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care in which surgical team bases its assessments, planning and interventions on the unique needs of the individual patient
patient-centered care
-
unique patient needs are revealed through what?
- information from others
- astute observation
- good communication
-
care that involves predicting the results of particular tasks and duties and choosing the correct course of action
outcome-oriented care
-
triangular hierarchy in which the most important needs are at the base levels
Maslow's hierarch of human needs - developed in 1970s
-
most basic needs on Maslow's hierarchy
physiological - they involve biochemical, mechanical and physical processes of life
-
according to Maslow's model, what happens if the most basic requirements for life are not met?
the needs at the higher levels cannot be fulfilled
-
Maslow's hierarchy of human needs triangle
- self-actualization
- self-esteem
- love
- security and safety
- physiological
-
process of oxygen exchange at the cellular and molecular level and many other complex physiological processes
respiration
-
physical expansion of the lungs and thoracic cavity
ventilation
-
who helps protect patient's airway when safety measures are enforced during laser surgery of the upper respiratory tract?
surgical technologist - they have suction available at all times during airway surgery to prevent aspiration
-
supplying fluid, electrolytes, and organic substances to cells to maintain electrical activity and transport of materials into and out of cells
nutrition
-
how does the surg tech contribute to information about fluid balance?
by tracking and reporting the amounts used for fluid irrigation during a procedure
-
how does the surg tech contribute to temperature regulation?
- maintains irrigation fluids at the correct temperature
- responsible for thermal devices and warm blankets for patient
-
body's way of avoiding painful or dangerous environments and stimuli
mobility
-
slowing down of metabolic functions
rest
-
why is rest necessary?
for repair and growth, and for maintaining alert mental functions that signal a person to respond when the body is in danger
-
body's natural response to fatigue
sleep
-
death from hospital-acquired infection is often a result of what?
combination of stress of surgery or illness and destructive effects of the infection itself
-
how can the surg tech prevent metabolic stress on the patient?
prevent postoperative infection by following strict aseptic technique and sound surgical conscience
-
physiological process of removing cellular and chemical waste products from the body
elimination
-
during the process of metabolism, what byproducts are produced?
both toxic and nontoxic byproducts such as urea, carbon dioxide and dead cells
-
important indicator of metabolism
kidney function
-
methods of monitoring kidney function during surgery
urinary catheterization and urine collection
-
at what levels does the elimination process take place?
cellular and tissue levels
-
by what is the physiological process maintained?
adequate fluid balance and gentle handling of tissues
-
how does the surg tech contribute to the patient's physical safety and security?
by being knowledgeable about and observing for environmental dangers such as dangers related to devices and equipment, procedures, infection control and many other activities
-
how does the surg tech respond to the patient's need to feel safe and secure?
through verbal and nonverbal communication
-
individual's ability to express and achieve personal goals
self-actualization
-
whatever individual defines as a goal or achievement
personal goal
-
why are surgical patients vulnerable to the risk of feelings of inability to achieve goals?
because of added psychological burden of altered body image or loss of function
-
role of caregiver
support and heal
-
some fears of surgical patients
- anesthesia
- death
- pain
- disfigurement
- helplessness
- fear that private information will be shared
-
condition in which patients awaken and/or feel all of the sensations of the procedure but are unable to move or respond
anesthesia awareness
-
the way we perceive ourselves physically in the eyes of others
body image
-
characteristics of therapeutic communication
- goal directed
- unique to each patient
- active engagement
- excellent observation and listening skills
-
therapeutic responses include?
- cue giving
- clarification
- restatement
- paraphrasing
- reflection
- touch
-
actions and words that encourage the patient to communicate
leads and cues
-
what does reflection allow the patient to do?
connect to his or her emotions with information provided in the immediate environment
-
ability to communicate and interact with people of different cultures and beliefs
cultural competence
-
most effective way to approach a patient whose cultural beliefs are different from one's own?
with knowledge of that culture
-
sense or understanding of something more profound than humanity that is not perceived by the physical senses
spirituality
-
infant stage
birth to 18 months
-
toddler stage
19 months to 3 years
-
preschool stage
4 to 6 years
-
school age stage
7 to 12 years
-
adolescent stage
13 to 16 years
-
care for infants
- need to be physically close to their caretakers
- difficult to comfort
- stress is high
-
care for toddlers
- suffer frustration, loss of autonomy, extreme anxiety
- cry and scream through aggression and regression
- difficult to restrain
- rapid sedation may be required
-
care for preschoolers
- suffer extreme fear
- view experience as a type of punishment or deliberate abandonment
- prone to fantasy
- concrete thinkers and understand words such as "cut," "bleed," and "stick"
-
care for school-age children
- more compliant and cooperative
- may tend to withdraw from caregivers
- curious about their bodies
- often insist on helping with their own care
- welcome explanations and descriptions
-
care for adolescents
- very sensitive about body image and changes in the body
- resent any intrusion on their privacy and bodily exposure
- potential loss of presence with their peers and fear of being "left out" because of illness
- fear loss of control
-
during transfer and positioning, elderly patients are especially at risk for?
skin, joint, muscle and bone injury
-
during the aging process, what does soft connective tissue lose?
tone, mass and elasticity, increasing the risk of skeletal injury
-
decreased body fat increases risk for?
hypothermia
-
communicating with elderly patients
- do not use cliches
- do not refer to the patient as names such as "honey" or "sweetie"
- do not assume they are mentally impaired
-
communicating with mentally impaired patients
- speak clearly and slowly
- face patient when speaking
- speak in normal voice
- provide additional communication cues such as gestures
-
what nutrients are high in demand in malnourished patients?
proteins and carbohydrates for rebuilding tissue
-
without enough food intake to support health
undernourished
-
lacking the right kinds of food to support body function
malnourished
-
endocrine disease that disrupts metabolism of carbs, fats and proteins
diabetes mellitus
-
what happens when diabetes is not controlled?
severe damage to vascular and neurological tissues results
-
what does body require to respond to trauma of surgery?
healthy immune system
-
how is HIV treated?
