| what are the classes of surgery? | elective, urgent or emergent |
| what are the two categories of surgery? | Major and Minor |
| surgery is performed for various purposes, what
are they? | diagnostic
ablative
palliative
reconstructive
curative
preventive
transplant
constructive and cosmetic |
| What are some common surgical settings? | Inpatient
one day
outpatient
short stay surgical center
short stay unit
mobile surgery unit |
| Anastomosis | surgical joining of two ducts or blood vessels
to allow flow from one to another.
to bypass an area ( Billroth I, joins stomach and duodenum.) |
| -ectomy | surgical removal of ( cholecystectomy, removal of
gallbladder) |
| Lysis | destruction or dissolution of ( lysis of adhesions,
removal of adhesions) |
| -orrhaphy | surgical repair ( herniorrhaphy, repair of a hernia) |
| -oscopy | direct visualization with a scope ( cystoscopy, direct
visualization of the bladder and urethra by means
of a cystoscope) |
| -ostomy | opening made to allow the passage of drainage
( ileostomy, formation of an opening of the ileum
onto the surface of the abdomen for passage of
feces) |
| -otomy | opening into ( thoracotomy, surgical opening into
the thoracic cavity) |
| -pexy | fixation of ( cecopexy, fixation or suspension of the cecum to correct its excessive mobility) |
| -plasty | plastic surgery |
| What can the nurse have the UAP do during patient preparation for surgery? | administer an enema or douche, obtain v/s , apply antiembolic stockings, and assist pt in removing clothing, jewelry and prostheses |
| ablative | excision or removal of diseased body part. ( amputation or removal of something |
| palliative | surgery for relief or reduction of intensity of disease of symptoms, not cure |
| what are some common fears associated with surgery? | fear of loss of control associated with anesthesia.
fear of the unknown.
fear of waking up during the operation.
fear of pain.
fear of death
fear of change in body image
fear of detection of cancer |
| what are some of the major problems younger and older patients have during surgical procedures. | temperature variations, cardiovascular shifts, respiratory needs, and renal functions. |
| list a few risks the older adults have when undergoing surgery. | Aspiration, atelectasis ( collapsed lung) pneumonia, thrombus formation, infection, altered tissue perfusion. |
| list what the perioperative nursing includes | preoperative phase , intraoperative and postoperative phase. |
| what type of communication will the nurse need to use in the surgical process. | nonverbal communication. |
| if the pt is showing signs of malnutrition what should you as then nurse do? | tube feeding , IV therapy of total parenteral nutrition can be initiated, |
| what does the ABCDEF mnemonic device to ascertain serious illness of trauma in the preoperative pt stand for? | A: allergy to medications, chemicals, and other including latex.
B: bleeding tendencies of use of meds like aspirin, heparin, or warfarin sodium
C: cortisone or steroid use
D: diabetes mellitus
E: embili any past hx.
F: fighting ability any pt with immune system problems |
| What are a few common fears associated with surgery? | loss of control
fear of the unknown
fear of the unknown
fear of pain
fear of death
fear of separation ( kids are a big one for this)
fear of disruption of life patterns
fear of change in body image
fear of detection of cancer |
| What are some of the perioperative meds and agents used? | anesthethetives, antimicrobials, anticoagulants , hemostatic agents, steroids , diagnostic imaging dyes, diuretics, central nervous system agents, emergency protocol medications. |
| why do you need to ask about herbal remedies as alternative or complementary therapy. | Most people do not think of them as medications and they may interact with or potentiate other medications and interfere with surgical procedures. |
| why do you need to know if your pt is on vitamine E? | it may prolong bleeding times |
| meds that need to be given the day of surgery are to be given with a sip of water in the morning what might these meds be? | antiseizure and cardiac drugs |
| who typically provides the teaching regarding preoperative instructions that maybe GI cleaning or assistive devices like crutches | the surgeons nursing staff |
| what are some per op considerations for
Echinacea | neg impact on liver, can interference with hepatic metabolism of anesthesia meds |
| what are some per op considerations for Ephedra sinica | increased risk of cardiac dysrhythmias |
| per op considerations for feverfew | has anticogulation factors can increase bleeding |
| what are per op considerations for Garlic and Ginger and Ginkgo biloba | increased bleeding and prolonged clotting times |
| per op considerations for Ginseng | may increase anesthetic agent requirments and potential for hypoglycemia in pt with DM |
| what are per op considerations for Gaurana | may reduce the efficacy of Warfarin |
| what are some per op considerations for Kava | may increase effects of certin muscle relaxants |
| what are some pre op considerations for Licorice | may cause hpyertension |
| what are some per op considerations for St. John's wort | should not be used with other psychoactive drugs, momoamine oxidase inhibitors or serotonin reuptake inhibitors this needs to be discontinue before surgery bc of possible drug interactions |
| what are some pre op considerations for Valerian root | should not be used with sedative or anxiolytice |
| what should the nurse explain to the family regarding what to expect right after surgery to the pt family? | that V/S, dressings, and tubes are assessed every 10 to 15 min until the pt is awake and stable |
| what are some laboratory tests commonly reviewed before surgery? | urinalysis
CBC
Blood chemistery profile to assess endocrine, hepatic and renal and cardiovascular functions.
