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Chp 14
| Question | Answer |
|---|---|
| Ambulatory surgery | surgery that requires fewer than 24 hours of hospitalization: sometimes referred to as same-day or outpatient surgery |
| Anesthesia | acts on the CNS to produce loss of sensation, reflexes, and consciousness |
| Anesthetist | may be medical doctor who administers anesthesia but has not completed a residency in anesthesia, a dentist who administers limited types of anesthesia, or a registered nurse (RN) (master's-prepared) who has completed an accredited CRNA program/exam |
| Dehiscence | separation of wound edges without the protrusion of organs |
| Evisceration | occurs when the wound completely separates and organs protrude |
| Intraoperative | includes entire surgical procedure until transfer of client to the recovery area |
| Malignant hyperthermia | an inherited disorder that occurs when body temperature, muscle metabolism, and heat production increase rapidly, progressively, and uncontrollably in response to stress/anesthetic agents 2 test to see if susceptible - skeletal muscle biopsy & blood test |
| Paralytic ileus | disorder in which the intestine becomes dynamic from an absence of normal nerve stimulation to intestinal muscle fibers |
| Perioperative | entire span of surgery, including before and after the actual operation |
| Phlebothrombosis | clot formation with minimal or absent inflammation |
| Postoperative | begins with admission to recovery area and continues until the client receives a follow-up evaluation at home or is discharged to a rehabilitation unit |
| Preoperative | begins with the decision to perform surgery and continues until client reaches the operating area |
| Procedural sedation | state in which patients are free of pain, fear, and anxiety and can tolerate unpleasant procedures while maintaining independent cardiorespiratory function and the ability to respond to verbal commands and tactile stimulation |
| Surgical asepsis | prevents contamination of surgical wounds |
| Thrombophlebitis | venous inflammation and clot formation in the veins |
| Categories of surgery based on urgency | 1emergency -life-threatening - gunshot wound 2urgent - within 24-30 hrs - acute gallbladder infection 3required- planned/required at some point - cataracts 4elective -no harm if not done/benefit if done - vaginal repairs 5optional- personal preference |
| What should be covered in the preoperative assessment? | -review pre-op lab and diagnostic studies -review client's health history and preparation for surgery -assess physical needs -assess psychological needs -assess cultural needs |
| Voluntary consent | consent must be freely given without coercion. Client must be at least 18 unless an emancipated minor. Physician must obtain consent while a professional staff member witnesses the client's signature |
| Incompetent client | individual who is not autonomous and cannot give or withhold consent (ex. cognitively impaired, mentally ill, or neurologically incapacitated) |
| Informed subject | informed consent in writing/ contain the following: -explanation procedure/risks -descriptions benefits/alternatives -offer answer questions about procedure -instructions client may withdraw consent -statement informing client if protocol differs |
| Surgical risk factors | -age -nutritional status -substance abuse -medical problems |
| Things to include in preoperative teaching | -preoperative medications -postoperative pain control -explanation/description of post anesthesia recovery room or postsurgical area -discussion of frequency of assessing vital signs and use of monitoring equipment |
| Physical preparation prior to surgery includes: | -skin preparation -elimination -food/fluids -care of valuables -attire/grooming -prostheses |
| Antianxiety medications | Lorazepam -reduce preop anxiety, cause slight sedation, slow motor activity, and promote induction of anesthesia |
| Histamine-2 receptor antagonists | Cimetidine -decrease gastric acidity and volume |
| Anticholinergics | Glycopyrrolate -decrease respiratory secretions, dry mucous membranes, and prevent vagal nerve stimulation during endotracheal intubation |
| Neuromuscular blocking agents | Succinylcholine -promote skeletal muscle relaxation during procedure, allow for rapid intubation |
| Opioids | Fentanyl -sedate and decrease the amount of anesthesia |
| Sedatives | Midazolam -promote sleep or amnesia and decrease anxiety |
| Antibiotics | Kanamycin -destroy enteric microorganisms |
| Preoperative checklist includes the following: | -assessment (identify allergies) -preoperative medications -IV (location, type, solution, rate) -preoperative preparations -medical records -other information -signatures |
| Four stages of induction of general anesthesia | Stage 1: induction Stage 2: excitement Stage 3: surgical anesthesia Stage 4: medullary depression |
