Acute Health Challenges- The Surgical Experience Flashcards Preview

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Flashcards in Acute Health Challenges- The Surgical Experience Deck (36)
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1

Define Surgery.

the art and science of treating diseases injuries and deformities by operation & instrumentation

2

Name 3 phases of preoperative period.

pre-operative
intra-operative
post operative

3

Reasons for surgery.

dx
cure
palliation
prevention
exploration
cosmetic

4

Elective surgery.

planned surgery

5

Emergency surgery.

unexpected or urgent

6

Where are surgeries performed?

- OR with admission
- Same day admission (ambulatory surgery/outpt) -discharged home after
- Dr.'s office
- ER
- Clinics

7

5 expected outcomes of surgical intervention.

- Dx
- Reconstructive
- Curative
- Palliative
- Transplant

8

Diagnostic surgery.

(biopsy) origins of symptoms & extent of disease

9

Reconstructive surgery.

correct disease or improve cosmetic appearance

10

Curative Surgery.

repair or remove disease organ- restore normal function (e.g. amputation, aneurysm)

11

Palliative Surgery.

decrease spread of disease and prolong life- alleviate pain

12

Transplant Surgery.

remove organ replace with functioning one

13

Preoperative nursing role.

- Co-ordinate client care
- Ensure pre-operative tests are WNR
- Varify documents (go through pre op checklist)
- Report abnormalities
- Major responsibility is teaching in preparation for OR

14

Pre-op Surgeon Responsibilities.

- Determine need for surgery: Pre-op assessment, determine surgical setting in collaboration with the client, diagnostic tests that directly correlate with the OR and Dx
- Consent for surgery
- Teaches client about outcomes and risk of OR
- Ensures client safety in OR
- Post-op management

15

When does the hx and physical done and by whom?

30 days before surgery by family physician

16

Anesthetist responsibilities.

- consent for anesthesia
- pre op evaluation (hx, complications from previous anesthesia, medications, OTC, Herbal, advise when to D\C meds prior to OR)
- select anesthetic agents
- teacher re: anesthetic medications and side effects and risk factors
- intubation and extubation
- monitors throughout OR

17

Nurses responsibilities re: consent for surgery.

- must advocate on the pts behalf if additional info is requested
- consent must be signed prior to the administration of pre-op medications

18

Who's responsibility is it to get consent for surgery.

the physician

19

Conditions for informed consent.

- adequate disclosure
- demonstration clear understanding and comprehension of the information being provided
- consent must be voluntarily

20

Assessment in the preoperative phase- Nursing Hx includes.

- factors that can increase risk or influence outcomes
- medical hx including family hx of anesthesia problems (malignant hyperthermia, etc)
- medication allergies, other allergies
- age related factors
- social/cultural/spiritual concerns (ex. blood transfusions for Jehovah Witness)
- psychological status (assess fears)
- 3rd person help with language/mental status if a needed

21

Components of psychological assessment of the pt before surgery.

SITUATIONAL CHANGES
- support system
- personal control, decision making, and independence
- impact of surgery on family and dependents, finance, etc.
- hope and anticipation of positive results
CONCERNS WITH THE UNKNOWN
- identify specific areas and depth of anxiety and fear
- identify expectations of surgery, changes in current health status, & effects on daily living
CONCERNS WITH BODY IMAGE
- current roles or view of self
- perceived or potential changes in role or relationships and their impact on body image
PAST EXPERIENCES
- review previous surgical experiences, hospitalizations and txt (positive or negative)
- current perception of surgery in re: to the above
KNOWLEDGE DEFICIT
- Identify what amount and type of preoperative information this specific pt wants to receive
- assess understanding
- identify accuracy in info

22

Subjective health hx data of pt about to undergo surgery.

PAST HEALTH HX
- past surgery? which one? complications?
- family hx of surgical complications?
- past hospitalizations?
- chronic health conditions?
- HTN? Cardiac disease?
- Hx of dyspnea, coughing, hemoptysis, COPD or asthma
CURRENT HEALTH HX
- usual or present height and weight? Recent weight loss or gain?
- present respiratory tract infection?
- do you wear glasses, contact lenses, or hearing aids?\
- Do you smoke? How many packs/day? How many years?
- Alcohol intake?
- problems healing?
- musculoskeletal problems that might affect positioning during surgery or activity level after surgery?
- limitation in mobility o your neck?
- equipment for ambulation?
- pain tolerance? methods used for pain relief?
- anxiety r/t surgery?
- support following discharge?
MEDICATIONS
- prescribed? OTC? herbal?
- allergies, or sensitivities to food or meds?

23

Considerations for the older adult.

- normal aging decreased immune system
- delayed wound healing
- decreased ability to withstand stress
- changes in mental status
- increased incidence of chronic disease
- increased cardiac pulmonary complications

24

Medical hx.

- previous admissions/ OR
- past illnesses
- reason for surgery
- complications previous OR
- prior blood transfusion or reactions
- objections to getting blood
- Medications (prescribed, OTC/herbal, ASA stopped 2 weeks prior to OR)

25

Preoperative physical assessment.

- VS
- CV
- Respiratory
- Renal
- Neurologic (oriented x3)
- Musculoskeletal
- Nutritional
- Psychosocial
- Results of dx tests

26

Benzodiazepines examples, purpose and effects.

Decreased anxiety
Induce sedation
Induce amnesia
ex. midazolam (Versed), diazepam (Valium), lorazepam (Ativan)

27

Narcotics examples, purpose and effects.

Relieve discomfort during preoperative procedure, decrease the amount of anaesthetic medication required.
Ex. morphine, meperidine (Demerol), fentanyl (Sublimaze)

28

Histamine H2 receptor antagonist examples, purpose and effects.

Increase gastric pH, decreased gastric volume
Ex. cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac)

29

Antiemetics examples, purpose and effects.

increase gastric emptying and decrease N&S
Ex. metoclopramide (Reglan), droperidol (Inaspine)

30

Anticholinergics examples, purpose and effects.

decrease oral and respiratory secretions, prevent bradycardia
ex. atropine, scopolamine