Card Set Information
N101 surgical patient test3
N101 care of the surgical patient for test 3
What is surgery?
The art and science of treating diseases, injuries, and deformities by operation and instrumentation.
Define the suffix -ectomy.
incision or removal of
Define the suffix -lysis.
Define the suffix -orrhaphy.
repair or suture of
Define the suffix -oscopy.
Define the suffix -ostomy.
creation of opening into
Define the suffix -otomy.
cutting into or incision of
Define the suffix -plasty.
repair or reconstruction of
What are some (6) purposes of surgery?
Relieving the symptoms of disease.
What are the (5) categories of surgical urgency?
What is emergent surgery?
Surgery that must be performed without delay.
: severe bleeding, extensive burns, gunshot/stab wounds, fractured skull, bladder/intestinal obstruction
What is urgent surgery?
Surgery that must be don within 24-30 hours
: acute gall bladder infections, kidney or ureteral stones
What is required surgery?
Surgery that should be planned within the next few weeks or months.
: prostatic hyperplasia,thyroid disorders, cataracts
What is elective surgery?
Surgery that if left undone will not be catastrophic.
: simple hernia, repair of scars
What is optional surgery?
Surgery that is a personal preference.
: cosmetic surgery
What are the stages of surgery?
List (7) tasks that are a part of preadmission testing.
Initiates initial preoperative assessment
Initiates teaching appropriate to patient’s needs
Involves family in interview
Verifies completion of preoperative diagnostic testing
Verifies understanding of surgeon-specific preoperative orders
Discusses, reviews advanced-directive document
Begins discharge planning by assessing patient’s need for postoperative transportation, care
List (5) things that put a patient at risk during surgery.
Greater than 65 years old
Prior surgical experience
Type of Procedure
List (11) items that are included in the preoperative assessment.
Spiritual and Cultural Beliefs
List (11) drugs that may affect the surgical experience.
What are some special considerations of gerontologic patients?
Have less physiologic reserve
Decrease ability to perspire
Sensory limitations – increased risk for falls
What are some special considerations of obese patients?
Dehiscence and wound infection more common
Shallow respirations – postop pulmonary complications
What are some special considerations of patients with disabilities?
List (9) items included in preoperative teaching.
Situational and Procedural Information
.... General Information
.... About Surgery
Sensation and Discomfort information
Skills Training Information
.... Breathing Exercises
.... Mobility and ambulation
What are some nursing interventions in holding area? (8)
Verifies surgical site and marks site
Establishes intravenous line
Ensures patient comfort
Provides psychological support
Administers medications if ordered
Communicates patient status to other members of the healthcare team
What is included in the preop checklist?
slide 14 (look in book)
What are the (8) types of medications used preoperatively?
Gastric acid blockers
Who are the (6) members of the surgical team?
Registered Nurse First Assistant
Anesthesiologist and Anesthetist
What are the duties of the Circulating Nurse?
What are the duties of the Scrub Nurse
What are the duties of the Surgeon
What are the duties of the Registered Nurse First Assistant
What are the duties of the Nurse Anesthetist
What are the types of anesthesia?
Peripheral nerve block
Tell me (5) things about local anesthesia?
Cause loss of sensation in limited areas of the body
Systemic absorption could cause toxic effects on the nervous system and the heart
Esters broken down immediately in plasma by enzymes
Amides metabolized more slowly in liver; serum levels of these drugs can lead to toxicity
Agent of choice depends on mode of administration, length of time for area to be anesthetized, and potential adverse effects
What are three types of general anesthesia?
What some advantages of inhalation anesthesia?
Induction and reversed via pulmonary ventalation
Few side efffects
What some advantages of IV anesthesia?
Rapid and pleasant induction
Low postop N/V
What some advantages of balanced anesthesia?
Minimal disturbance to physiological function
Can be used with older and high risk patients
What some advantages of regional or local anesthesia?
Gag and couch reflex is left intact
Participation and cooperation by patient
Decreased disruption of physiological and emotional effects
Decreased sensitivity to agent
Decreased itraop stress.
What some disadvantages of inhalation anesthesia?
Need combination agents
Limited muscle relaxant
Postop nausea & shivering common
What some disadvantages of IV anesthesia?
Must be metabolized and excreted tor reverse effects
Contraindicated in renal and hepatic patients
Increased cardiac and resp, depression
Retained by fat cells
What some disadvantages of balanced anesthesia?
Pharmacological effects my be unpredictable
What some disadvantages of regional or local anesthesia?
Difficult to administer to upset or uncooperative patients
No way to control agent after administration
absorbs rapidly in blood - cardiac depression/overdose
Increased nervous system stimulation
Nit practical for extensive procedures
List (4) modes of administering local anesthesia.
