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This phase begins with the admission of the patient to the perianesthesia care unit (PACU) & continues until the patient's recovery is completed.
Physicians who perform surgical procedures are called_____?
The period when an anesthetic is 1st given until full anesthesia is reached?
This phase begins with the decision to have surgery & ends with transfer of the patient to the operating room
This phase begins when the patient is transferred to the operating room & ends when the patient is admitted to the PACU
An ____ agent is medication (such as narcotics, muscle relaxants, or anti emetics) used with the primary anesthetic agent.
The sudden bursting open of a wound's edges that may be preceded by an increase in serosanguineous drainage is referred to as:
Physicians who administer anesthesia
Causes a loss of sensation hand allows the surgical procedure to be done safely.
Occurs from hypoventilation or mucous obstruction that prevents some alveoli from opening and being fully ventilated.
The removal of necrotic & infected tissue
Body temperature that is below normal range
The viscera spilling out of the abdomen
-Surgery done at request of patient
-Surgery planned & scheduled without immediate time constraints
-skin lesion removal
-Surgery needed within 24-30 hours
-Surgery needed when any delay jeopardizes the patient's life or limb
-Ruptured aorotic aneurysm or appendix
-Traumatic limb amputation, loss of extremity pulse
True or false
All medications that patients are taking must be reviewed preoperatively.
True or false
Most anticoagulants, such as warfarin (coumadin) do not need to be stopped before surgery
- The surgeon determines if the anticoagulant therapy is stopped several days before surgery, which it often is.
True or False
Diabetic patients on insulin are told to increase their normal insulin dose the day of surgery
- The patient may be told by the physician to either take no insulin, the normal dose of insulin, or half of the normal dose.
True or False
Blood glucose monitoring for diabetic patients is ordered on admission
True or False
If a patient is on chronic oral steroid therapy it cannot be abruptly stopped when nil per os (NPO)
True or False
Surgery is not a serious stressor for the body.
- Surgery is a serious stressor for the body
true or False
Chronic oral steroid therapy should be continued via the parental route if the patient is NPO
True or False
Circulatory collapse can develop if steroids are not stopped abruptly
- Circulatory collapse can develop if steroids ARE STOPPED ABRUPTLY
Time Frame- Incision to 2nd postoperative day
Wound Healing- Inflammatory response
Patient Effect- Fever, malaise
- Phase 1
- Time Frame, Wound Healing, Patient Effect
Time Frame- 3rd to 14th postop day
Wound Healing- Granulation tissue forms
Patient Effect- Feeling better
- Phase 2
- Time frame, Wound healing, Patient effect
Time Frame- 3rd to 6th postop week
Wound Healing- Collagen deposited
Patient Effect- Raised scar formed
Time Frame- Months to 1 year
Wound Healing- Wound contracts & shrinks
Patient Effect- Flat, thin scar
- Phase 4 IV
- Time Frame, Wound healing, Patient effect
Its for nursing interview, diagnostic testing, anesthesia interview, & preoperative teaching to ensure patient is in the best possible condition for surgery
Laboratory tests:blood glucose, creatinine, blood urea nitrogen (BUN), electrolytes, complete blood count, prothombin time, partial thrombosplastin time, bleeding time, type & screen & urinalysis are some common test; oxygen saturation, electrocardiogram, chest x-ray
what pre admission testing may be done:
What are the 2 primary responsibilities of the perianesthesia care nurse?
Maintaing the patient's airway and safety
What does deep breathing & coughing prevent?
Atelectasis & pneumonia
Leg exercises & activity prevent?
Drains are inserted to prevent____?
Fluid accumulation & infection
When the patient's signature is witnessed by the nurse on the surgical consent, what does that mean?
The nurse verified that the patient signed the consent.
What is an intraoperative outcome for a patient undergoing an inguinal hernia repair?
Maintains skin integrity
What kind of goals:
-Demonstrates leg exercises
-Explains deep breathing exercises
Discharge criterion from the PACU for a patient following surgery?
Oxygen saturation above 90%
Discharge criteria from ambulatory surgery for patients following surgery?
Understands discharge instructions
Long term steroid therapy cannot be abruptly stopped because?
Higher steroid levels are needed during stress.
Complications that a nurse would correctly explain to a patient can be prevented with early postoperative ambulation
Pneumonia can be prevented with lung expansion promoted by ambulation
The nurse is caring for a patient with a bowel resection. What would indicate that the patient's gastrointestinal tract is resuming normal function
- Presence of flatus
- It occurs with normal bowel functions
Bowel is not functioning when:
Firm abdomen & absent bowel sounds
After surgery, patient's urine is dark amber & concentrated? Why?
The sympathetic nervous system saves fluid in response to stress of surgery
The patient develops a low-grade fever 18 hours post-operarively & has diminished breath sounds. What should the nurse do to prevent complications?
- Encourage coughing & deep breathing
- -Ambulate patient as ordered
May be elective, urgent or emergency
Purpose: To preserve life, repair or remove body part
Purpose: To restore function, remove skin lesion & to correct deformities
May be major or minor. Make or confirm diagnosis
Ex: breast diagnosis
Usually major. Diseased body part removed.
