administers chemical agents which temporarily eliminate sensation and pain |
| Anesthetist | a nurse specialist who administers anesthesia under the direcion of a physician |
| What type of anesthesia eliminates all sensation and consciousness or memory of the event? | general anesthesia |
| What type of anesthesia blocks sensation in an area, but consciousness if unaffected? | regional anesthesia |
| What type of anesthesia eliminates sensation in lower extremities, lower abdomen and pelvis? | epidural or spinal anesthesia |
| What type anesthesia blocks sensation in a circumscribed area of skin and subcutaneous tissue? | local anesthesia |
| What type oa anesthesia inhibits sensation where directly applied in epithelial tissues like skin or mucous membranes? | topical anesthesia |
| What are the types of surgery? | diagnostic, exploratory, curative, palliative, cosmetic |
| Diagnostic surgery | removal and study of tissue to make a diagnosis |
| What is a breast biopsy or a biopsy of a skin lesion an example of? | diagnostic surgery |
| Exploratory surgery | more extensive means to diagnose a problme; exploration of a body cavity |
| What is exploring the abdomen for unexplained pain or to explore laparoscopy an example of? | exploratory surgery |
| Curative surgery | the removal or replacement of defective tissue to restore function |
| What is a cholecystectomy or total hip replacement an example of? | curative surgery |
| Palliative surgery | releif of symptoms or enhancement of function without cure |
| What is the resection of a tumor to relieve pressure and pain an example of? | palliative surgery |
| Cosmetic surgery | correction of defects, improvement of appearance or change two physical features |
| What is rhinoplasty, cleft lip repair, or mamoplasty an example of? | cosmetic surgery |
| Outpatient surgery, same day surgery or ambulatory surgery | operative procedures performed on clients who return home the same day |
| The client can be discharged after outpatient surgery when the client... | is awake and alert, voids a sufficient quantity of urine, has received dischargeinstructs, vital signs are stable, pain and nausea are controlled, and oral fluids are retained |
| What does LASER stand for? | light amplification by the stimulated emission of radiation |
| What are some advantages of laser surgery? | cost effective, reduces need for general anesthesia, smaller incisions, minimal blood loss, reduced swelling, less pain, decreased incidence of wound infections, reduced scarring, less time recuperating |
| What are some procedures in which laser surgery is used? | reattach retina, remove skin tattoos, revascularize ischemic heart muscle |
| What is the highest priority when using laser surgery? | safety |
| What type substances are not used around lasers due to their flammability? | volatile substances like alcohol or acetone |
| When a laser is used, what does it release? | a plume |
| Plume | a substance composed of vaporized tissue, carbon dioxide, and water |
| Informed consent | permission a client gives after an explanation of the risks, benefits, and alternatives |
| Who is responsible for providing information that meets the criteria for informed consent? | the physician |
| If an adult client is confused, unconscious or mentally imcompetent, who can sign the informed consent? | clients spouse, nearest blood relative, or someone with durable power of attorney |
| If a client is under the influence of a mind altering drug like a narcotic or is alcohol intoxicated, how will the informed consent get signed? | must be delayed until the drug has been metabolized |
| In a life threatening emergency, what may be done with signing an informed consent? | mthe court may waive the need to obtain a written or verbal consent on the basis of substituted judgment |
| Substituted judgment | court belief that a client would issue consent if her or she had the capacity to do so |
| If a client is younger than 18 years of age, who signs the consent form? | parent or legal guardian |
| Which adolescents may sign their own consent forms? | adolescents younger than 18 years and live independently supporting themselves (emancipated minors) |
| Emancipated minors | adolescent living independently of parents or guardians and supporting him/herself |
| When do clients need to sign the informed consent? | before receiving any preoperative sedatives or when everything has been explained to the client |
| Autologous transfusion | self donated blood |
| Directed donors | blood donors chosen from among the clients relatives and friends |
