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medsurg
pre-operative part 1
| Question | Answer |
|---|---|
| surgical classifications (based on urgency | emergent, urgent, required, elective, optional |
| emergent | immediate, life threatening need level 1, OR ready, team on call |
| urgent | needs prompt attention 24-30 hours |
| required | needs attention before getting worst, but more time |
| elective | should have it, but not catastrophic if dont |
| optional | not needed, like cosmetic |
| informed consent | telling the pt exactly what they need to know before agreeing necessary for all non emergent surgical procedures |
| criteria for valid informed consent | -voluntary consent -freely given, without coercion -informed subject ( explain procedure, risks, benefits. offer to answer questions, can refuse) -patient able to comprehend |
| preparation for surgery | complete history and physical points of emphasis |
| points of emphasis - preparation for surgery | adverse anesthesia effects mediations (OTC, Px, discont. ) allergies PMH PSM substance abuse (rxn to analgesics, withdrawl) nutritional status |
| why nutritional status is important | healing recovery obesity |
| pre-op diagnostic testing | confirm completed and all results available common tests specific testing for pre-existing disease processes |
| common pre-op tests | CBC, electrolytes, UA EKG chest Xray type and screen / type and cross pregnancy test (urine or blood) |
| blood products | need a written consent to administer can be part of surgical consent (separate section) confirm ordered : type and screen, type and cross |
| what blood products can we administer as students? | Nothing! |
| pre-op patient teaching is the key to... | better post-op outcomes |
| deep breathing/coughing steps | sitting in position splint incision deep breath x3 quick deep breaths strong cough repeat x3 (hold pressure on incision to decrease stress) |
| incentive spirometer | shows how well pt is breathing decreases risk of pneumonia like lung exercises |
| teaching steps | sit at edge of bed or raise HOB seal lips around mouth piece breath in slowly and deeply raise piston to yellow indicator hold breath for 5 seconds allow piston to fall repeat 10x/hr (awake) yellow indicator= best effort after 10, cough |
| foot exercises | point toes to HOB and foot of bed repeat 5 times each foot. |
| purpose of foot exercised | decrease risk of DVT promotes circulation prevents stasis |
| leg exercises | bend leg at knee and raise towards chest, straighten leg and hold, lower leg down. repeat 5x with each leg |
| ankle exercises | rotate both ankles making a complete circle circle to the right then to the left repeat 5x |
| SCDs (sequential compression devices) and TED hose | promote circulation and prevent DVT |
| mobility, turning, positioning | promotes healing and decreases length of stay OOB day of surgery or 1st post-op day, unless other reason assistive devices to promote mobility physical therapy |
| abductor pillow | to keeps hips in alignment often after hip replacements |
| post-op drains | explain anticipated drains and purpose of drains provide literature with illustrations |
| Nasogastric tube | inserted through the nasal cavity and goes down into the stomach may connect to suction to drain gastric contents tell pt why they got it and how long it'll be there |
| chest tube to underwater seal drain | mainly used for thoracic surgeries to drain fluid pts must be careful when ambulating with tube |
| suction vac drain | aka hemovac drain, suctions out fluid |
| J.P. drain | bulb-like drain |
| pain management | teaching pain communication skills pre-op is best for post-op explain pain scale pre-operatively instruct pt to ask for pain meds as frequently as needed |
| pca pump | patient controlled analgesia filled with analgesics w pre-set PRN dose (ex. 2mg q2hr) pt clicks button and to give themself a bolus |
| regional pain pumps | surgically implanted devices that deliver medication directly into spinal fluid to treat severe pain |
Created by:
ago24