Infiltration – injecting anesthetic directly into tissues
Prevents nerve endings form transmitting impulses to the brain
Nerve Block – inject along the nerve or nerves that run to and from the region in which loss of pain or muscle paralysis is desired
What is the therapeutic action of local anesthesia?
Affect permeability of nerve membranes to sodium ions
Stops nerve from depolarizing
Particular section of nerve cannot be stimulated and nerve impulses directed toward that section are lost when they reach that area
What are contraindications of local anesthesias?
Allergy to any one of these agents or parabens
Shock – could alter local delivery and absorption
Decreased plasma esterases – could result in toxic levels of ester-type
What are adverse and interactions of local anesthesias?
: H/A, restlessness, anxiety, dizziness, tremors, blurred vision, & backache
GI – N/V
Cardiovascular – peripheral vasodilation, myocardial depression, arrhythmias, & BP changes, cardiac and respiratory arrest
: increased and prolonged neuromuscular blockade
: less risk of systemic absorption & increased local effects
Nursing? slide 36
.... localized blanching
.... therapeutic effects
.... Promptly report adverse effects
.... Monitor continued effects
.... Patient education
.... Ensure patient safety
What is conscious sedation?
IV sedative/hypnotic/opiod meds used to decrease LOC but allow client to maintain patent airway and follow commands
Short acting/ rapid recovery
Nurses administer with special training
Tell me about conscious sedation.
No oral intake x 30 min
Can’t drive post op
.... Useful for short procedures
.... Easy to administer
What are some medications used for conscious sedation?
What are some uses of conscious sedation?
What must be monitored during conscious sedation?
VS q15-30 min
What are the (4) Stages of Anesthesia
: Beginning Stage
.... most dangerous and distressing
: Surgical anesthesia
: Medullary depression
.... too much anesthesia
Tell me about general anesthesia.
Lipid soluble --> distributed widely throughout body
Wait 4-6 hrs after recovery before nursing baby
What are some contraindications and cautions of general anesthesia?
No IV access
What are some cautions of general anesthesia?
Severe cardiovascular disease
Conditions where hypnotic effects may be prolonged or potentiated (IICP, myasthenia gravis)
What are some adverse effects & interactions of general anesthesia.
Circulatory depression, hypotension, shock, decreased CO, arrhythmias
respiratory depression (apnea, laryngospasm, bronchospasm, hiccups, coughing), H/A, N/V, prolonged somnolence, delirium, malignant hyperthermia
skin breakdown r/t immobility
Ketamine & Halothane --> severe cardiac depression
Ketamine may potentiate muscular blocking of NMJ blockers requiring prolonged period of respiratory support
What are some general properties of gases for general anesthesia?
Enter bronchi and alveoli, rapidly pass into capillary system, and are transported to heart to be pumped through body
High affinity for fatty tissue
Pass quickly into brain and cause severe CNS depression
What are some general properties of nitrous oxide?
Weakest and least toxic of gas anesthetics
Rapid onset (1-2 min) and recovery
Does not produce complete LOC or relaxation of skeletal muscle
Usually combined with other agents
Can block reuptake of oxygen after surgery, causing hypoxia
Always given in combination with oxygen
What are some general properties of the volatile liquid, halothane (Fluothane)?
Unstable at room temp. and release gases
Primarily used with other anesthetic agents
Associated with vomiting, bradycardia, hypotension, and hepatic toxicity
Recovery syndrome (rare) – fever, anorexia, nausea, vomiting, and eventual hepatitis and hepatic necrosis
Not used more frequently than every 3 weeks to reduce risk
What are adverse effects of halothane (Fluothane)?
Dysrhythmias are a concern
Lowers blood pressure and respiratory rate
Overcomes reflex mechanisms that normally keep contents of stomach from entering lungs
Increased intracranial pressure
What are some interactions of halothane (Fluothane)?
Excessive hypotension with antihypertensive drugs
Potentiates action of nondepolarizing neuromuscular blocking agents
Aminoglycosides – skeletal muscle weakness, resp. depression, or apnea
Levadopa – increases level of dopamine in CNS
Discontinue 6-8 hours prior to surgery
What are some general properties of succinylcholine?
Depolarizing NMJ blocker
Attaches to Ach receptor site on muscle cell, depolarizing the muscle
Inhibits neuromuscular transmission, causing flaccid paralysis
Indications – adjunct to general anesthesia, facilitate endotracheal intubation, induce skeletal muscle relaxation during surgery or mechanical ventilations
What are the pharmocokinetics of succinylcholine?
onset 30-60 secs
duration 4-6 min
Half life- 2-3 min
metabolized in tissues
excreted unchanged in urine
What are the contraindications & cautions of succinylcholine?