| When directed donors are chosen for a client undergoing surgery, which people don't need to donate? | clients siblings or a male sexual partner of a woman in her reproductive years |
| Why should siblings not be directed donors? | it would rule them out as future organ or tissue donors for the client because antigens in the transfused blood would sensitize the recipient which increases risk for organ or tissue rejection |
| Why should a male sexual partner of a woman not be a directed donor? | to avoid possible antibody reactions against a fetus in any future pregnancy |
| What are the criteria for autologous donation? | physicians recommendation, hematocrit WNL, free of infection, weight requirement, donate 40 to 3 days before, donate one a week preferred but no more frequently than ever 3 to 5 days, assume responsibility for cost, blood will be discarded if unused |
| What are the criteria for directed donation? | 17 years old, meet criteria of public donor,same blood type as recipient or one compatible, not have recieved a blood transfusion within 6 months, donate 20 to 3 days before use, be free from blood borned pathogens and high risk behaviors |
| How many days does the person have before surgery to donate his/her own blood? | 40 to 3 days before |
| How old must a person be to be a directed donor? | 17 years old |
| How many days prior to surgery, should the blood be donated for a directed donation? | 20 to 3 days before |
| What things must be completed in the immediate preoperative period or few hours before surgery? | assessment, preop teaching, methods of physical preparation, give meds, assist with psychosocial preparation, complete surgical checklist |
| While the nurse is reviewing preoperative instruction and client has admitted to not carrying out a specific portion, who does the nurse notify? | the surgeon immediately |
| What medications may increase the risk for gastrointestinal side effects like bleeding? | ibuprofen (advil) or naproxen (aleve) |
| What may increase the risk for bleeding postoperatively? | herbs like ginkgo or ginseng |
| What are some risk factors which increase the liklihood of perioperative complications? | age, dehydration, malnutrition, obesity, smoking, diabetes, cardiopulmonary disease, drug and alcohol disuse, bleeding tendencies, low hbg and red cells, pregnancy |
| What are some potential complications for the very young with surgery? | respiratory obstruction, fluid overload, dehydration, hypothermia infection |
| What are some potential risk for the elderly with surgery? | decreased metabolism, fluid overload, renal failure, formation of bood clots delayed wound healing, infection, confusion, respiratory complication |
| What are some potential complications for the malnourished during surgery? | fluid andelectrolyte inbalances, cardiac dysrhythmias, delayd wound healing, wound infections |
| What are some potential complications for the obese during surgery? | atelectasis, pneumonia, blood clots, delayed wound healing, wound infection, delayed metabolism, and excretion of anesthetics and pain meds |
| What are some potential complications for a person who is a substance abuser during surgery? | atelectasis, pneumonia, altered effectiveness of anesthesis and pain meds, drug interactions, drug withdrawal |
| What are some potential complications of a client with immunity difficulty with surgery? | adverse reactions to medications, blood transfusions or latex infection |
| What are some potential complications with a client with respiratory problems which may incur during surgery? | atelectasis, bronchopneumonia, or respiratory failure |
| What are some potential complications for a client with cardiovascular problmes with surgery? | hypo/hypertension, fluid overload, CHF, shock, dysrhythmias, myocardial infarction, stroke, or blood clots |
| What are some potential risks for a client with hepatic problmes during surgery? | delayed drug metabolism leading to drug toxicity, disrupted clotting mechanisms leading to excessive bleeding or hemorrhage, confusion, or increased risk for infection |
| What are some potential complications for a client with renal problems with surgery? | fluid and electrolyte imbalances, CHF, dysrhythmias, delayed excretion of drugs leading to drug toxicity |
| What are some potential risks for clients with endocrine problmes like diabetes with surgery? | hypo/hyperglycemia, hypokalemia, infection, or delayed wound healing |
| What are some things in which may require postponing or canceling the surgery? | unexplained elevation in temperature, abnormal laboratory data, current infectious disease, or significant deviations in vital signs |
