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Periperative care

perioperative chapter review

Define- preoperative before surgery
Define- intraoperative during surgery
Define- perioperative the operative experience consisting of the preop, intraop, and postop time periods
Define- postoperative after surgery
What does preoperative nursing place special emphasis on? Safety/ Advocacy/ Patient education
Define- Diagnostic surgery This is performed to determine the origin and cause of a disorder or the cell type for cancer.
What kind of conditions or procedures are done for diagnostic surgery? Breast biopsy/ exploratory laparotomy/ arthroscopy
Define- curative surgery This is performed to resolve a health problem by repairing or removing the cause
What kind of conditions or procedures are done for curative surgery? Cholecystectomy/ appendectomy/ hysterectomy
Define- restorative surgery This is performed to improve a patient’s functional ability
What kind of conditions or procedures are done for restorative surgery? Total knee replacement/ finger reimplantation
Define- palliative surgery This is performed to relive symptoms of a disease process but does not cure
What kind of conditions or procedures are done for palliative surgery? Colostomy/ nerve root resection/ tumor debulking/ iliostomy
Define- cosmetic surgery This is performed primarily to alter or enhance personal appearance
What kind of conditions or procedures are done for cosmetic surgery? Liposuction/ revision of scars/ rhinoplasty/ blepharoplasty
Define- elective surgery This is a planned surgery for correction of a nonacute problem (non urgent)
What kind of conditions or procedures are done for elective surgery? Cataract removal/ hernia repair/ hemorrhoidectomy/ total joint replacement
Define- urgent surgery This requires prompt intervention; may be life threatening if tx is delayed more than 24-48 hr
What kind of conditions or procedures are done for urgent surgery? Intestinal obstruction/ bladder obstruction/ kidney or ureteral stones/ bone fx/ eye injury/ acute cholecystitis
Define- emergent surgery This requires immediate intervention because of life threatening consequences
What kind of conditions or procedures are done for emergent surgery? Gunshot or stab wound/ severe bleeding/ abd aortic aneurysm/ compound fx
Define- minor surgery This is a procedure without significant risk; often done with local anesthesia
Define- major surgery This is a procedure of greater risk; usually longer and more extensive than a minor surgery
What kind of conditions or procedures are done for minor surgery? Incision and drainage (I&D)/ implantation of a venous access device (VAD)/ muscle biopsy
What kind of conditions or procedures are done for major surgery? Mitral Valve replacement/ Pancreas transplant/ lymph node dissection
What kind of conditions or procedures are done for simple surgery? Simple/ partial mastectomy
What kind of conditions or procedures are done for radical surgery? Radical prostatectomy/ radical hysterectomy
What kind of conditions or procedures are done for minimally invasive surgery? Arthroscopy/ tubal ligation/ hysterectomy/ lung lobectomy/ coronary artery bypass/ cholcystectomy
Define- simple surgery This is when only the most overtly affected areas are involved
Define- radical surgery This is extensive surgery that is beyond the obvious areas; this is directed at finding a root cause
Define- minimally invasive surgery (MIS) This is when surgery is performed in a body cavity or body area through one or more endoscopes
What do Minimally invasive surgery (MIS) do? This surgery can correct problems/ remove organs/ take tissue for biopsy/ re-route blood vessels/ drain systems
What surgery is the fast growing and ever changing type? Minimally invasive surgery (MIS)
Define- inpatient or same-day admission This type of patient may be admitted the day of or more often, the day of surgery
Define- outpatient or same-day surgery This type of patient who goes to the surgical area the day of surgery and returns home the same day
What are some types of outpatient facilities? Ambulatory surgical centers/ freestanding surgical centers/physicians' offices/ and ambulatory care centers
What type of stressors are involved with anaesthsia and surgery physical and emotional stressors
What are some factors that increase risks for surgery and postop Age/ meds/ medical hx/ Prior surgical experience/ health hx/ type of surgery planned
What are some of the medical histories that can effect surgery and postop? decreased immunity/ DM/ pulmonary dz/ cardiac dz/ hemodynamic instability/ multisys dz/ coagulation defect or disorder/ anemia/ dehydration/ infection/ HTN/ hypotension/ any chronic dz
