Chapter 2 Care for the Surgical Patient
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Chapter 2 Care for the Surgical Patient - Leaderboard
Chapter 2 Care for the Surgical Patient - Details
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| What are the 3 types of surgeries? | 1) Elective-not life preserving but patients choice 2) Urgent-to keep additional health problems from occurring 3) Emergent-Life preserving or bodily function preserving to be performed immediately |
| What are some reasons surgery may be performed(9) | 1)Diagnostic-Surgical exploration that allows confirmation of diagnosis 2)Ablative-Excision or removal of diseased body part 3)Palliative-for relief or reduction of intensity of symptoms 4)Reconstructive-Restoration of function or appearance following malformation or trauma 5)Curative-Cures the problem 6)Preventative-Prevents future damage or problems from occurring 7)Transplant-Replacement of malfunctioning organs 8)Constructive-Restoration of function lost or reduced due to congenital anomalies 9)Cosmetic-Alteration of appearance |
| What are the three admission statuses for a surgical patient? | 1) Ambulatory- The patient enters the setting, has surgery and is discharged the same day(i.e. breast biopsy, cataract extraction, hemorrhoidectomy, scar revision) 2) Same-day admit-The patient enters the setting, undergoes surgery and remains in the hospital(i.e. carotid endarterectomy, cholecystectomy, mastectomy, hysterectomy) 3)Inpatient-The patient enters the setting, undergoes surgery and remains in the hospital for more than one night(i.e. amputation, heart transplant, laryngectomy, resection of aortic aneurysm) |
| What are some common surgical settings?(4) | 1) Outpatient- patient is not hospitalized and is admitted either to short-stay unit or directly to the surgical suite 2) Short-Stay Surgical Center- Surgery is performed when overnight hospitalization is not required 3)Short-Stay Unit- Department where patient's stay does not exceed 24 hours 4) Mobile Surgery Unit- A unit that moves from place to place(Moves to patient instead of patient moving to the unit) |
| What are some factors that influence surgery outcomes?(7) | 1)Age(Very young and old do not tolerate surgery as well) 2)Physical condition 3)Nutritional Status(Protein is essential to build and repair tissue) 4)Psychosocial Needs(The patients ability to comply to surgery and support structure influence recovery) 5)Socioeconomic and cultural needs 6)Current Medications(Polypharmacy may lead to adverse drug reactions and interactions and may involve pre-operative meds) 7)Education and Experience(Be sure to communicate at a level the patient can understand) |
| What are some supplements and herbs that must be discontinued prior to surgery? | Vitamin E, Garlic and Ginseng may prolong bleeding time. As well as St Johns Wort which may potentiate drug interactions |
| What are some common medications that are not discontinued prior to surgery?? | Anti-seizure and cardiac medications |
| What are some cultural considerations regarding interaction with a surgical patient? | 1) Use the patients language to help relieve anxiety 2) Some Asian, Native American and Middle Eastern cultures consider eye contact disrespectful 3)Chinese Americans may not ask for pain medication and may need further teaching on keeping ahead of pain and its importance in promoting healing 4)Native Americans often appear stoic when ill. Avoid undertreatment of pain 5) Some Arab Americans believe verbal consent is more meaningful than written consent. Education on the importance of written consent may be necessary 6) Some Vietnamese patients feel more comfortable with having an interpreter. Be considerate regarding sensitivity of information conveyed through an interpreter. Men are the decision makers so speaking to the male head of the family may be necessary |
| What are the goals of the pre-operative phase? | Patient education and prevention of complications |
| When is pre-op teaching best delivered? | 1-2 days prior to surgery |
| What are some important points to assess regarding a patients health history prior to surgery? | Acute and chronic illnesses, nutritional status, current medications and supplements, allergies, alcohol use, smoking and drug use, mental status, baseline vitals and height and weight |
| Why is collecting a allergy history for a patient prior to surgery important? | They may have an allergy to a medication or substance used during surgery. Furthermore a history of allergic responsiveness increases the chance of having hypersensitivity to anesthesia |
| Why does a patient who smokes have an increased chance of pneumonia following surgery? | A patient who smokes has decreased lung capacity. This may cause mucus to get trapped in the lungs causing atelectasis and eventual pneumonia |