| Stage 1: induction | crucial for producing unconsciousness. Inhaled or IV anesthetics used. -client experiences dizziness, detachement, temporary heightened awareness to noises, "heavy" extremities. When unconscious, endotracheal tube used to secure airway |
| Stage 2: excitement | client may struggle, shout, talk, sing, laugh, or cry. May make uncontrolled movement, protect client from injuring self. quick/smooth administration of anesthesia can prevent this phase |
| Stage 3: surgical anesthesia | client is unconscious through continuous administration of anesthetic agent -muscles relaxed, breathing is depressed -this stage can be maintained for hours with a range of light to deep anethesia |
| Stage 4: medullary depression | occurs when client receives too much anesthesia -client has shallow respirations, weak pulse, widely dilated pupils unresponsive to light. -without prompt intervention, death will occur |
| Sedation | refers to a pharmacologically induced state of relaxation and emotional comfort |
| Local anesthesia | administered topically or by local infiltration -palliative pain management may be delivered by pump into subcutaneous tissue -local loss of sensation -primarily for dental, eye, and minor surgeries |
| Spinal anesthesia | local anesthetic injected into subarachnoid space of lumbar area -used for surgery involving the abdomen, perineum, & lower extremities |
| Conduction nerve block | local anesthetic injected into or near a specific nerve trunk -uses vary - epidural for obstetrics or brachial plexus block for arm/hand surgeries, trigeminal face pain |
| Three phases of the sedation process | 1-titration of sedative medications, which is the administration of multiple small doses of medication until the desired drug effect is achieved 2-performance of the diagnostic or therapeutic procedure 3-recovery phase |
| Surgeon | heads medical team -responsible for determining the surgical procedure required, obtaining client's consent, performing the procedure, and following the client after surgery |
| Surgical assistants | 1st assistant - assists in surgical procedure and may be involved with the client's preoperative and postoperative care (endorsed by AORN) 2nd & 3rd assistant - RNs, LPNs, or surgical technologists who assist the surgeon and first assistants |
| Scrub nurse | -may be RN, LPN, or surgical technologist -wears a sterile gown/ gloves and assists surgical team by handing instruments to the surgeons and assistants, preparing sutures, receiving specimens for lab examination, & counting sponges and needles |
| Circulating nurse | RN -wears OR attire but not a sterile gown, and is responsible for overseeing the health and safety of the client by monitoring all activities of the surgical team -assessment of client for signs of injury, intervening as needed |
| Unrestricted zone | central point to monitor the arrival of patients, personnel, and supplies. Street clothes are allowed in this area |
| Semi-restricted zone | includes peripheral support area of surgical suite, storage area for sterile/ clean supplies, work areas for processing, storage of instruments, and corridors leading to restricted area of OR. -surgical attire, 2 piece pantsuits, cover jackets, caps |
| Restricted zone | includes OR & procedure room -full surgical attire & cover all head/facial hair. 2 piece pantsuit, cover jackets, head coverings, shoes/shoe covers, masks, protective eyewear, & other protected barriers as indicated |
| Initial postoperative assessment | assess airway patency, effectiveness of respirations, presence of artificial airways, mechanical ventilation, supplemental oxygen, circulatory status, vital signs, wound condition, fluid balance, level of consciousness, and pain |
| Prevention of postoperative complications | -monitor for hemorrhage -monitor for shock -monitor for hypoxia -monitor for aspiration |
| Signs and symptoms of shock | pallor, fall in BP, weak and rapid pulse rate, restlessness, and cool, moist skin. -must be detected early and treated promptly because it can irreversibly damage vital organs such as the brain/kidneys/heart |
| Phases of wound healing | Inflammatory stage proliferative phase maturation phase |
| Inflammatory stage | blood clot forms, swelling occurs, and phagocytes ingest the debris from damaged tissue and the blood clot. lasts 1-4 days |
| Proliferative phase | collagen is produced and granulation tissue forms occurs over 5-20 days |
| Maturation phase | lasts from 21 days to at least several months and even 1-2 years during this phase, the tensile strength of the wound increases through synthesis of collagen by fibroblasts and lysis by collagenase enzymes |
| Three modes of wound healing | -primary intention -secondary intention -tertiary intention |
| Primary intention | wound layers are sutured together so that wound edges are well approximated. This type of incision usually heals in 8-10 days with minimal scarring |
| Secondary intention | granulating tissue fills in the wound for the healing process. skin edges are not approximated. this method is used for ulcers and infected wounds. Slow healing |