- HAART (highly active antiretroviral therapy)
- with this therapy, HIV is becoming recognized as a manageable illness
-
period when death is expected
end of life
-
inability to provide or cessation of attempts to prolong life
dying period
-
best-known model of death and dying was developed by whom and when?
by Swiss psychiatrist Elisabeth Kubler-Ross in the 1960s
-
Kubler-Ross's model stages of grief
- denial
- anger
- bargaining
- depression
- acceptance
-
how should the surg tech support and comfort the dying patient?
- never imply that a surgical procedure may "cure" the patient but offer possibility of good outcome
- offer hope for a longer survival period or one that is physically tolerable
-
whose responsibility is it to provide information to family/friends about the patient's medical condition?
physicians and nurses
-
right of every individual to make decisions about how he or she lives and dies
self-determination
-
to whom do decisions about end-of-life care fall when the patient is not able to communicate his or her wishes?
the family
-
intentional harm to a person, at their request, to promote or cause death
assisted suicide
-
what regions of the world allow assisted suicide?
- Netherlands, Oregon, Washington, and Montana
- the process involves stringent preconditions and extensive review by an ethics committee
-
when is the request not to resuscitate made official?
when the patient signs the DNR order
-
when must the patient's DNR status be verified?
- throughout the period of patient care
- in most facilities, DNR status is renewed with each admission
-
medical and supportive care provided to the dying patient
palliative care
-
document which specifies the exact nature of palliative care that they accept
living will
-
how are clinical decisions made in the absence of a living will?
by consensus of the patient (when able), family, and care providers
-
how is decision of organ donation made if not made by the patient?
physician is required by law to ask the patient and family to consider organ donation
-
support and care across cultures
cultural competence
-
who must verify that death has occurred in surgery?
surgeon and anesthesia care provider
-
what specific medical assessment tests are carried out to determine brain death?
- EEG
- administration of painful stimuli
- testing of cranial reflexes
-
prepares body for viewing by the family and assists in further handling procedures carried out by the morgue and mortuary
postmortem care
-
exact protocol for postmortem care is defined by?
every health facility
-
natural changes in the body after death
- body begins to cool immediately
- sphincter muscles lose tone
- eyes remain open and jaw drops
- dependent areas of the body begin to collect fluid
-
after death, condition in which areas around the ears and cheeks that turn purple or red
livor mortis
-
natural stiffening of the body
rigor mortis
-
when does rigor mortis begin?
approximately 15 minutes after death and peaks at 8 to 10 hours
-
when do the changes of the body after death begin to regress?
at 18 hours
-
where does rigor mortis begin and end?
begins at the head (eyelids) and progresses to the feet
-
where must the body remain after death until a decision is made about a coroner's investigation?
intact on the operating table
-
for postmortem care, how is the head of bed positioned?
raised at 30 degrees
-
for postmortem care, how are the eyelids handled?
closed and held gently shut until they remain in place
-
for postmortem care, how is the jaw handled?
closed and supported with a rolled towel
-
for postmortem care, how are urine and feces handled?
- pads are placed under the patient to absorb urine and feces
- folded towel is placed under the scrotum to elevate the testicles, preventing bodily fluids from accumulating
-
for postmortem care, how are catheters, IV lines, tubes and other devices handled?
- left in place
- capped or occluded securely with tape and gauze to prevent leakage
-
for postmortem care, how are wounds handled?
- dressed with a single layer of gauze and surgical tape
- cloth adhesive tape should not be used on the skin
-
for postmortem care, how are imbedded foreign objects or debris handled?
must be protected from dislodgement
-
for postmortem care, how is the body cleansed?
- if it is not a coroner's case, body may be cleansed
- if it is a coroner's case, body may not be cleansed
-
for postmortem care, how is appearance handled?
- hair is combed and a clean pillow is placed under the patient's head
- all soiled sheets are exchanged for clean ones
-
for postmortem care, if the body is to be viewed by family, how is the body transported?
should be transported in a closed stretcher or in a manner that is discrete and does not expose the body to others in the environment
-
for postmortem care, by whom is required documentation completed?
- licensed nurse
- all records remain with the patient until transport to the morgue
-
cases in which mandatory autopsy is required
coroner's cases
-
criteria for coroner's cases
- death in OR or ER
- unwitnessed death
- death after admission from another facility
- death in which criminal activity is suspected
- suicide
- death of incarcerated individual
- death as a result of infectious disease that might pose a public health risk
-
donation of tissue or whole organ from a deceased person for transplantation into another individual
organ procurement
-
law that requires medical professionals and other caregivers to ask the family for permission to procure organs from the deceased
required request law
-
protocols for medical procurement, care of tissue and identification of tissue are formulated by?
American Association of Tissue Banks
-
when does organ procurement take place?
as soon as possible after death because the vitality of some tissues is time dependent
-
cadaver in which tissue perfusion can be maintained during and immediately after death to preserve the life of the tissue
heartbeating cadaver
-
cadaver in which tissues are restricted to those that do not need perfusion to sustain viability for later transplantation (cornea, blood vessels, heart valves, bone and skin)
nonheartbeating cadaver
-
criteria for organ procurement in a heartbeating cadaver
- systolic BP of >90 mmHg
- central venous pressure of 5 to 10 mmHg
- urine output minimum of 100 mL/hour
- core body temp 98.6 F (37 C)
- donor maintained on IV fluids and 100% oxygen
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