Ex: Appendectomy, Amputation
To restore function to traumatized or malfunctioning tissue
Ex: Scar revision, plastic surgery
To replace organs or structures that are diseased
Ex: heart, kidney, liver & cornea
Influencing factors of surgery
- Age: old & young don't tolerate surgical procedures
- Physical condition: Pt's with chronic disease or health problems require longer recovery periods.
- Nutritional factors:
Vitamin B (Thiamine) is for
Vitamin C is for
Blocks central awareness centers in brains, Administered by IV, inhalation
-Loss of consciousness, sensation, skeletal muscle relax & reduction of reflex
Minimal, can move
Surface/ topical applied directly to skin & mucous membranes
Used in minor procedures like skin biopsy / suturing
Anesthesia in nerve trunk
Via lumbar puncture into subarachnoid space
-Protects the client, physician & the health care institution, legal document
-Description of the procedure /Treatment
-Name & qualification of person performing procedure
-Explanation of risks involved
-Explains alternatives/ possible effects of not having treatment
-Info. that patient has the right to refuse treatment
Consent forms are not legal if:
- client is considered a minor, confused, unconscious, sedated, mentally incompetent
- -consent in these instances may be given by parent/guardian
Height, weight, VS, general appearance, provides base line data
-status of skin
*Immunologic status:history of allergies, immunosuppression common with radiation & chemo therapy
*Abd status: Bowel sounds, size, shape, last BM
*Endocrine status: in uncontrolled diabetes, hazard in hypoglycemia from anesthesia
*Neurologic status: Mood, motor & sensory function, follows all commands
Pre-operative Physical Assessment
The edges of the wound are approximated with staples or sutures. Minimal scarring.
-occurs in a clean wound
1st intention (Primary)
The wound is left open & allowed to heal by inside/out. Scarring is usually big w/ longed healing.
-Large, irregular or infected wounds
-Pressure ulcers are or chronic wounds are treated this way.
2nd intention (Secondary)
An infected wound is left open until there is no evidence of infection & the wound is then surgically closed.
-Granulation tissue fills in for some wound healing & then edges are approximated
-Wider scarring occurs
3rd intention (tertiary)
White blood cells, dead & live bacteria, warm, reddened, & tender and may have drainage (pus).
place the patient in low fowlers position with flexed knees. Cover the wound w/ sterile dressings or towels moistened w/ warm sterile normal saline. -Notify Dr. immediately of surgical emergency.
-Apply gentle pressure over the wound
-Monitor VS for evidence of shock
-Prepare pt for immediate surgery
If dehiscence or evisceration occur:
Mostly clear portion of blood, large #s of RBC's
Composed of fluid & cells escaping from blood vessels
Caused by bacterial invasion
WHat kind of asepsis for dressing changes
Excessive blood loss wither internally or externally
-May occur from a slipped suture, clot or stress on operative site
-Assess for restlessness
Goal: stopping the bleeding, replacing the blood volume
-Intervention: Pressure dressing to bleeding
Partial or total disruption of wound layers
-Goal: prevention- good nutritional status promotes wound healing, aseptic technique
-If superficial, may only need steristrips
Spilling of viscera thru the incision
-Goal: good nutrition
-Interventions: Cover wound area w/ a saline soaked sterile towel
-DO NOT TRY TO PUSH ORGANS INSIDE
Provides a sinus tract
For bile drainage after a gall bladder
Decreases dead space by collecting drainage usually after abdominal surgery
Decreases dead space by collecting drainage usually w/ orthopedic surgery
Purpose: Inspect for healing & sign of infection
Advantages: absorbs drainage, protect the wound, used as pressure dressing, splint or immobilize the wound
Supplies: Cleansing agent, Dressing, Tape, / montgomery straps
-Cause: Decreased blood flow, decreased circulation to body part, decreased oxygen called ischemia
-Risk: bony prominents
Superficial layer (epidermis/dermis)
Damage or necrosis of subcutaneous tissue
Damage to muscle-bone
Chronic renal disease
For dehisced surgical incisions that resist healing, aids in healing the incision.
-Applies negative pressure to wound edges
Vac (vacuum assisted closure)
Removal by cutting
Suture of or repair
Formation of a permanent artificial opening
Incision or cutting into
Formation or repair
Not smoking increases the action of the lungs defense mechanisms & makes more hemogoblin available to carry oxygen during surgery.
Long term alcohol use causes nutritional & liver damage. It can create bleeding problems, fluid volume imbalances & drug metabolism alterations.
Collapse of the lung caused by hypoventilation or mucous obstruction preventing some alveoli from opening & being fully ventilated
Do this hourly while awake, sets of 5, for 24-48 hours postoperatively
Prevents atelectasis by increasing lung volume, alveoli expansion & venous return
-For elderly & people w/ respiration problems
-sit at 45 degrees
-Take 2 normal breaths
-Inhale until target is reached
-hold for 3-5 seconds
Perform 10 sets of breaths each hour
causes the patient to loose sensation, consciousness, & reflexes.
-Acts directly on the central nervous system
Blocks nerve impulses along the nerve where it is injected, resulting in the loss of sensation to a region of the body w/o the loss of consciousness
Local anesthesia (regional)
A localized collection of extravasated blood, usually clotted, in an organ, space or tissue