VNSG 1509

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Author:
jensball
ID:
125809
Filename:
VNSG 1509
Updated:
2012-01-04 12:13:57
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NURSING HEALTH ILLNESS
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UNIT 1
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  1. INDICATIONS FOR SURGERY BASED ON
    • RISK FACTOR: MAJOR OR MINOR
    • URGENCY: ELECTIVE, URGENT, EMERGENT
  2. DIAGNOSTIC SURGERY
    • DETERMINE THE ORIGIN AND CAUSE OF A DISORDER OR CELL TYPE IN CANCER
    • EXAMPLE: BIOPSY, EXPLORATORY LAP
  3. CURATIVE/ABLATIVE SURGERY
    • RESOLVE A HEALTH PROBLEM BY REPAIRING OR REMOVING THE CAUSE
    • EXAMPLE: APPENDECTOMY, HYSTERECTOMY
  4. RESTORATIVE SURGERY
    • IMPROVE A CLIENT'S FUNCTIONAL ABILITY
    • EXAMPLE: TOTAL KNEE REPLACEMENT
  5. PALLIATIVE SURGERY
    • RELIEVE SYMPTOMS OF A DISEASE BUT DOES NOT CURE
    • EXAMPLE: COLOSTOMY, NERVE ROOT RESECTION, TUMOR RESECTION
  6. COSMETIC SURGERY
    • IMPROVE APPEARANCE OR CHANGE SHAPE
    • EXAMPLE: LIPOSUCTION, REVISION OF SCARS, RHINOPLAST, BELPHAROPLASTY
  7. CONSTRUCTIVE SURGERY
    • BUILD TISSUE/ORGANS THAT ARE ABSENT
    • EXAMPLE: REPAIR OF CLEFT PALATE
  8. RECONSTRUCTIVE SURGERY
    • REBUILD TISSUE/ORGAN THAT HAS BEEN DAMAGED
    • EXAMPLE: SKIN GRAFT AFTER A BURN, TOTAL JOINT REPLACEMENT
  9. TRANSPLANT SURGERY
    • REPLACE ORGANS/ TISSUE TO RESTORE FUNCTION
    • EXAMPLE: HEART, LUNG, KIDNEY TRANSPLANT
  10. INPATIENT SURGERY
    REQUIRES ADMISSION TO A HOSPITAL BEFORE AND AFTER SURGERY
  11. AMBULATORY SURGERY
    SURGICAL PROCEDURES PERFORMED ON A NONHOSPITALIZED CLIENT UNDER LOCAL OR GENERAL ANESTHESIA
  12. LAPARASCOPIC SURGERY
    BECOMING MORE COMMON; MINIMALLY INVASIVE, DONE THROUGH SMALL OPENINGS IN THE ABDOMEN, QUICKER RECOVERY, LAPARASCOPIC CHOLECYSTECTOMY
  13. SAME DAY SURGERY
    CAN BE PERFORMED IN A DOCTORS OFFICE
  14. OUPATIENT SURGERY
    AT HOSPITAL OR SURGERY CENTER, CLIENT GOES HOME THAT DAY
  15. INPATIENT SURGERY
    CLIENT IS EITHER IN HOSPITAL OR COMES IN THROUGH OUTPATIENT THE MORNING OF, STAYS OVERNIGHT OR LONGER
  16. PSYCHOSOCAIL NEEDS OF THE PREOPERATIVE CLIENT
    SOCIOECONOMIC AND CULTURAL NEEDS, EDUCATION AND EXPERIENCE, CULTURAL AND ETHNIC CONSIDERATIONS,
  17. EMOTIONAL RESPONSES TO SURGERY
    DENIAL, ACCEPTANCE, RESIGNATION, HAPPY, ANGRY, FEAR
  18. FEAR IS NUMBER ONE EMOTIONAL RESPONSE
    FEAR OF UNKNOWN, ANESTHESIA, PAIN, COMPLICATIONS, DYING, DISRUPTION OF LIFE
  19. NURSING ACTIONS TO DECREASE ANXIETY
    ASSESS SPECIFIC SOURCES OF ANXIETY, ANSWER ALL QUESTIONS, ACTIVE LISTENING, SPIRITUAL,ANTIANXIETY AGENTS
