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What are the different purposes for any sugery?
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
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
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
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
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
What is the purpose of and examples of a transplant procedure?
- Replaces malfunctioning organs.
- Examples: Cornea, heart, joints, kidney
What are the two types of degrees of risk?
Major and Minor
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
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
What are the different types of urgencies for surgery?
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
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
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
What are the different admission status for patient who are having a surgery?
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
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
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
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
- Physical assessment
What do you look for in the clients medical history?
- Chronic illness
- last menstrual period
- previous hospitalizations
- previous surgeries
- family Hx of surgery
During a physical assessment what is necessary for a preoperative surgery?
- VS (BP, RR, HR, Temp, O2)
- Respiratory pattern and rythm
- Circulatory (apical pulse)
- Emotional status
- lab test
- last meal
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
What are Benzodiazepines used for and examples?
- Reduce anxiety and promote amnesia
- Examples: Midazlolam (Versed), Diazepam (Valium), Lorazepam (Ativan)
What are Opiods used for and examples?
- Relieve pain
- Examples: Morphine, Meperidine (Demerol)
What are Histamine Receptor Antagonists used for and examples?
- Decrease acid secretions
- Examples: Cimetidine (Tagamet), Famotidine (Pepcid)
What are antiemetics used for and examples?
- Increase gastric emptying (nausea and vomiting)
- Examples: Metoclopramide (Reglan), Ondansetron (Zofran)
What are anticholinergics used for and examples?
- Decrease oral and respiratory secretions
- Examples: Atropine, Scopolamine
What are antibiotics used for and examples?
- Decrease risk for infection
- Examples: Ancef
Why is it important to teach your patient?
- Decreases complications
- Increases client satisfaction
- Decreases length of stay
- Promotes psychological well-being
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
When is the best time to teach postoperative activities to the client?
Before leaving the room
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)
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
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)
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
What are the 5 W's of common causes of postoperative fever?
- Wonder drugs or "What did we do?" or "Wonder Why"
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