| What type of information should be included when preoperative teaching? | preoperative medications, pain control, explanation and description of postanesthesia recovery room or postsurgical protocol, discussion of frequency of assessing bitals and use of monioring evmvironment |
| What is a form of controlled ventilation that opens and fills small air passages in the lungs? | deep breathing |
| In which clients is deep breathing an advantage? | those receiving general anesthesia or who breathe shallowly after surgery |
| What does deep breathing reduce the postoperative risk for? | respiratory complications like atelectasis or pneumonia |
| Atelectasis | airless, collapsed lung areas |
| Pneumonia | lung infection, inflammation of the lung or accumulation of fluid in the lung |
| What involves inhaling deeply using the abdomial muscles, holding breath for several seconds, and exhales slowly referred to as? | deep breathing |
| What are ways to promote deep breathing? | incentive spirometer or deep breathing |
| What is a natural method for clearing secretions form the airways | coughing |
| Forced coughing | coughing that is purposely produced |
| In which clients would forced coughing be appropriate? | those with diminished or moist lung sounds or thick sputum |
| Coughing is painful for clients with abdominal or chese incisions. How can the pain/discomfort be reduced when couhing? | administer pain meds 30 minutes before coughing, or splint incision site during coughing |
| What are the methods of splinting? | pressing on incision with both hands, pressing on a pillow placed over incision site, or wrap a bath blanket around client |
| What helps to promote circulation and reduce the risk for forming a thrombus? | leg exercises |
| Thrombus | a stationary blood clot |
| When do blood clots form? | when venous circulation is sluggish or when fluid component of blood is reduced |
| Antiembolism stocking | knee high or thigh high elastic stockings |
| What are antiembolism stockings also referred to as? | thromboembolic disorder hose or TEDS) |
| What helps to prevent thrombi and emboli | antiembolism stockings |
| Emboli | mobile blood clots |
| How does antiembolism stockings help prevent thrombi and emboli? | by compressing superficial veins and capillaries. this redirects more blood to larger and deeper veins where it flows more effectively toward the heart |
| What are some physical preparations the nurse may perform at time of admission? | skin prep, elimination, restriction of food/fluids, care of valuables, donning of surgical attire, or disposition of prostheses |
| What involves cleansing the skin and in some cases hair removal? | skin preparation |
| What is the goal for skin preparation? | to decrease transient and resident bacteria without compromising skin integrity |
| Reducing bacteria helps to? | prevent postoperative wound infections |
| If a surgery is planned, the client may be asked to bathe or shower in what and how? | chlorhexidine and for a minimum of 2 minutes contact time, dry with fresh towel and put on clean clothes |
| What does shaving cause? | microabrasions |
| Microabrasions | tiny cuts that provide an entrance for microorganisms |
| Depilatory agents | chemicals that remove hair |
| What are depilatory agents associated with? | skin irritation and allergic reactions |
| A client may be prescribed an enema or laxative preoperatively. What is the purpose of administering these? | to cleanse the lower bowel to improve visualization of the surgical site and prevent trauma to intestines or accidental contamination of abdominal cavity with feces |
| Who gives specific instructions about how long to restrict food and fluids preoperatively? | physican |
| What is done to reduce the risk for aspirating stomach contents while a client is under anesthesia in regards to preop instructions? | fasting from midnight foward |
| Normally a client is npo at midnight, but the American Society of Anesthesiology recommends now that healthy preop clients can consume what? | clear liquids 2 hours before elective surgery, have light breakfast 6 hours before surgery, or eat heavier meal 6 to 8 hours before surgery |
| The nurse encourages clients to maintain good nutrition and hydration before being NPO to promote nutrients like what? Why are these important? | protein, ascorbic acid or vitamin C and zinc needed for wound healing |
| The period of fluid restriction may be shortened prior to surgery for older adults Why? | to reduce risk for dehydration and hypotension |
