Flashcards in Acute Health Challenges- The Surgical Experience Deck (36)
the art and science of treating diseases injuries and deformities by operation & instrumentation
Name 3 phases of preoperative period.
Reasons for surgery.
unexpected or urgent
Where are surgeries performed?
- OR with admission
- Same day admission (ambulatory surgery/outpt) -discharged home after
- Dr.'s office
5 expected outcomes of surgical intervention.
(biopsy) origins of symptoms & extent of disease
correct disease or improve cosmetic appearance
repair or remove disease organ- restore normal function (e.g. amputation, aneurysm)
decrease spread of disease and prolong life- alleviate pain
remove organ replace with functioning one
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
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
When does the hx and physical done and by whom?
30 days before surgery by family physician
- 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
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
Who's responsibility is it to get consent for surgery.
Conditions for informed consent.
- adequate disclosure
- demonstration clear understanding and comprehension of the information being provided
- consent must be voluntarily
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
Components of psychological assessment of the pt before surgery.
- 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
- review previous surgical experiences, hospitalizations and txt (positive or negative)
- current perception of surgery in re: to the above
- Identify what amount and type of preoperative information this specific pt wants to receive
- assess understanding
- identify accuracy in info
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?
- prescribed? OTC? herbal?
- allergies, or sensitivities to food or meds?
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
- 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)
Preoperative physical assessment.
- Neurologic (oriented x3)
- Results of dx tests
Benzodiazepines examples, purpose and effects.
ex. midazolam (Versed), diazepam (Valium), lorazepam (Ativan)
Narcotics examples, purpose and effects.
Relieve discomfort during preoperative procedure, decrease the amount of anaesthetic medication required.
Ex. morphine, meperidine (Demerol), fentanyl (Sublimaze)
Histamine H2 receptor antagonist examples, purpose and effects.
Increase gastric pH, decreased gastric volume
Ex. cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac)
Antiemetics examples, purpose and effects.
increase gastric emptying and decrease N&S
Ex. metoclopramide (Reglan), droperidol (Inaspine)