serum electolytes
chest x-ray
electrocardiogram
BUN |
| What meds can be given over a period of days to detoxify and sterilize the GI tract for a bowel surgery ? | neomycin
sulfonamides
erythromycin |
| once the pt is in the OR an antiseptic solution to kill adherent and deeper residing bacteria is used what are these called | povidoneiodine or betadine and chlorhexidine |
| what are the ways latex allergy occur | 1. as irritant contact dermatitis
2. as a type IV allergic reactions
3. as a type I allergic reaction |
| true latex allergy is the type I allergic reaction and occures shortly after exposure to the proteins in lates rubber. | this happens by touch inhaled or ingested |
| what might the OR surgeon order for a pt with latex allergy? | prophylactic treatment with glucocorticoid steroids and antihistamines |
| why is it important to ventilate the lungs post op | to prevent or treat atelectasis, improve lung expansion and improve o2 and prevent post op pneumonia |
| What is given to help the pt with improve lung expansion post surgery | incentive spirometer |
| what are to two types of incentive spirometer | flow-oriented incentive spirometer
volume-oriented spirometer |
| when is an inventive spirometer contraindicated | in cranial and spin- related surgeries |
| why should the pt not massage the legs after a surgery? | because of the risk of dislodging a thrombus |
| how much fluid should you have your pt drink after awake post surgery? | 8 oz every hour unless contraindicated. |
| true or false
urinary retention is a common postoperative complication. | true |
| Benzodiazepines | midazolam
diazepam (Valium)
lorazepam ( Ativan)
decrease anxiety and produce sedation.
monitor for resp depression, hypotension, drowsiness and lack of coordination |
| Opioid anglgesics | morphine
fentanyl citrate ( sublimaze)
decrease anxiety and allow decreased anesthetics
monitor for resp depression, n/v hypotension and pruritus |
| H2 receptor antagonists | famotidin ( pepcid)
ranitdine ( zantac) not on market as of now
reduce gastric acid volume and concentration
monitor for confusion and dizziness in older adults |
| antimetics | metoclopramide ( reglan)
droperidol ( inapsine)
ondansetron HCI ( 5-HT3 receptor antagonist)
Zofran
enhance gastric emptying , tranquilizing effect , prevent postop n/v
monitor for sedation and involuntary movement
have pt report any problem breathing |
| Anticholingergics | atropine sulfate
glycopyrrolate (robinul)
reduce oral and resp secretion to decrease risk of aspiration decrease n/v
monitor for confusion, restlessness and tachycardia pt my have dry mouth |
| Antibiotics | cefazolin sodium (ancef)
cefotaxime sodium (claforan)
ceftriaxone
bactericidal minimizes risk of wound and infections
monitor of s/s of abd pain, diarrhea severe anal or genital pruritus and severe mouth soreness |
| Adrenocortical steroid | methylperdisolone ( depo- medrol, solu- medrol )
decreases inflammation
determin if pt had DM and anticipate and increase in antidiabetic drug regimen bc of raised blood glucose levels |
| nonsteroidal Antiinflammatory drugs NSAID | ketorolac
reduces intensity of pain and inflammations
assess pt for pain onset location and have they respond to the drug. |
| medications for the perioperative
anticoagulants | enoxaparin sodium ( Lovenox)
heparin sodium ( Heparin)
warfarin sodium (coumadin)
prevent new clot formation of secondary embolic complications
dont not give IM but subQ and tell the pt not to take OTC drugs like aspirin |
| Anticoagulants | are stopped several days before surgery, can cause prolonged clotting times which can lead to hemrrhage |
| antihypertensives | can cause hypotension when combined with anesthetic agents and narcotics |
| antiseizure drugs | can interact with anesthetic agents |
| corticosteroids | may prolong bleeding and hamper healing time. and may hamper body abilty to deal with stress of surgery |
| diuretics | can cause hypotension after surgery and decreased serum potassium levels |
| herbal therapies | affect clotting times, ginseng may increase hypoglycemia with insulin therapy |
| insulin | pt with DM may need a decrease need for insulin after surgery bc nutritional intake is decreased and stress |
| NSAID's | inhibit platelet function and may prolong bleeding leading the possible hemorrhage |
| What do some common anesthetic agents include? | propofol ( a nonbarbiturate IV anesthetic)
nitrouse oxide gas and desflurane and sevoflurance vapors, muscle relaxants |
| what is done to establish and airway | intubation with and endotracheal tube or use of a laryngeal mask airway |
| what is the greatest risk from general anesthesia? | cardiovascular depression of irritability, respiratory depression and liver and kidney damage |
| what is suctioned to decrease the risk of aspiration and laryngeal spasm after extubation? | the oropharynx |
| if the pt is having difficulty maintaining a patent air way after extubation, what is used until the pt is fully conscious | an oral airway |
