Nur103 test 2

• purpose
• urgency
• risk

• Determine or confirm a diagnosis
• Breast biopsy
• bronchoscopy

• Remove diseased tissue, organ, or extremity Appendectomy
• amputation

Build tissue/ organs that are absent (congenital anomalies) Repair of cleft palate

• Rebuild tissue/ organ that has been damaged
• Skin graft after a burn,
• total joint replacement

• Alleviate symptoms of a disease (not curative)
• Bowel resection in patient with terminal cancer

• Replace organs/ tissue to restore function
• Heart, lung, liver, kidney transplant

• Diagnostic
• Ablative
• Pallitive
• Constructive
• Reconstructive
• Transplant

• minor
• major

• Minimal physical assault with minimal risk
• Removal of skin lesions,
• dilation and curettage ( D& C),
• cataract extraction

• Extensive physical assault and/ or serious risk
• Transplant,
• total joint replacement,
• thoracotomy,
• colostomy,
• nephrectomy

• Suggested, though no foreseen ill effects if postponed Cosmetic surgery,
• cataract surgery,
• bunionectomy

• Necessary to be performed within 1 to 2 days
• Heart bypass surgery,
• amputation resulting from gangrene,
• fractured hip

• Performed immediately
• Obstetric emergencies,
• bowel obstruction,
• ruptured aneurysm,
• life- threatening trauma

Informed consent is disclosure of risks associated with the intended procedure or operation to the patient.

The surgeon.

• Witness the signing,
• answer the pt's questions
• assess whether the pt is understanding the procedure
• inform the surgeon if there are questions or doubts

• Need for the procedure in relation to the diagnoses
• Description and purpose of the proposed procedure
• Possible benefits and potential risks
• Likelihood of a successful outcome
• Alternative treatments or procedures available
• Anticipated risks should the procedure not be performed
• Physician’s advice as to what is needed
• Right to refuse treatment or withdraw consent

• Diversity in age and physical, cognitive, and psy-chologic maturation makes preparation for surgery vary in content and inclusion of significant others.
• Increased need for control, privacy, and peer inter-action poses special challenges in the acute care setting.

• related changes that affect physiologic, cognitive, and psychosocial responses to the stress of surgery;
• decreased tolerance of general anesthesia and postoperative medications;
• delayed wound healing.

• Reserves may not be sufficient to allow the body to respond to surgery;
• organ failure and shock
• Increased metabolic demands may result in poor wound healing and infection.

• delayed wound healing,
• wound dehiscence,
• infection,
• pneumonia,
• atelectasis,
• thrombophlebitis,
• dysrhythmias,
• heart failure.

• limited access to health care, pathology may be more advanced at diagnosis
• Greater risk of exposure to hazardous waste
• emotional stress
• poor nutrition
• lack of exercise
• poor social support systems

• malnourished
• experience delirium tremens
• more general anesthesia may be required
• hemorrhage and delayed wound healing can result from liver damage and poor nutritional status

Inflammation or degenerative changes in joints limits mobility and comfort

• increased risk of heart failure,
• hemorrhage and shock,
• hypotension,
• venous thrombosis,
• pulmonary embolism,
• stroke (especially in the older patient),
• fluid volume overload.

• increased risk for fluctuating blood glucose levels, hypoglycemia
• ketoacidosis
• increased risk for cardiovascular disease,
• delayed wound healing,
• wound infection.

impaired ability to resist infection and promote tissue repair.

• Advanced age
• HIV
• autoimmune diseases
• chronic pain
• immune deficiency diseases
• malnutrition
• splenectomy
• alcohol abuse

• increased risk for respiratory complications:
• pneumonia
• atelectasis
• bronchitis
• because of increased mucous secretions and a decreased ability to expel them.

• poorly tolerate general anesthesia
• have fluid/ electrolyte imbalances
• acid– base imbalances
• decreased metabolism and excretion of drugs
• increased risk for hemorrhage
• delayed wound healing.