Crosses placenta, but accurate timing prevents serious effects on fetus
Effects during lactation not known
Allergy, myasthenia gravis, renal or hepatic disease
Family or personal history of malignant hyperthermia
Pulmonary or cardiovascular dysfunction, altered fluid and electrolyte, patients with fractures, narrow angle glaucoma, penetrating eye injuries, paraplegia or spinal cord injuries, conditions causing low plasma cholinesterase levels
What are the adverse effects of succinylcholine?
Profound and prolonged muscle paralysis
Never use without anesthesiologist or nurse anesthetist
Histamine release can cause respiratory obstruction with wheezing and bronchospasm
Hypotension and cardiac arrhythmias
GI – constipation, vomiting, regurgitation, and aspiration
What are the interactions of succinylcholine?
NMJ blockers & aminoglycoside antibiotics – increased neuromuscular blockage, increased risk of dysrhythmias
Lower dose of NMJ blocker and prolonged support and monitoring
Calcium channel blockers increase paralysis r/t effect on calcium channels in muscle
Decrease NMJ blocker dose and close monitoring
Cholinesterase inhibitors- effectiveness of NMJ blocker decreased r/t buildup of Ach in synaptic cleft
Xanthines (theophylline) – could result in reversal of neuromuscular blockage
What are some Intraoperative Complications
Hypoxia, respiratory complications
Disseminated intravascular coagulation (DIC)
What is Malignant Hyperthermia?
Rare & inherited muscle disorder
R/T hypermetabolic condition involving altered mechanisms of calcium function in skeletal muscle cells
How is Malignant Hyperthermia Managed?
D/C anesthesia, dantrolene sodium
.... decrease metabolism
.... reverse acidosis
.... correct dysrrhythmias
.... decrease temp
.... correct electrolyte imbalance
Potential Adverse Effects
Allergic reactions, drug toxicity or reactions
CNS changes, oversedation, undersedation
: laryngeal, oral, nerve, skin, including burns
Refer to Chart 19-1
What are some intraoperative nursing interventions
Reducing latex exposure
Preventing intraoperative positioning injuries
Protecting patient from injury
Serving as patient advocate
Monitoring, managing potential complications
What tasks are part of PACU Management?
Assessment – airway, respiratory & cardiovascular function, skin color, LOC, and ability to respond to commands, surgical site, VS, postop analgesia
Maintain patent airway
Maintain cardiovascular stability
Hypotension and shock
HTN & dysrhythmias
Relieve pain and anxiety
Gerontologic – change position frequently
Classification of Hemorrhage
Secondary or delayed
What is primary hemorrhaging?
Hemorrhaging that occurs at the time of surgery
What is intermediary hemorrhaging?
Hemorrhaging that occurs a few hours after surgery when the BP rises to its normal level.
What is secondary or delayed hemorrhaging?
Hemorrhaging that occurs some time after surgery
Delayed occurs 7-10 days after surgery
What is capillary hemorrhaging?
Slow general ooze
What is venous hemorrhaging?
Dark colored bubbles out quickly.
What is arterial hemorrhaging?
appears in spurts with each heart beat
What is evident hemorrhaging?
Can be seen
What is concealed hemorrhaging?
In a body cavity
Cannot be seen
Inpatient Nsg Management Postop
Initial primary concerns – adequate ventilation, hemodynamic stability, incisional pain, surgical site integrity, N/V, neuro status, & spontaneous voiding
Then regaining independence
Managing potential complications
.... Wound dehiscence
Types of Drains
Outpatient Surgery/Direct Discharge
Discharge planning, discharge assessment
Provide written, verbal instructions regarding:
.... follow-up care
.... wound care
Give prescriptions, phone numbers
Discuss actions to take if complications occur
Give instructions to patient, responsible adult who will accompany patient
Patients are not to drive home or be discharge to home alone
Sedation, anesthesia may cloud memory, judgment, effect ability
List common postop complications.
Deep Vein Thrombosis
When is atelectasis likely to occur (postop)?
When is a postop fever likely to occur?
What is wound dehiscence?
A closed wound that has reopened
What is wound evisceration?
a protrusion of wound contents
List postop teaching topics.
Incision and Drain care
.... Inspect daily
.... Site care
.... Sutures and Steristrips
.... Note color of drainage from drains. Empty as needed.
.... Assess needs, follow-up appts, and wound checks
.... Assess environment for safety
.... Medication education
.... Fatigue may last several weeks.
.... Avoid strenuous exercise
.... Assess support systems and need for home care
When to Call Physician?
Fever with chills
Increased pain or pain not adequately controlled by medications
Incision is re, painful, or has drainage
Difficulty voiding or unable to void