  20. SURGICAL RISK FACTORS: CHRONIC DISEASES
    DIABETES MELLITUS: STRESS OF SURGERY CAN CAUSE SWINGS IN BLOOD GLUCOSES LEVELS, SLOWER WOUND HEALING, GREATER CHANCE OF INFECTION

    LIVER AND KIDNEY DISEASE: MORE DIFFICULT TO METABOLIZE AND ELIMINATE ANESTHESIA
  21. SURGICAL RISK FACTOR: ADVANCED AGE
    OLDER ADULTS HAVE AGE-RELATED CHANGES THAT AFFECT RESPONSES TO THE STRESS OF SURGERY, SLOWER HEALING, UNPREDICTIED RESPONSE TO MEDICATIONS AND ANESTHESIA
  22. SURGICAL RISK FACTORS: NUTRITIONAL FACTORS
    OBESITY: RISK FOR DELAYED WOUND HEALING, INFECTION,PNEUMONIA, THROMBOPHLEBITIS, DYSRYTHMIAS

    MALNUTRITION: POOR WOUND HEALING AND INFECTION, ORGAN FAILURE AND SHOCK
  23. SURGICAL RISK FACTORS: FLUID/ELECTROLYTE IMBALANCE
    DEHYDRATION AND HYPOVOLEMIA: REDUCED CIRCULATING VOLUME REDUCES KIDNEY PERFUSION, REDUCED URINE OUTPUT, THROMBUS FORMATION
  24. SURGICAL RISK FACTORS: CARDIOVASCULAR DISORDERS
    INCREASED RISK OF: HEMMORHAGE AND SHOCK, HYPOTENSION, THROMBOPHLEBITIS, PULMONARY EMBOLISM, STROKE AND FLUID VOLUME OVERLOAD
  25. SURGICAL RISK FACTOR: RESPIRATORY STATUS
    ACUTE INFECTIONS-MAY NEED TO DELAY SURGERY, CHRONIC CONDITIONS IMPAIR GAS EXCHANGE ->RESPIRATORY DEPRESSION, RESPIRATORY COMPLICATIONS ARE SOME OF THE MOST COMMON POST OP COMPLICATIONS
  26. SURGICAL RISK FACOTRS: ALCOHOL/ TABACCO USE
    • ALCHOLISM: CLIENT MAY NE MALNOURISHED; MAY REQUIRE MORE GENERAL ANESTHESIA;RISK FOR DELAYED WOUND HEALING
    • SMOKING: INCREASED RISK FOR RESPIRATORY COMPLICATIONS
  27. SURGICAL RISK FACTORS: MEDICATIONS
    ASPIRIN, NONSTEROIDAL ANTI-INFLAMMATORY MEDS, ANTICOAGULANTS; MAKE CLIENT MORE PRONE TO BLEEDING
  28. SURGICAL RISK FACTORS: CORTICOSTEROIDS
    REDUCE BODY'S RESPONSE TO INFECTION, DELAY HEALING PROCESS
  29. SURGICAL RISK FACTORS: HEART MEDS, ANTIHYPERTENSIVES
    TAKEN DAY OF SURGERY OR TOLD TO HOLD?
  30. PRE-OP PREPARATION
    IDENTIFY PATIENT, VERIFY PROCEDURE TO BE PERFORMED, VERIFY NPO STATUS,OBTAIN CONSENT, VITAL SIGNS, LABORATORY TESTS, RADIOLOGY PROCEDURES
  31. NPO STATUS
    AT LEAST 8 HOURS, USUALLY 12, BEFORE SURGERY; EXPLAIN WHY IMPORTANT, RISK FOR ASPIRATION
  32. OBTAINING CONSENT: "INFORMED" CONSENT
    OPERATIVE PERMIT- A LEGAL DOCUMENT REQUIRED FOR ALL INVASIVE PROCEDURES; PROTECTS CLIENT, NURSE,PHYSICIAN AND HEALTH CARE FACILITY; PHYSICIAN WHO PERFORMS PROCEDURE IS RESPONSIBLE FOR OBTAINING CONSENT, NURSE CAN DISCUSS WHAT WAS PRESENTED BUT QUESTINOS AND CONCERNS OF CLIENT MUST BE ADDRESSED BY PHYSICIAN, MUST BE SIGNED BEFORE ANY PREOPERATIVE MEDS GIVEN
  33. VITAL SIGNS
    INCREASED RELATED TO ANXIETY IS NORMAL, BUT HOW MUCH? WHAT ABOUT MEDS?
