Med Surg- Ch18

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Author:
mwebb01
ID:
128262
Filename:
Med Surg- Ch18
Updated:
2012-01-16 19:16:41
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Description:
Preoperative Care
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  1. Classifications for surgical procedures
    • seriousness
    • urgency
    • purpose
  2. Common fears of surgery
    • pain and discomfort
    • fear of the unknown
    • mutilation
    • death
    • anethesia
    • disruption of life style
  3. Pre-operative Nursing Roles
    • physical prep for surgery
    • maintaining surveillance
    • preventing complications
    • facilitating recovery
  4. Elective surgery
    performed on the basis of the clients choice
  5. Urgent surgery
    necessary for the clients health
  6. Emergency surgery
    must be done immediately to save life
  7. Purpose: Diagnostic-
    confirm diagnosis
  8. Purpose: Ablative-
    remove diseased body part
  9. Purpose: Palliative-
    relieves or reduces intensity of disease, will not produce cure
  10. Purpose: Procurement-
    transplant
  11. Purpose: Restorative-
    restores function or appearance
  12. Purpose: Constructive-
    restores function lost or reduced as result of congentital anomalies
  13. Purpose: Prevention-
    prevent complications (ex: mole removal)
  14. Purpose: Exploration-
    examination to determine the nature or extent of a disease
  15. Purpose: Cosmetic-
    improve personal appearance
  16. -ectomy
    excision or removal of
  17. -lysis
    destruction of
  18. -orrhaphy
    repair or suture of
  19. -oscopy
    looking into
  20. -ostomy
    creation of opening into
  21. -otomy
    cutting into or incision of
  22. -plasty
    repair or reconstruction of
  23. Medications with implications for the Surgical Client:
    Antibiotics
    potentiate action of anesthetics
  24. Medications with implications for the Surgical Client:
    Antidyrhythmics
    may reduce caridiac contractility
  25. Medications with implications for the Surgical Client:
    Anticoagulants
    alter normal clotting thus increase risk for hemmorrage
  26. Medications with implications for the Surgical Client:
    Anticonvulsants
    may alter metabolism of anesthetic agents
  27. Medications with implications for the Surgical Client:
    Antihypertensives
    cause bradycardia, hypotension and impaired circulation
  28. Medications with implications for the Surgical Client:
    Coticosteriods
    reduce the body's ability to withstand stress
  29. Medications with implications for the Surgical Client:
    Insulin
    stress response & IV glucose after surgery may increase need
  30. Medications with implications for the Surgical Client:
    Diuretics
    potentiates electrolyte imbalance (especially potassium) after surgery
  31. Medications with implications for the Surgical Client:
    NSAIDS
    inhibit platelet aggregation & may cause prolonged bleeding
  32. WBC


    4-10
  33. RBC
    3.8-5.7
  34. Platelets
    150,000-400,000
  35. Hgb
    11.7-17.3
  36. Hct
    35-50
  37. PT:
    INR:
    • 11-16
    • 2-3
  38. BUN
    6-20mg/100ml

    ability of kidneys to excrete urea and nitrogen which indicates kidney function
  39. Creat
    0.6-1.3mg/100ml

    ability of kidneys to excreate by-product of muscle metabolism
  40. BUN:CREAT
    12:1-20:1
  41. Na (Sodium)
    135-145
  42. K (Potassium)
    3.5-5.0
  43. Ca (Calcium)
    7.1-11
  44. Cl (Chloride)
    95-110
  45. 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.
  46. 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.
  47. 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.
  48. 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
  49. 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
  50. 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
  51. 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
  52. General Surgery Information
    • deep breathing
    • coughing
    • early ambulation
    • give rationale and practice technique
  53. 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
  54. 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
  55. 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
  56. Nurses role regarding informed consent forms
    • obtain signature
    • witness
    • answer questions
    • inform surgeon if questions arise
  57. 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
  58. Benzodiazepines and/or Barbituates
    midazolam(Versed), diazepam(Valium), lorazepam(Ativan)

    • sedate
    • amnesiac properties
  59. Antiemetics
    metoclopramide(Reglan), droperidol(Inapsine)

    decrease N/V
  60. 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
  61. Herbs that increase risk for hemmorage
    • feverfew
    • garlic
    • ginger
    • ginkgo biloba
    • ginseng
    • vitamin E
  62. risk factors for hypersensitivity reactions to drugs administered during anethesia
    Hx of any allergic reactions
  63. risk factors for latex allergies
    • longterm/multiple exposure
    • hx of hay fever or asthma
    • allergies to: avocados, bananas, chestnuts, potatoes, peaches
  64. conditions likely to influence or compromise respiratory function
    • sleep apnea
    • obesity
    • spinal, chest and airway deformities
    • upper airway infections
    • COPD
    • asthma
    • hx of smoking
  65. 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
  66. Hepatic dysfunction can cause what perioperative complications:
    • increased perioperative risk for clotting abnormalities
    • liver detoxifies many anesthetics and adjuncts -adverse responses to medications
  67. complications associated with diabetic pts and surgery
    • hypoglycemia
    • hyperglycemia
    • ketosis
    • CV alterations
    • delayed wound healing
    • infection
  68. 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
  69. 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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