| What are some other diseases that may increase the chance of reduction of respiratory system function following surgery? | COPD and asthma |
| What are some benefits of providing effective patient teaching prior to surgery?(8) | 1)Reduction of patient fears and anxiety 2)Reduction of amount of anesthesia needed 3)It is linked to improved intra-operative and post-operative behavior and improved outcomes 4)Reduces post-surgical pain and pain meds required 5)Reduces corticosteroid production 6)Decreases complications that may develop 7)Speeds up wound recovery 8)Includes the patient and the family(provides support foundation) |
| How can you verify patient understanding of education you have given? | 1)Ask questions that require response 2)Avoid yes/no questions 3)Provide printed material 4)Provide with support group information |
| What factors influence pre-op prep? | Patient age, physical and nutritional status, type of surgery and surgeons preference |
| What are some common pre-op labs?(8) | UA, CBC, Blood Chemistry, Serum Electrolytes(Especially Potassium to prevent dysrhythmia), Kidney function-Creatinine, BUN, x-ray, EKG |
| What are the duties of the surgeon in obtaining informed consent? | Explaining the risks, benefits and consequences of surgery as well as available alternatives. It is the surgeons job to have the consent signed |
| What are the duties of the nurse in obtaining informed consent? | To witness the patient signature and ensure that the signature was voluntary and the patient was competent |
| When is informed consent not necessary prior to surgery? | In an emergency situation when a patient is unable to give own consent and a responsible party is unable to be located physically or by phone. |
| What instructions should be given prior to surgery to avoid aspiration? | Current recommendation is clear liquids up to 2 hours prior to surgery unless delayed gastric emptying develops. Some facilities still require NPO status the midnight prior to surgery. |
| Why might a bowel cleanser be ordered prior to surgery? | Anesthesia relaxes the bowel |
| According to the CDC when might hair removal prior to surgery be necessary? | When it interferes with exposure or closure of the surgical sit and interferes with surgery(Facility policy and surgeon preference dictated). |
| Why is lung ventilation an important part of post-op education and care? | It prevents and treats atelectasis, improves lung expansion, improves oxygenation and prevents post-op pneumonia |
| What are some important points of post-operative education regarding lung ventilation? | Encouraging IS use in regular interval during the day and encouraging turn, cough and deep breathing(Unless contraindicated by surgery i.e. intracranial, eye, ear, nose, throat or spinal) |
| Why is it important to teach a patient to splint prior to coughing? | This reduces the risk of wound dehiscence |
| What are some nursing interventions to be performed in the presence of wound dehiscence and evisceration? | Apply a moist sterile dressing, raise the HOB to Semi-Fowlers, Flex the patients knees, turn q2h while awake |
| Why is it contraindicated to place a patient in supine position following surgery? | Supine position promotes blood stasis and the formation of a thrombus and eventual embolus |
| What are some nursing interventions to prevent blood stasis following surgery? | Leg exercises, anti-embolism stockings, Sequential Compression Devices(SCD) and early and often ambulation when possible |
| What is the most common complication following surgery? | Urinary retention |
| What causes urinary retention following surgery? | General anesthesia causes decrease in bladder tone which can lead to urinary retention |
| How long does it take for bladder tone to return to normal following general anesthesia? | Approximately 8 hours |
| What are some possible types of wound closures used in surgery? | Sutures, Staples, Steri-Strips, Transparent Strips and Tissue Adhesives |
| What is an important point of education for a patient regarding opioid administration? | Many patients have a fear of addiction. Therefore it is important to inform the patient that post-op addiction is rare due to the short amount of time that pain relief is required |
| What are some common pre-op medications? | 1)Opioid analgesics(Morphine, Fentanyl Citrate) 2)Benzodiazepines(Midazolam, Diazepam, Lorazepam) 3)Anticholinergics(Atropine Sulfate, Glycopyrrolate) |
| What are the effects of general anesthesia? | Amnesia, analgesia, muscle paralysis and sedation |
| 4 types of anesthesia | 1) General Anesthesia 2)Regional Anesthesia 3)Local Anesthesia 4)Conscious Sedation |