| Why may the physician order antiembolism stockings to wear during surgery? | to prevent venous stasis |
| What are some common preoperative medications given? | anticholinergics, antianxiety, histamine 2 receptor antagonists, narcotics, sedatives, or antibiotics |
| What are anticholinergics and what is an example? | glycopyrrolate or robinul; decreases respiratory secretions, dries mucous membranes, and prevents vagal nerve stimulation during endotracheal intubation |
| What are antianxiety meds and what is an example? | loraxepam or ativan; reduces preoperative anxiety (causes light sedation, slows motor activity, and promotes induction of anesthesia) |
| What are Histamine 2 receptor antagonists and what is an example? | Cimetidine or Tagamet; decreases gastric acidity and volume |
| What are narcotics and what is an example? | morphine sulfate; sedates client and decreases amount of anesthesia |
| What are sedatives and what is an example? | midazolam or Versed; promotes sleep or conscious sedation and decreases anxiety |
| What are antibiotics and what is an example? | Kanamycin or Kantrex; destroys enteric microorganisms |
| Preoperative checklist | a form that identifies the status of essential presurgical activities and is completed before surgery |
| When should psychosocial preparation begin for a client undergoing surgery? | as soon as client is aware that surgery is necessary |
| Who is responsible for completing and signing the checklist? | nurse |
| Intraoperative period | the time during which the client undergoes surgery |
| What involves the transportation to a receiving room then to a operating room where anesthesia is administered and procedure is performed? | intraoperative period |
| Receiving room | a place in the surgery department where clients are observed until the operating room and surgical team are ready |
| What nursing tasks may be performed while in the nursing room? | preoperative medication is administered and skin preparation maybe done here |
| What type of anesthesia acts on the central nervous system to prodce a loss of sensation, reflexes, and consciousness? | general anesthesia |
| How are general anesthesia meds commomly administered? | inhalation or IV routes |
| What is the client monitored closely for during surgery and recovery phase? | effective breathing and oxygenation, circulatory status, BP, pulse,temperature regulation, adequate fluid balance, following commands, breathing independently |
| What type anesthesia interferes with the conduction of sensory and motor nerve impulses to a specific area of the body? | regional anesthesia |
| Which type of anesthesia is when the client experiences a loss of sensation and decreased mobility to a specific anesthetized area and consciousness is unaffected? | regional anesthesia |
| What are the types of regional anesthesia? | local, spinal, epidural nerve block, peripheral nerve block |
| What is the major advantage of regional anesthesia? | decreased risk for respiratory, cardiac, GI, complications |
| Conscious sedation | a state in which clients are sedated but not unconscious |
| Which route is used to administer medications creating conscious sedation? | IV route |
| Reversal drugs | medications that counteract the effects of those used for conscious sedation |
| What must be readily available in case the client becomes overly sedated? | reversal drugs |
| What are examples of reversal drugs? | naloxon(Narcan) flumazenil(Romazicon) |
| What is an antagonist for opiates like morphine? | naloxone(narcan) |
| What reverses antianxiety drugs like midazolam(Versed)? | flumazenil(Romazicon) |
| Surgical waiting area | the room where family and friends await information about the client |
| Postoperative period | begins after the operative procedure is completed and client is transported to an area to revocer from the anesthesia and ends when client is discharged |
| Postanesthesia care unit(PACU) or recovery room | the area in the surgical department where clients are intensively monitored |
| Postoperative care | nursing care after surgery |
| What refers to the first 24 hours after surgery? | immediate postoperative period |
| What do nurses monitor clients for during the postoperative period? | complications |
| What is the responsibility of the PACU's nurse? | ensure patent airway, help maintain adequate circulation, prevent or assist with management of shock, maintain proper functions of drains, tubes, IV infusions, and detect any complications |