What are some medications that can effect surgery and postop antihypertensives/ tricyclic antidepressants/ anticoagulants/ NSAIDS
What are some cardiac problems that can increase surgical risks? Coronary heart dz, angina, MI within 6 mo, heart failure, HTN, dysrrhythmias
What is the effects of ETOH withdrawal before surgery? ETOH can lead to delirium tremens
Define- carboxyhemoglobin this is carbon monoxide on O2 binding sites of the hgb molecule
What effects does carboxyhemoglobin have in smoking patients? Smoking increases the blood levels of this which decreases oxygen delivery to organs
What is atelectasis? What are the effects on anesthesia? this is collapse of aveoli and it reduces gas exchange and causes intolerance of anesthesia
What type of allergy is common also with allergies to bananas and other fruits? Latex
If someone is allergic to shellfish- what precaution should be taken in prep for surgery? The patient may have a reaction to the povidone-iodine (betadine) due to it containing some of the same allergens
Define- autologous donations this is blood that is donated by the patient for themselves a few weeks (5) prior to surgery for their surgery
What effects does surgery have on the body? it increases metabolic rate and depletes potassium/ vit C/ B vitamins/ all which are needed for wound healing and blood clotting
Define- directed blood donation This is where a friend or familyof the same blood typing donated blood specifically for a patient
What is the use for epoetin alpha in surgery? This is a medication that helps the patient stimulation their own RBC production, given before during and after surgery
What can be prescribed before surgery that will help RBC formation? Supplemental iron, folic acid, vit B12 and vit C
When is discharge planning started? before surgery
Define morbidity serious problem
Define mortality deaths
Why to assess cardiovascular status? because cardiac problems may cause as many as 30% of surgery related deaths
How do you do check cardiovascular status? check the patient for HTN, listen to the hear- note rate, rythym, and abnmlsl, examine hand, feet for edema, temp, color, pulses
How do you do check respiratory status? consider age, smoking hx, and chronic illnesses; observe rate rythym depth of respirations and effort, clubbing of fingertips, cyanosis
Why to assess cardiovascular status? this affects the excretion of drugs and waste products, including analgesic and anesthetic products. If this is reduced, electrolytes can be altered
How do you do check renal status? ask about frequency, dysuria, nocturia, difficulty starting flow, and oliguria. Ask about color and appearance, intake and output and ability.
A patient with a decreased kidney function has confusion, disorientation, apprehension and restlessness. What drugs could cause this? scopolamine(Buscopan), morphine, meperidine (demerol), and barbiturates
Why to assess neurologic status? this information is needed before planning preoperative teaching and care after surgery
How do you do check neurologic status? this is assessing the mental status, LOC, orientation, ability to follow commands, and motor and sensory defects
What does surgery do to the nutritional status? surgery increase metabolic rate and depletes potassium, vit C, and V vitamins.
Why does the body need potassium, vit C, and V vitamins for after surgery? these provides the body the ability for wound healing and blood clotting
Negative nitrogen balance may be a result from depleted protein stores. What problem does this present after surgery? it increases the risk for skin breakdown, delayed wound healing, possible dehiscence or evisceration
What are the indications for poor fluid nutritional status? brittle nails, muscle wasting, dry or flaky skin, decreased skin turgur, and hair changes, orthostatic hypotension, decreased serum protein levels and abnml serum electrolyte values
When is preadmission testing performed? 24 hours to 28 days before the scheduled day
What are the commom lab tests that are ordered for persurgery? UA, ABO-rh, CBC or H/H, PT-INR, aPTT, electrolyte values, serum creatinine nad blood urea Nitrogen levels, HCG serum. ABGs with patients with chronic pulmonary problems
What risk does hypokalemia present to surgical patients? it increases the risks for toxicity if the patient is taking dig, slows the recovery from anesthesia, and increases cardiac irritability
What risk does hyperkalemia present to surgical patients? it increases the risk for dysrhythmias, especially with use of anesthesia
