meg surg

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meg surg
2013-05-20 03:43:50
chapter 12

pt having surgery
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  1. surgical procedure suffix
    • -ectomy= removal by cutting.
    • -orrhaphy=suture/repair.
    • -oscopy= look into
    • -ostomy=formation of a permant opening.
    • -otomy=incision/cutting into.
    • -plasty= formation or repair.
  2. surgery urgency level & purpose
    • emergany: immediate-ruptured aortic.
    • urgent: surgery w/i 24-30hrs-fracture repair.
    • diagnostic: obtain sample for diagnosis-biopsy
    • palliative: alleviation of symptoms when cannot be cured-rhizotomy.
  3. perioperative surgical phases
    • periop-3 phases
    • preop-begin decision of surgery, transfer to op room.
    • intraop-(pacu)
    • postop-recovery room.
  4. patient family
    experience anxiety during surgery.
  5. pt experience
    • anxiety and fear.
    • fear of not waking up. (postpone surgery)
  6. cancellation of surgery
    can result if pt has not been NPO as ordered.
  7. postop exercises
    deep breath, cough, spirometry leg exercises.
  8. deep breathing
    prevent development of atelectasis (collapse lung caused by hypo ventilation or mucus obstruction preventing some alveoli from opening and being fully ventilated).
  9. spirometer
    • sit up 45 degreesminimum
    • take 2 normal breaths, place spirometer in mouth.
    • inhale till target,designed by spirometer light or rising ball is reached and hold breath for 3-5 seconds.
    • exhale completlty
    • perform 10 sets breath each hr.
  10. chronic oral steroid therapy
    don't stop taking.
  11. anesthesia
    used during surgery prevent pain.
  12. two types anesthesia
    • general: iv/inhaled.anxious pt. lose sensation and consciousness.
    • local:sedation of specific body part, no sleep.
  13. malignant hyperthermia
    • muscular disease triggered by general anesthetic agent.
    • symtom: high fever and respiratory acidosis.
    • stop surgery, anesthesia discontinued.
    • oxygen 100% is given.
    • pt cooled with ice and ice infusions solutions
    • antidote: dantrolene sodium.
  14. spinal and epidural block
    • spinal block a local agent into subarachnoid space.
    • epidural block local in epidural space.
    • both lower extremities.
    • respiratory depression.
  15. conscious sedation
    • twilight sleep
    • minimal sedation that doesn't cause the complete loss of consciousness.
    • dental/diagnostic
  16. pt safty interventions
    • bed in low position, rails up.
    • call button is close to reach.
    • assist with ambulation.
    • 1 or 2 health care wker should assist pt, dangle first.
  17. fine crackles
    • crackles in the lungs, pt should deep breath and cough.
    • listen again to see if cleared.
    • airway is compressed immediately support airway, call dr.
    • situp, give oxygen, no fluids.
  18. ineffective breathing d/t pain
    pain slows healing, give morphine to help relax for deep breathing and cough.
  19. ineffective airway
    ambulate pt, immobility decreases movement of mucus secretion.
  20. ineffective tissue perfusion.edema
    • leg exercise hrly.
    • apply thigh length compression stocking
    • avoid pressure under knees.
    • give anticoagulants or plasma expanders.
  21. pain
    hinders deep breathing and coughing and hinder walking. increasing complications and longer stay in hospital & health cost.
  22. ibuprofen
    effectivly used for postop pain relief.
  23. analgesics IM
  24. wound healing phases
    • 1: inflammatory response. fever
    • 2:granulation tissue forms. feel better
    • 3: collagen deposited. raised.
    • 4: collagen deposited.flat.
    • healing by 3rd intention, infected wound is left open until there is no evidence of infection and then the wound is surgically closed.
  25. dehiscence
    bursting open wound edges.
  26. serosaguineous
  27. evisceration
    • viscera spilling out abdoman
    • intestine spill out.
    • lead to shock.
    • something let loose/gave way.
    • pain/vomiting
  28. dehiscence or evisceration
    • 1: pt in low Fowler with flexed knees.
    • 2: cover wound with sterile dressing/towel, moisten with warm steral normal saline.
    • 3: call dr
    • 4: appy pressure over wound.
  29. zophan
    • inject zophan if pt vomits meds.
    • don't give over 5ml injection.