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ch 2 care of the surgical patient

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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