What imaging procedures with possibly be ordered before surgery? CXR-for heart size, infection, lung size, and major vessels and for a baseline. CT or MRI- patient with back pain before spinal surgery. ECG- order age groups or hx of cardiac dz
Potassium is increased in…? dehydration, renal failure, acidosis, cellular/tissue damages, and hemolysis of the specimen
Potassium is decreased in…? NPO status when required amt is inadequate, excessive use of non-potassium sparing diuretics (Spironolactone(Aldactone)), v/d, malnutrition, alkalosis
Na is increased in…? cardiac or renal failure, HTN, excessive IV with NS, edema, dehydration (hemoconcentration)
Na is decreased in…? NG drainage, v/d, excessive lax or diuretic use, excessive IV with water, syndrome of inappropriate antidiuretic hormone(SIADH)
Cl is increased in…? resp alk, dehydration, renal failure, excessive amt of fluid with NaCl
Cl is decreased in…? excessive NG drainage, v/d, excessive use of diuretics
CO2 is increased in…? chronic pulm dz, intestional obstruction, vomiting or NG suctioning, metabolic alk
CO2 is decreased in…? hypervent, diabetic ketoacidosis, diarrhea, lactic acidosis, renal failure, salicylate toxicity
Nml CO2 level 22-28 (differs with age)
Nml K levels 3.5-5.0
Nml Na levels 135-145
Nml Cl levels 96-106
Nml Glucose levels 70-110
Nml Creatinine levels 0.5-1.2 (differs with gender and age)
Nml BUN levels 10-20 under 60yrs, 2.9-23 over 60yrs
Nml PT levels 11-12., 85%-100%, 1:1:1 pt control ratio
Nml INR levels 0.7-1.8
Nml aPPT levels 30-40sec
Nml WBC levels 5.0-10.0
Nml Hgb levels 12-16 (differs with age and gender)
Nml Hct levels 0.37-0.52 (differs with age and gender)
Glucose is increased in…? hyperglycemia, Excessive IV with glucose, stress, steroid use, pancreatic or hepatic dz
Glucose is decreased in…? Hypoglycemia, ecess insulin
Creatinine is increased in…? renal damage with destruction of lg numbers of nephrons, renal insuff, acute renal failure, chronic kidney dz, end-stage kidney dz
Creatinine is decreased in…? atrophy of muscle tone
BUN is increased in…? dehydration, renal failure, excessive protein in diet, liver failure
BUNis decreased in…? overhyration, malnutrition
PT is increased in…? coagulation defects (bleeding disorder)
PT is decreased in…? coagulation disorder such as thrombophlebitis or pulm embolus
INR is increased in…? anti-coag therapy (warfarin, ASA)
INR is decreased in…? extensive CA
aPTT is increased in…? coag defect, anti-coag therapy, liver dz
aPTT is decreased in…? Coag disorder, extensive CA
WBC is increased in…? infection, inflammation, stress, tissue necrosis
WBC is decreased in…? immune disorder, immunosuppressive therapy
Hgb is increased in…? dehydration, polycythema, chronic pulm dz, CHF
Hgb is decreased in…? Blood loss, anemia, liver failure
Hct is increased in…? dehydration, polycythemia, high altitude
Hct is decreased in…? Blood loss, anemia, renal failure
What does an informed consent mean when the patient has it signed? the pt understand nature and reason, who will be perform it and if others will be there, all available options and risks assoc, the risk assoc with procedure and the use of anesthesia and its potential outcomes
Define splinting and function. splinting is holding the incision site with an item that will provide support, promotes a feeling of security, and reduces pain during coughing
What benefits does mobility have on a post-op patient? it stimulates intestinal motility, enhances lung expansion, mobilizes secretions, promotes venous return, prevents joint rigity, and relieves pressure
What patients are at greater risk for DVT? obese, older than 40yrs, CA, decreased mobility, immobility, spinal cord injury, hx of DVT, PE, varicose veins, edema, taking oral contraceptives, smoke, decreased cardiac output, and hip fx, or total hip or knee replacement
Preoperative medications sedatives-hydroxyzine (Atarax, Vistaril), hypnotics- lotazepam(Ativan), anxiolytics- midazolam (Versed), opioid analgesics- morphine, hydromorphone, meperidine), and anticholenergic agents- atropine
Medication for rapid emptying the stomach for surgery metoclopramide (Reglan)
Medication for long procedures that help prevent the cause of ulcers H2 histamine blockers- cimetidine (Tagamet), ranitidine (Zantec)
Preop check list includes… signed informed consent, confirmed surg date/type, ID of left or right, allergies, height and weight, results of lab and imaging, blood info/donations, vital signs (1-2hrs prior to surg)
Created by: kmichalle
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