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medsurge1
ch 2 care of the surgical patient
| Question | Answer |
|---|---|
| elective surgery | not necessary to preserve life and performed any time the patient chooses |
| example of elective surgery | plastic surgery |
| urgent surgery | is required to keep additional health problems from occurring |
| example of urgent surgery | removal of gallbladder or excision of a tumor |
| emergency surgery | performed immediately to save a life or function of a body part |
| example of emergency surgery | removal of ruptured appendix or control of internal hemorrhage, repair of traumatic amputation |
| major surgery | involves extensive recontruction or alteration in body parts poses great risks to well-being |
| example of major surgery | coronary artery bypass |
| minor surgery | involves minimal alteration in body parts often designed to correct deformities |
| example of minor surgery | skin graft tooth extraction |
| diagnostic | surgical exploration to confirm a diagnosis |
| example of diagnostic | laparotomy breast mass biopsy |
| ablation | excision or removal of diseased body part |
| example of ablation | amputation removal of appendix removal of gall bladder |
| palliative | surgery for relief of reduction of intensity if disease symptoms will not produce a cure |
| example of palliative | colostomy debridement of necrotic tissue |
| reconstructive surgery | restoration of function or appearance to traumatized or malfunctioning tissue |
| example of reconstructive surgery | scar revision internal fixation of fractures breast reconstruction |
| constructive surgery | restoration of function lost or reduced as a result of congenital anomalies |
| example of constructive surgery | repair of cleft palate closure of atrial septal defect in the heart |
| cosmetic surgery | alteration of personal appearance |
| example of cosmetic surgery | rhinoplasty to reshape nose breast augmentation |
| perioperative nursing | refers to the nurses role during the preoperative, intraoperative and postoperative phases of nursing |
| perioperative nursing | stresses the importance of providing continuity of care for the surgical patient using the nursing process |
| the nurses major responsibility is | safe consistent and effective nursing interventions during each pahse of surgery |
| influencing factors for surgery | age, physical condition, nutritional factors, psychosocial needs socioeconomic and cultural needs medications education and experience |
| preoperative preperation constitutes | the patients age and physical and nutritional status, the type of surgery and the surgeons preferance |
| informed consent | permission to perform a specific test or procedure the patient must be alert and competent and agrees to have surgery that is stated on the form |
| the witness of informed consent | a nurse ( does not verify that the patient understands the procedure |
| who discusses the procedure being sone on the informed consent | the surgeon |
| when should the informed consent not be obtained | if the patient is disoriented unconscious mentally incompetent or in some facilities under the influence of sedation |
| what should you do if a patient does not understand english or are deaf | you can obtain an interpreter, if a patient does not hear or see well allow extra time to explain surgery |
| should you coerse a patient o sign an informed consent | never |
| in an emergency situation and the person is unable to give consent | make every effort to locate a family member, if not and its a true emergency to sustain life the surgeon can perform surgery with out consent |
| bowel prep before a surgery | the patient is given golytely to rapidly evacuate the colon of fecal matter and NPO after midnight |
| when is golytlely contraindicated | with patients that have a GI obstruction, gastric retention bowel perferation toxic colitis and megacolon |
| skin prep before surgery | must be shaved at the surgical site and washed with hibiclens |
| factors influencing latex allergies | history of anaphylic reaction of unknown etiology, multiple surgical procedures food allergies specically to kiwi bananas avacados and chestnuts, a job with daily exposure to latex history of reactions to latex ,allergy to pinsettias allergies and asthma |
| what do you do if the patient is suspected or have a known latex allergy | all latex is avoided, place a med alert breacelet on patients wrist and clearly flag the patients status clearly in chart |
| what is the rationale for using a inspirometer | to promote adequate lung expansion to prevent atelectasis |
| thrombus | an accumulation of platelets, fibrin, clotting factors and cellular elements in the blood attached to the anterior wall of a vessel sometimes occuring in the lumen |
| embolus | a dislodged thrombus that can travel to the heart brain lungs where the vessel can be occluded |
| infarct | localized necrosis |
| preoperative medication | reduces the patients anxiety and decreases the amount of anesthesia needed and reduces respiratory tract infections |
| barbiturates and tranquilizers that are sometimes given | phenobarbital and vailium are sometimes given |
| anticholinergics | dries up secretions and reduces spasms of the smooth muscles |
| atropine | anticholinergic |
| the 4 C's of anticholinergics are | can't see, Can't pee, can't spit, can't shit |
| opiod analgesics meperidine and morphine is given | in a pca pump and only the patient is allowed to administer |
| benzodiazepines | midazolam(versed, valium and ativan) monitor for respiratory depression, hypotension and drowsiness and lack of coordination |
| opioid analgesics | morphine (mscotin) and fentanyl citrate monitor for respiratory depression nausea and vomiting orthostatic hypotension and pruritus |
| anticholinergics | atropine sulfate, transcop patch robinul monitor for confusion restlessness and tachycardia |
| NSAIDS | ibuprofen, advil, motrin, |
| the antagonist for opioids is | narcan |
| the antagonist for tylenol | mucomyst acetylcoline |
| stageI | begins with anesthetic agents |
| stageII | begins with loss of consciousness and ends with the onset of regular breathing and loss of eyelid reflexes (excitement and delirium phase) |
| stageIII | begins with the onset of regular breathing and ends if respirations cease (operative or surgical phase) |
| stage IV | begins with the cessation of respirations and must be avoided or it will necessitate CPR and may lead to death |
| the induction phase | the induction of anesthestic agents and intubation |
| the maintenance phase | positioning the patient skin prep and performing the surgery |
| the emergence phase | decreasing anethetics and the patient begins to awaken |
| regional anesthesia | loss of sensation in body part does not lose consciousness but is usually sedated |
| local anesthesia | loss of sensation at the intended site |
| conscious sedation | the administration of drugs that supress the CNS or provide analgesia to relieve anxiety or provide amnesia |
| immediate post operative observations and interventions are | follow the ABC's of of airway, breathing, consciousness,circulation and systems |
| how often do you assess a patients vitals | every 15 minutes during the recovery phase and monitor respirations and GI functions |
| signs of hypovolemic shock | a drop in BP rise in pulse/thready, cool clammy skin and reduced urinary output and restlessness |
| dehiscence | the separation of a surgical incision or rupture of a wound |
| evisceration | protrusion of an internal organ through a wound or surgical incision |
| cachexia | ill health malnutrition and wasting as a result of a chronic illness |
| to ese pressure on the incision | support the surgical site with a pillow, rolled blanket or the heel of the hand |
| acute pain | subesides with in 24-48 hours |
| objective pain factors | signs that the body is responding to pain change in vital signs restlessness diaphoresis and pallor |
| subjective signs of pain | pain is what the patient tells you it is moaning, grimmacing favoring body area |
| venous stasis | a disorder in which the normal flow of fluid through a vesselof the body is slowed or halted is the underlying cause of thrombus formation |
| early ambulation | assists in restoring GI activity |
| paralytic ileus | a decrease or absence of intestinal peristalsis that may occur after abdominal surgery peritoneal trauma severe metaolic disease or other disorders |
| most common side effect of opioids | constipation adverse side effect respiratory depression |
| opioids | bind to receptor sites in the brain |
| NSAIDS | supress part of the antiinflammatory path way |
| most common side effect of NSAIDS | GI bleeding adverse effect is induction of asthma |
| the post op coctail | versed and fentanyl |
Created by:
sonjasig
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