  34. LABORATORY TESTS
    • PERFORMED TO PROVIDE BASELINE DATA AND DETECT PROBLEMS THAT MAY MAY PLACE THE CLIENT AT RISK DURING AND AFTER SURGERY; NEED TO KNOW NORMALS:
    • CBC-HGB,HCT,WBC,PLATELETS
    • ELECTROLYTES- NA+, K+
    • COAGULATION STUDIES- PT,PTT
    • UA, BUN
    • LIVER FUNCTION
    • BLOOD TYPE/ CROSSMATCH
  35. RADIOLOGY PROCEDURES
    CHEST XRAY, XRAYS OF SPECIFIC SURGICAL SITE, EKG
  36. NURSE'S ROLE IN PREOPERATIVE DIAGNOSTIC TESTING
    VERIFY TEST HAVE BEEN DONE, REPORT ABNORMALS TO SURGEON
  37. PHYSICAL PREPARATION
    SKIN PREP, INSERTION OF FOLEY CATHETER, INSERTION OF IV LINE, BOWEL PREP, NPO STATUS
  38. PRE OP TEACHING
    • LUNG EXERCISES: DEEP BREATHING, FORCED EXHALATION COUGHING, INCENTIVE SPIROMETER
    • RANGE OF MOTION: LEG, ANKLE AND FOOT EXERCISES, DECREASED MOVEMENT LEADS TO DECREASED BLOOD FLOW LEADS TO CLOT FORMATION
    • TED HOSE, SCD
  39. PAIN RELIEF
    ASSURE CLIENT THAT THEIR POST OP PAIN WILL BE CONTROLLED; EXPLAIN: PAIN SCALE, PCA PUMP, INJECTIONS, ORAL MEDS
  40. ANY SPECIAL TREATMENTS OR DEVICES THAT MAY BE USED POST-OP
    DRAINS, TUBES, EQUIPMENT FOR IV LINES, O2, DRESSINGS, SPLINTS, CASTS
  41. IMMEDIATE PRE OP CARE
    CLEAN GOWN, NO UNDERWEAR, HAIR COVERED, JEWELRY OFF, ALL PIERCINGS REMOVED, DENTURES OUT, GLASSES LEFT OUT USUALLY, PRE-OP MEDS ( GIVEN ON CALL, 45-60 MINUTES BEFORE), DOCUMENTATION
  42. NURSING CARE: FOCUS DURING PRE-OP PHASE
    CLIENT AND PROCEDURE IDENTIFIED, ASSURING CLIENT IS PROPERLY INFORMED, MANAGING POSSIBLE ANXIETY
  43. INTRAOPERATIVE PHASE: SURGICAL HOLDING ROOM
    CIRCULATING NURSE VERIFIES: CLIENTS IDENTIFICATION, ALL PREOP ORDERS DONE, ALL PREOP TEST RESULTS AVAILABLE
  44. ANESTESHIA PROVIDER
    MAKES FINAL DECISION IF CLIENT CAN HANDLE ANESTHESIA AND WHAT TYPE WILL BE USED, STARTS IV
  45. SURICAL TEAM
    • STERILE: SURGEON, SURGICAL ASSISTANT, SCRUB NURSE
    • NONSTERILE: ANESTHETIST, CIRCULATING NURSE
  46. MAJOR FUNCTIONS OF SCRUB PERSON
    GATHERS ALL EQUIPMENT, PREPARES STERILE SUPPLIES, GOWNS AND GLOVES SURGEON UPON ENTRY IN OPERATING ROOM, MAINTAINS STERILITY WITHIN STERILE FIELD, HANDS INSTRUMENTS TO SURGEON, MAINTAINS COUNT OF ALL SPONGES SHARPS AND INSTRUMENTS
  47. MAJOR FUNCTIONS OF CIRCULATING NURSE
