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Classifications for surgical procedures
- seriousness
- urgency
- purpose
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Common fears of surgery
- pain and discomfort
- fear of the unknown
- mutilation
- death
- anethesia
- disruption of life style
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Pre-operative Nursing Roles
- physical prep for surgery
- maintaining surveillance
- preventing complications
- facilitating recovery
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Elective surgery
performed on the basis of the clients choice
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Urgent surgery
necessary for the clients health
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Emergency surgery
must be done immediately to save life
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Purpose: Diagnostic-
confirm diagnosis
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Purpose: Ablative-
remove diseased body part
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Purpose: Palliative-
relieves or reduces intensity of disease, will not produce cure
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Purpose: Procurement-
transplant
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Purpose: Restorative-
restores function or appearance
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Purpose: Constructive-
restores function lost or reduced as result of congentital anomalies
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Purpose: Prevention-
prevent complications (ex: mole removal)
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Purpose: Exploration-
examination to determine the nature or extent of a disease
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Purpose: Cosmetic-
improve personal appearance
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-ectomy
excision or removal of
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-orrhaphy
repair or suture of
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-ostomy
creation of opening into
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-otomy
cutting into or incision of
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-plasty
repair or reconstruction of
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Medications with implications for the Surgical Client:
Antibiotics
potentiate action of anesthetics
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Medications with implications for the Surgical Client:
Antidyrhythmics
may reduce caridiac contractility
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Medications with implications for the Surgical Client:
Anticoagulants
alter normal clotting thus increase risk for hemmorrage
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Medications with implications for the Surgical Client:
Anticonvulsants
may alter metabolism of anesthetic agents
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Medications with implications for the Surgical Client:
Antihypertensives
cause bradycardia, hypotension and impaired circulation
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Medications with implications for the Surgical Client:
Coticosteriods
reduce the body's ability to withstand stress
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Medications with implications for the Surgical Client:
Insulin
stress response & IV glucose after surgery may increase need
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Medications with implications for the Surgical Client:
Diuretics
potentiates electrolyte imbalance (especially potassium) after surgery
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Medications with implications for the Surgical Client:
NSAIDS
inhibit platelet aggregation & may cause prolonged bleeding
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Platelets
150,000-400,000
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BUN
6-20mg/100ml
ability of kidneys to excrete urea and nitrogen which indicates kidney function
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Creat
0.6-1.3mg/100ml
ability of kidneys to excreate by-product of muscle metabolism
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Five minutes after receiving a preoperative sedative medication by IV injection, a patient asks to get up to go to the bathroom to urinate. Which of the following is the most appropriate action for the nurse to take?
Offer the patient to use the urinal/bedpan after explaining the need to maintain safety.
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Which of the following is the primary reason for accurately recording the patient’s current medications during a preoperative assessment?
Some medications may interact with anesthetics, altering the potency and effect of the drugs.
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As the nurse is preparing a patient for surgery, the patient refuses to remove a wedding ring. Which of the following is the most appropriate action by the nurse?
Tape the ring securely to the finger and document this on the preoperative checklist.
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While performing preoperative teaching, the patient asks when she needs to stop drinking water before the surgery. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, the nurse tells the patient that
She can drink clear liquids up to 2 hours before surgery
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The nurse is admitting a patient to the same-day surgery unit. The patient tells the nurse that he was so nervous he had to take kava last evening to help him sleep. Which of the following nursing actions would be most appropriate?
Inform the anesthesiologist of the patient’s recent use of kava
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What DVT risk factors should be included in perioperative patient assessment?
- previous thrombosis
- blood clotting disorders
- cancer
- varicosities
- obesity
- smoking
- heart failure
- COPD
- inactivity
- immobility and positioning during procedure
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Teaching - 3 types of information:
(also read p.343 Table 18-7)
- Sensory- what the pt will see, hear, feel, and smell during the surgery
- Process- general info flow of what's going to happen, patients transfer to to holding area, visits by nurse and ACP before transfer to OR, and waking up in PACU
- Procedural- specific details, IV line starting in holding area, the surgeon will mark surgical site with indelible marker to verify site and side
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General Surgery Information
- deep breathing
- coughing
- early ambulation
- give rationale and practice technique
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Ambulatory Surgery Information
- time to arrive/time of surgery
- pt registration
- parking
- what to wear
- what to bring
- the need to have a responsible adult present for transportation
- restrictions of fluids and foods
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Preoperative fasting recommendations:
- Clear liquids - 2hr
- breast milk - 4 hr
- nonhuman milk - 6hr
- light meal (toast and clear liquids) - 6hr
- regular meal - 8 or more hrs
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3 conditions that must be met for consent to be valid
- adequate disclosure- of diagnosis, nature and purpose of Tx, risks and consequences of purposed Tx, probability of successful outcome, availability, benefits, and risks of alternative Tx, prognosis if Tx is not insitituted
- understanding and comprehension-of info provided before receiving sedation meds
- consent voluntarily-must not be persuaded or coerced
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Nurses role regarding informed consent forms
- obtain signature
- witness
- answer questions
- inform surgeon if questions arise
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Anticholinergics
- Atropine, scopolamine, and glycopyrrolate (Robinul)
- ACTIONS:
- dry secretions & decrease risk of aspiration & airway irritability
- CNS depressants
- dilate pupils (mydriasis) and paralysis of accommidation (cycloplegia)
- decrese stomach secretions, gastric annd intestinal motility
- increase heart rate
- dilate smooth muscles of ureters
- SIDE EFFECTS:
- dry mouth
- blurred vision & aversion to bright light
- N/V, heartburn
- urinary hesitancy and/or retention
- palpations
- headache
- nervousness
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Benzodiazepines and/or Barbituates
midazolam(Versed), diazepam(Valium), lorazepam(Ativan)
- sedate
- amnesiac properties
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Antiemetics
metoclopramide(Reglan), droperidol(Inapsine)
decrease N/V
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ambulatory surgery
- procedures have an operating time of less than 2 hrs
- requires less than 24hr stay postoperatively
- involves minimal lab test
- requires less fewer meds (pre &post)
- reduces hospital acquired infection
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Herbs that increase risk for hemmorage
- feverfew
- garlic
- ginger
- ginkgo biloba
- ginseng
- vitamin E
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risk factors for hypersensitivity reactions to drugs administered during anethesia
Hx of any allergic reactions
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risk factors for latex allergies
- longterm/multiple exposure
- hx of hay fever or asthma
- allergies to: avocados, bananas, chestnuts, potatoes, peaches
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conditions likely to influence or compromise respiratory function
- sleep apnea
- obesity
- spinal, chest and airway deformities
- upper airway infections
- COPD
- asthma
- hx of smoking
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Renal dysfunction can cause what perioperative complications:
- fluid & electrolyte imbalances
- coagulopathies
- increased risk for infection
- impaired wound healing
- metabolism/excretion of drugs occurs here- altered response to drugs and unpredictable elimination
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Hepatic dysfunction can cause what perioperative complications:
- increased perioperative risk for clotting abnormalities
- liver detoxifies many anesthetics and adjuncts -adverse responses to medications
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complications associated with diabetic pts and surgery
- hypoglycemia
- hyperglycemia
- ketosis
- CV alterations
- delayed wound healing
- infection
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Nursing responsibilities immediately before surgery
- verify presence of:
- signed informed consent
- lab and diagnostic data
- H&P
- any consults
- baseline vitals
- completed nursing notes
- site & side is marked w/ indelible marker
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Elderly pt considerations
- sensory deficits- hearing & vision
- thought processes and cognitive ability - slow or impaired
- allow more time for pre-op testing and to understand instructions
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