SUR 101 unit 3
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care in which surgical team bases its assessments, planning and interventions on the unique needs of the individual patient
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
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
- security and safety
process of oxygen exchange at the cellular and molecular level and many other complex physiological processes
physical expansion of the lungs and thoracic cavity
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
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
slowing down of metabolic functions
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
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
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
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
whatever individual defines as a goal or achievement
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
- 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
the way we perceive ourselves physically in the eyes of others
characteristics of therapeutic communication
- goal directed
- unique to each patient
- active engagement
- excellent observation and listening skills
therapeutic responses include?
- cue giving
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
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
birth to 18 months
19 months to 3 years
4 to 6 years
school age stage
7 to 12 years
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?
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
lacking the right kinds of food to support body function
endocrine disease that disrupts metabolism of carbs, fats and proteins
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
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
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
to whom do decisions about end-of-life care fall when the patient is not able to communicate his or her wishes?
intentional harm to a person, at their request, to promote or cause death
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
document which specifies the exact nature of palliative care that they accept
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
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?
- 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
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
natural stiffening of the body
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
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
- 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
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
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)
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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