    OVERSEES THE ENVIROMENT,VERIFIES CONSENT IS SIGNED AND SURGICAL SITE IS MARKED, GREETS CLIENT AND PERFORMS ASSESSMENT, SETS UP OPERATING ROOM, ADJUSTS LIGHTS, OPENS STERILE SUPPLIES FOR SCRUB, ASSISTS WITH TRANSFER OF CLIENT TO OPERATING TABLE, PLACES ELECTROCAUTERY GROUND PAD UNDER CLIENT, MPREP CLIENTS SKIN BEFOER STERILE DRAPE PLACED, LABELS AND DISPOSITION OF SPECIMENS, COMMUNICATES WITH FAMILY, DOCUMENTS
  48. SURGICAL ATTIRE
    • UNRESTRICTED: STREET CLOTHES
    • SEMIRESTRICTED: SCRUB ATTIRE, SHOE COVERS, AND CAP
    • RESTRICTED: LOCATED WITHIN O.R.-AREA SURROUNDING OPERATING TABLE AND INSTRUMENT TRAYS, MASKS, STERILE GOWN, AND GLOVES
  49. STERILE FIELD
    AREA SURROINDING PATIENT AND SURGICAL SITE, CREATED BY DRAPING
  50. O.R. SAFETY: BEFOER SURGERY BEGINS
    • ASEPSIS: HAND SCRUB, SURGICAL PREP
    • POSITIIONING, SPONGE AND INSTRUMENT COUNT
  51. GENERAL ANESTHESIA
    INHALANT OR IV: CLIENT IN A DEEP SLEEP, MUSCLE RELAXATION, ENDOTRACHEAL TUBE INSERTED FOR AIRWAY
  52. INDUCTION STAGE OF GENERAL ANESTHESIA
    UNCONSCIOUSNESS INDUCED, ENDOTRACHEAL TUBE INSERTED, MAINTENANCE, TIME DURING WHICH SURGICAL PROCEDURE IS PERFORMED
  53. EMERGENCE STAGE OF ANESTHESIA
    SURGERY COMPLETE, CLIENT RETURNED TO CONSCIOUSNESS, NEUROMUSCULA BLOCKING AGENTS RESERVED
  54. REGIONAL ANESTHESIA
    TEMPORARILY MAKES A REGION OF THE BODY INSENSIBLE TO PAIN, COMBINED WITH SEDATION, USES NERVE BLOCK TO ANESTHETIZE LOCAL ARE AND AREA DISTAL TO THE BLOCK: PELVIC OR LOWER EXTREMITY, OBSETRIC CASES
  55. NERVE BLOCK
    SPINAL, EPIDURAL
  56. COMPLICATIONS OF REGIONAL ANESTHESIA
    • CSF LEAKS FORM SPINAL COLUMN: POSTUAL HEADACHE, BLOOD PATCH MAY BE NEEDED, BEDREST IN SUPINE POSITION, HYDRATION AND PRESSURE TO PUNCTURE SITE
    • LOWERS BP S/T SYMPATHETIC NERVE BLOCK, RESPIRATORY DEPRESSION, RESIDUAL SENSORY BLOCK: CHECK FOR LEVEL OF SENSATION RETURN
    • RESIDUAL MOTOR BLOCK: TEMPORARY PARALYSIS---PT CANT MOVE BODY PART
  57. PROCEDURAL SEDATION
    LOCAL ANESTHESIA TO NUMB THE AREA PLUS IV SEDATION: PROVIDES ANALGESIA AND AMNESIA, CNS DEPRESSION, DECREASED PT AWARENESS, DECREASED ANXIETY; VERSED, VALIUM, MORPHINE, PROPOFOL
  58. POTENTIAL INTRAOPERATIVE COMLICATIONS
    RISK FOR INFECTION, FLUID VOLUME EXCESS, FLUID VOLUME DEFECIT, HYPOTHERMIA, INJURY RELATED TO POSTIONING FOR LONG PERIODS
  59. NURSING CARE: FOCUS DURING INTRA OP PHASE
    MAINTAING CLIENT SAFETY, PROPER IDENTIFICATION OF CLIENT, PROPER POSTIONING, MONITORING SURGICAL ASEPSIS

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