| What are some things the nurse monitors in the PACU? | LOC, vitals,presence of or need of supplemental O2, condition of wound and dressing, location of drains and drainage characteristics, location type rate of IV fluid, level of pain, need for analgesia, presence of catheter and output |
| What are somme post operative complications? | airway occlusion, hemorrhage, shock, pulmonary embolus, hypoxemia, adynamic ileus, evisceration, dehiscence, wound infection, urinary retention |
| What is the obsruction of the throat? | airway obstruction or occlusion |
| How would you treat an airway occlusion? | tilt head, lift chin, insert artifical airway |
| What is a severe, rapid blood loss? | hemorrhage |
| What is the treatment for hemorrhage? | control bleeding, admininster IV fluid, and replace blood |
| What is inadequate blood flow? | shock |
| How would shock be treated? | placing the client in a modified trendelenburg, replace fluids, administer oxygen, and give emergency drugs |
| What is the obstruction of circulation through the lung as a result of a wedged blood clot beginning as a thrombus? | pulmonary embolus |
| What is the treatment for pulmonary embolus? | give oxygen and administer anticoagulant drugs |
| What is inadequate oxygenation of blood? | hypoxemia |
| What would be the treatment for hypoxemia? | administer oxygen |
| What is the lack of bowel motility? | adynamic ileus |
| What is the treatment for adynamic ileus? | to treat cause, client is NPO, insert NG tube and connect to suction, and administer IV fluid |
| What is the inability to void? | urinary retention |
| What is the treatment of urinary retention? | insert a catheter |
| What is the proliferation of pathogens at or beneath the incision? | wound infection |
| What is the treatment for wound infection? | cleanse with antimicrobial agents, open and drain incision, and administer antibiotics |
| What is the separation of the incision? | dehiscence |
| What is the treatment for dehiscence? | reinforce wound edges and apply binder |
| What is the protrusion of abdominal organs through a separated wound? | evisceration |
| What is the treatment of evisceration? | cover with wet dressing and reapproximate wound |
| Food and fluids are withheld immediately after surgery until the client? | is awake, is free of nausea and vomiting, and bowel sounds are active |
| Why do surgical clients need to ambulate as soon as possible? | to reduce the risk for pulmonary and vascular complications |
| Pneumatic compression | a machine that promotes the circulation of venous blood and relocation of excess fluid into the lymphatic vessels |
| What measures are used to prevent thrombi? | drink plenty of fluids, avoid long periods of sitting, keep legs uncrossed, ambulate, change position frequently |
| Discharge instructions | directions for managing self care and medical followup |
| When giving discharge instructions to the client, what things need to be addressed? | how to care for incision site, signs of complications, drugs usd to relieve pain, how to administer medications, when activity can be resumed, if or how much weight can be lifted, foods to consume or avoid, when and where to return for f/u appointment |
| Thrombophlebitis | inflammation of a vein as a result of a thrombus |
| Surgery | an invasive process in which an incision is made into the body or a part is removed |
| Elective surgery(optional) | client may choose whether or not to have the surgery |
| General anesthetics | block all body sensations and cause unconsciousness, relaxation and loss of reflexes |
| Regional anesthesia | a type of local anesthesia in which absence of sensation in a particular area is induced by interruption of sensory nerve conductivity |
| Local anesthesia | pain and sensation blocked in a limited area, most often by injection of an anesthetic agent into a small area or by topical application |
| Conduction block | a nerve group affected by injection of the anesthetic |
| Hemorrhage | escape of blood from torn blood vessels |
| Splinting | helps to relieve some pain and discomfort which may be experienced during coughing |
| Thrombolytic agents | medications that dissolve or split up existing blood clots |
| Dehiscence | the splitting open or separation of the surgical incision |
| Evisceration | an incision that opens enough that abdominal organs protrude |
| Venous access lock | a saline lock |
| Paralytic ileus | intestinal paralysis; the bowel has no peristaltic activity at all |
| Hypothermia | core temperature below 97.5 F |
| Suture or stitches | thread used to hold an incision together while it heals |
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