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