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What are the different purposes for any sugery?
- Diagnostic
- Ablative
- Palliative
- Reconstructive
- Constructive
- Transplant
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What is the purpose of and examples of a diagnostic procedure?
- Surgical exploration to assist in making a diagnosis (may involove biopsy)
- Examples: breast biopsy, bronchoscopy, exploratory laparotomy, skin biopsy
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What is the purpose of and examples of a ablative procedure?
- Removal or excision of diseases body part or organ
- Examples: amputation, appendectomy, colon resection, Thyroidectomy
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What is the purpose of and examples of a palliative procedure?
- Reduces intensity of disease or illness symptoms but is not intended to be curative.
- Examples: Arthroscopy, Colostomy, debulking of malignant tumor, never root resection
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What is the purpose of and examples of a reconstructive procedure?
- Restores function or apperance to traumatized tissue.
- Examples: breast reconstruction, internal fixation of fracture, scar revision, skin graft
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What is the purpose of and examples of a constructive procedure?
- Restores function in congenital anomalies.\
- Examples: cleft palate repair, closure of atrial-septal heart defect
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What is the purpose of and examples of a transplant procedure?
- Replaces malfunctioning organs.
- Examples: Cornea, heart, joints, kidney
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What are the two types of degrees of risk?
Major and Minor
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What type of procedure and examples are major?
- To improve or maintain health, to restore function, or to preserve life; includes opening the abdomen, thorax, or cranium
- Examples: Exploratory laparotomy, Nephrectomy, Traumatic injury repair
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What type of procedure and examples are minor?
- Restores function or corrects deformities, such as lesions
- Examples: Arthroscopy, cataract extraction, dilatation and curettage, removal of warts, tooth extraction
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What are the different types of urgencies for surgery?
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What type of surgies are considered to be elective?
- Surgey that is delayed and has no ill effects
- Surgery is performed on basis of clients preference
- Examples: breast reconstruction, hernia repair, joint bunioectomy, tonsillectomy
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What type of surgies are considered to be urgent?
- Surgery necessary for client's health and may prevent futher damage
- usually done within 24-28 hours
- Examples: amputation, colon resection for obstruction, coronary artery bypass
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What type of surgies are considered to be emergency?
- Surgery performed as soon as possible to save clients life or to preserve a body part or organ
- Examples: control of hemorrhage, repair perforated ulcer, tracheostomy
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What are the different admission status for patient who are having a surgery?
- Ambulatory
- Same-Day
- Inpatient
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What happens to a client that is ambulatory and what are examples of their surgeries?
- Client enters setting on same day as procedure and is discharged the same day.
- Examples: breast biopsy, cataract extraction, hemorrhoidectomy, scar revision
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What happens to a client that is same-day and what are examples of their surgeries?
- Client enters hospital and undergoes surgery same day but remains in hosiptal for at least one night.
- Examples: carotid endarterectomy, cholecystectomy, mastectomy, vaginal hysterectomy
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What happens to a client that is inpatient and what are examples of their surgeries?
- Client is admitted to hospital, undergoes surgery, and remains in hospital for several days.
- Examples: amputation, heart transplant, laryngectomy, resection of aortice aneurysm
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What do you assess for on a patient who is preoperative?
- Client have any communication issue
- Client understanding of procedure
- Client have an Advanced Directive
- Clients medical history
- Physical impairments that affect positioning (arthritis, kyphosis)
- Prostheses & implants (denture, hearing aids, pacemakers)
- Smoking, ETOH, drug use
- Occupation
- Physical assessment
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What do you look for in the clients medical history?
- Chronic illness
- last menstrual period
- medications/OTC/herbals
- allergies
- previous hospitalizations
- previous surgeries
- family Hx of surgery
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During a physical assessment what is necessary for a preoperative surgery?
- height/weight
- VS (BP, RR, HR, Temp, O2)
- Respiratory pattern and rythm
- Circulatory (apical pulse)
- Neurological
- Musculoskeletal
- Skin
- Emotional status
- lab test
- last meal
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What are pre-operative medications for and when should they be given?
- They are to DECREASE anxiety, secretions in resipratory tract, acidity and production of gastric secretions, pain, risk of infection.
- Oral meds are to be given 60-90 min before transport with small sips of water
- IM/SQ/IV meds are to be given 30-60 min before transport
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What are Benzodiazepines used for and examples?
- Reduce anxiety and promote amnesia
- Examples: Midazlolam (Versed), Diazepam (Valium), Lorazepam (Ativan)
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What are Opiods used for and examples?
- Relieve pain
- Examples: Morphine, Meperidine (Demerol)
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What are Histamine Receptor Antagonists used for and examples?
- Decrease acid secretions
- Examples: Cimetidine (Tagamet), Famotidine (Pepcid)
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What are antiemetics used for and examples?
- Increase gastric emptying (nausea and vomiting)
- Examples: Metoclopramide (Reglan), Ondansetron (Zofran)
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What are anticholinergics used for and examples?
- Decrease oral and respiratory secretions
- Examples: Atropine, Scopolamine
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What are antibiotics used for and examples?
- Decrease risk for infection
- Examples: Ancef
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Why is it important to teach your patient?
- Decreases complications
- Increases client satisfaction
- Decreases length of stay
- Promotes psychological well-being
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What are the key things to teach the patient?
- Not to eat anything past midnight
- No fluids 2 hours before
- No meat or fried foods 8 hours before
- Light meal up to 6 hours before
- Which meds to take and not to take morning of surgery
- Any procedures to do at home to prep
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When is the best time to teach postoperative activities to the client?
Before leaving the room
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What are the activites for postoperative are needed to be taught to the client?
- Turning in bed & sitting up in bed (every 2 hours)
- Coughing & Deep breathing (every 2 hours)
- Incentive Spirometer (10 x evry hour)
- Leg exercises-ankle rotation, dorsiflexion/plantar flexion, flexing/extending kness, raising/lowering leg (repeat 10-12 x every 1-2 hours)
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What are guidelines to prevent surigcal site infection?
- Do not remove hair unless it will interfere with the operation and remove it using only electric clippers if possible
- Administer prophylactic antibiotics
- Maintain glucose control for major cardiac patients
- DVT prophylaxis
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What is the time frame for administering prophylactic antibiotics?
- 1 hour before surgical incision
- 2 hours before surgical incision if giving vancomycin and fluoroquinolones
- may need to redose for longer surgeries
- discontinued within 24 hours after surgery end time (48 hours for cardiac patients)
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What are the postoperative phases?
- Immediate postanesthesia recovery- time client leaves OR until they get back on floor
- Early recovery- time client is released from PACU until going home
- Convalescent Phase - when client goes home
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What are the 5 W's of common causes of postoperative fever?
- Wind
- Water
- Walking
- Wound
- Wonder drugs or "What did we do?" or "Wonder Why"
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What are some expected outcomes for a patient in early postoperative recovery?
- breath sounds clear bilaterally
- VS remain WNL
- Pain <4
- Fluid balanced as evidence by Is/Os
- Normal BS
- Incision well approximated
- Client reports understanding of post op teaching
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