| Tertiary intention | approximation of wound edges is delayed secondary to infection. when the wound is drained and cleaned of infection, wound edges are sutured together. Resulting scar is wider than that with primary intention |
| Criteria for patient to leave hospital/outpatient setting | -has stable cardiovascular function and a patent airway -is easily aroused -has intact protective reflexes -can talk -can sit up unaided -is adequately hydrated |
| A nurse is reviewing a list of clients scheduled for outpatient surgery the following day. What clients would be of most concern to the nurse? | a client who reports a blood clotting problem having abdominal hernia repair |
| Nurse is caring for a 16yr old client who requires surgery to realign the bones in a fractured tibia sustained while backpacking with a youth group. In this case, from who is it most appropriate to obtain consent to perform the surgical procedure? | the client's parent |
| The nurse recognizes that more preoperative teaching is needed when hearing the client state which of the following statements? | "I can have a small breakfast of orange juice and coffee the morning of surgery" |
| A nurse is caring for a client scheduled for right rotator cuff repair. The client expresses concern about having the wrong shoulder operated on. What responses by the nurse should help to relieve the client's fears? (Select all) | -"The OR nurse will ask you to identify which shoulder is being operated on" -"You are asked to mark your right shoulder with an 'X' to ensure the surgery is on the correct side" -"Your surgeon will have to verify that the right shoulder is correct" |
| A nurse needs to explain a postoperative client the importance of performing leg exercises after surgery. What is the nurse's best explanation? | "contracting and relaxing leg muscles prevents the formation of blood clots" |
| The nurse observes that a surgical client is experiencing abdominal incisional discomfort when coughing postoperatively. Which nursing intervention is most appropriate for reducing the client's discomfort? | "Apply light pressure to the incision with a pillow" |
| The nurse notes that a postoperative client is on a clear liquid diet. Which food item is most appropriate to provide? | A dish of gelatin |
| The nurse explains the purpose of the Penrose drain positioned in the postoperative client's abdomen. What is the nurses best explanation? | "An open wound drain removes fluid from the surgical area" |
| The nurse notes that a postoperative abdominal surgical client who is NPO is complaining of a dry mouth. What is the best action for the nurse to take? | Assist the client to perform frequent oral hygiene. |
| A client is hospitalized for a surgical procedure. during the assessment, the nurse notes that the client has not carried out a specific portion of the pre-op instructions. Which of the following nursing interventions should the nurse perform? | Notify the surgeon |
| A nurse applying for a position in the local hospital asks the interviewing nurse what the responsibilities of a circulating nurse would be. what would be the interviewing nurse's most appropriate response? | The circulating nurse obtains and opens wrapped sterile equipment |
| The nurse explains to the student nurse the factors that may promote anxiety for a client undergoing a surgical procedure. Which factors would the nurse be most likely to include? | -Unfamiliar environment -Postoperative pain |
| A nurse needs to care for a client during the immediate postoperative period. Which of the following factors predisposes the client to hypoxia? | -pooling of secretions in the lungs |
| A nurse explains to a client who underwent surgery the rationale for using caution when changing the wound dressings. What would be the nurse's most appropriate explanation? | -caution is needed to prevent damaging new tissue |
| What does weight gain during the postoperative period signify? | -fluid accumulation |
| Which of the following preoperative medications causes decreased respiratory tract secretions, dry mucous membranes, and interrupts vagal stimulation? | -anticholinergics |
| Which type of anesthesia describes a state in which the client is free of pain, fear, anxiety; can tolerate unpleasant procedures while maintaining independent cardiorespiratory function, the ability to respond to verbal commands and tactile stimulation? | -procedural sedation |
| Which of the following postoperative complications results from saliva, mucus, vomitus, or blood, making its way into the lungs as a result of difficulty in swallowing or a client's inability to expectorate oral secretions? | -aspiration |
| A client asks the nurse about the healing of the surgical wound. The nurse explains the stages of healing, with one stage lasting 21 days to at least several months, allowing for increased wound strength through physiologic processes. What stage? | the maturation phase |
Created by:
ahoyyitbeaddi
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