• bronchitis,
• atelectasis,
• pneumonia
• Respiratory depression from general anesthesia and acid– base imbalance

understands the procedure

• reduces number of pathogens
• referred to as clean techniques
• used in administration of medications
• enemas
• tube feeding
• daily hygiene
• handwashing is number 1

• eliminates all pathogens
• referred to as sterile technique
• used in dressing changes
• catheterizations
• surgical procedures

• medical clearance
• labs
• sometimes need blood,
• cross matched and typed
• how long has the patient been NPO
• scrubbing or showering, or shaving
• prophylactic antibiotic

Before the medications are started. After the surgery, the anesthesia will make the pt too drowsy to learn.

• will there be a drain
• how much pain to expect
• how much what kind tubes, iv, o2
• not allowed to get out of bed alone
• coughing deep breathing
• anti embolism thingies,
• stockings,
• pulses, etc,
• leg exercises,
• early ambulation,

• surgeon
• first assist
• anesthesiologist
• holding area nurse
• circulation nurse
• scrub nurse or tech

• control traffic flow
• zones
• surgical scrub
• time out
• sponge and instrument count

• 1. unrestricted zone
• street clothes
• 2. semi restricted
• scrub clothes
• 3. restricted
• sterile, mask, gowns, etc.

• 1. 5-10 min. hand washing
• 2. no jewerly
• 3. sterile drapestime

• Everything stops as the patient is identified,
• what is going to be done and where, and
• positioning w/ documentation

• maintain standards
• safety of pt
• prevent infection
• maintaining sterile field

artificially induced state of partial or total loss of sensation, occurring with or without LOC

• central nervous system depression
• unconscious
• no pain
• no memory
• skeletal muscles relax
• reflexes diminish

• rapid excretion of anesthesia
• quick reversal of effects when wanted
• used with all age groups
• used with all types of surgery

• Risks associated with impaired systems:
• circulatiory
• respiratory
• renal
• hepatic

• 1. induction
• 2. maintenance
• 3. emergence

Medicine is instilled around the nerves of a particular region of the body. The nerves can't send impluses to the brain. The pt is conscious but can't feel pain.

• 1. local nerve inflitration
• 2. nerve blocks
• 3. epidural blocks

limits feeling in a small part of the body for stitches, biopsy, etc.

anesthesia is injected into the nerve trunk to numb a larger part of the body such as an extremity

Anesthesia is injected directly into the spinal cord. Safer than general anesthesia.

Moderate sedation to block sensations but the pt is still conscious. Pt can respond to directions.

• 1. give pt a sedative
• 2. patient receives the anesthetic agent intravenously or by inhalation
• 3. maintain airway
• 4. surgery is done, anesthesia is maintained, vitals monitored
• 5. anesthesia withdrawn or drugs reversed
• 6. pt begins to awaken
• 7. pt breathes on own
• 8. extubation
• 9. pt goes to PACU

• high risk of injury r/t postioning
• fluid volume defict
• high risk for infection
• fear and powerlessness

• loc/alertness
• allergies to meds
• type of surgery done
• how long it lasts
• how it was tolerarted
• limb immobility
• language
• location of incision drains, how many where complications

• stable VS
• pulse ox,
• temp
• standing order for o2
• overt bleeding
• bleeding on the dressing,
• amount of drainage in the drain,
• return of gag reflex
• airway patency
• suction equip,
• adequate repirs
• nasal canual, face mask,
• intubation
• peripheral circulation
• cap. refill
• fluid volume
• loc
• pain (usually not in the PACU)
• N/V

• urinary retention
• ineffecite airway clearance
• constipation

separation or splitting open of layers of a surgical wound, nothing comes out

extrusion of viscera or intestine through a surgical wound

• monitor vital signs
• inspect the incision
• locate drain cath
• ask about pain
• make sure of coughing, deep breathing,
• maintain suction
• assess dressings,
• assess/measure drainage
• administer analgesia
• client and family teaching
• progressive activity
• continue discharge planning