| What are the phases of anesthesia? | 1)Induction phase(Patient is awake and is completed when patient loses consciousness) 2)Maintenance phase(Patient is kept at appropriate levels of anesthesia throughout the surgery) |
| What are some common adjunct anesthetic agents? | Propofol, nitrous oxide gas, desflurane and sevoflurane vapors, and muscle relaxants |
| What are some types of regional anesthesia?(3) | 1) Epidural-blocks sensation to the vaginal and perineal areas(Safer than spinal injection in the epidural space) 2) Nerve Block-Injected into a nerve blocking the nerve supply 3)Spinal anesthesia-Lumbar puncture of local anesthetics into the CNS fluid in the subarachnoid space extends to the tip of the xiphoid process to the feet |
| What are some important nursing interventions regarding spinal anesthesia? | Hyperextend the neck and have oral airway as well as ventilatory support devices ready |
| What are the benefits of conscious sedation? | Decreased patient anxiety, enhanced patient cooperation, pain relief, rapid recovery, provides amnesia |
| The Joint Commission established universal protocols to prevent surgery errors. what are the 3 main steps? | 1)Pre-op Verification process 2) Marking the side with indelible ink 3)Prior to the procedure the team must have a time out to verify correct patient, site and any implants |
| Who assumes responsibility for the pre-op checklist? | The nurse who signs it |
| T/F: The pre-op checklist may be completed following medication administration | False: The pre-op checklist must be completed prior to medication administration |
| What are the duties of the circulating nurse?(6) | 1)Observes for breaks in aseptic technique and reports 2)Counts sponges, needles and instruments with scrub nurse before surgery and ensures that all are accounted for 3)Prepares the operating room 4)Visits the patient preoperatively 5)Provides supplies to the scrub nurse 6)Accompanies the patient to the recovery room for handoff |
| What are the duties of the scrub nurse?(7) | 1) Performs surgical hand scrub 2)Dons Sterile gown and gloves 3)Checks instruments 4)Gown and gloves surgeon 5)Assists with surgical draping 6) Maintains neat and orderly sterile field 7)Maintains sponge, needle and instrument count |
| What is the immediate focus of the post-op phase? | Airway, Breathing, Circulation and Consciousness |
| When can transfer to a unit occur following surgery? | Once the patients airway is established, vitals are stable and the patient is conscious and responds to stimuli |
| What are the responsibilities of the nurse in later post-op care? | 1)Assessment of the incision site, tubes, IV, Vital signs, post-op orders 2)Review of body systems 3)General assessment(using times four factor 4)Safety 5)Keeping an open airway by hyperextending the neck 6) monitoring for s/s of hypovolemic shock(Significant decrease in B/P, anxiety and agitation, cool and clammy skin, confusion, decreased or no urine output, general weakness, skin pallor, tachypnea, diaphoresis) |
| How should a nurse respond if shock occurs? | 1)Provide Oxygen 2)Elevate legs above heart level 3)Increase IV rate 4)Notify anesthesia and surgeon 5)Provide medications 6)Assess and respond with interventions |
| What assessment should be provided regarding the wound site? | 1) Assess for excessive bleeding or drainage(must be reported to surgeon immediately in the first 24-48 hours following surgery) 2)Circle the shadowed drainage on the bandage with time and date assists in determining if more or continued bleeding occurs 3)Dehiscence with distention, vomiting, coughing or infection must be monitored |
| What are the signs and symptoms of pulmonary embolism? | Sudden chest pain, dyspnea, tachycardia, cyanosis, diaphoresis, hypotension |
| What are some objective signs and symptoms of pain? | Increased pulse, Increased B/P, restlessness, diaphoresis, pallor |
| What are some subjective signs and symptoms of pain? | Patient states there is pain or Pain scale |
| What are some common GI changes following surgery? | 1)Abdominal distention(Due to anesthesia, surgical manipulation, narcotics and carbon dioxide in the abdominal cavity) 2)Peristalsis is slowed 3)Absent bowel sounds(Each quadrant must be assessed for 3-5 mins to determine absence) 4)Paralytic ileus(This is a medical emergency) 5)Singulitis(Due to irritation of the phrenic nerve) |
| What education must be provided to the patient prior to discharge? | 1)Medication and side effects 2)Activity level 3)Wound and dressing care 4)Dietary restrictions/modifications 5)Symptoms to report 6)Follow up care/appointments |
| What must be provided by the patient before discharge may occur? | Verbal and written verification of responsible party and driver |