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VN 148 midterm
| Question | Answer |
|---|---|
| DIAGNOSTIC SURGERY | removal and study of tissue to make an accurate diagnosis |
| EXPLORATORY SURGERY | usually requires opening a body cavity to diagnose and determine the extent of a disease process |
| CURATIVE SURGERY | remove diseased tissue or to correct defects |
| ablation | refers to removal of tissue |
| PALLIATIVE SURGERY | relieves symptoms or improves function without correcting the basic problem |
| COSMETIC SURGERY | corrects serious defects that affect appearance; often the pt wants to change a physical feature |
| variables affecting surgical outcomes | age, nutritional status, fluid balance, medical diagnoses, drugs, smoking, alcohol |
| AGE | older adults respond differently to drugs because of age-related changes in liver and kidney function and drug interactions |
| NUTRITIONAL STATUS | MALNOURISHED - at risk for poor wound healing and infection; OBESE - generally in surgery longer & more likely to have postoperative resp and wound complications |
| FLUID BALANCE | adequate fluids necessary to maintain blood vol & urine output. Excess body fluid can overload the heart. Electrolyte imbalances may predispose pt to dangerous cardiac dysrhythmias |
| MEDICAL DIAGNOSES | BLEEDING DISORDERS, HEART DISEASE, CHRONIC RESP DISEASE, LIVER DISEASE, DIABETES MELLITUS |
| BLEEDING DISORDERS | at risk for excessive bleeding and must be closely monitored |
| HEART DISEASE | cardiac complications related to anesthesia/stress of surgery |
| CHRONIC RESPIRATORY DISEASE | pulmonary complications due to anesthesia or hypoventilation |
| LIVER DISEASE | impaired wound healing; may experience drug toxicity from the inability to metabolize drugs effectively |
| DIABETES MELLITUS | heal more slowly and at greater risk for infection |
| DRUGS | many drugs have the potential to interact with anesthetic agents. The effects of surgery or additional drugs may require dosage adjustments in drugs the pt has been taking routinely |
| SMOKING | increases the risk of pulmonary complications because secretions are more copious and tenacious and ciliary activity is less effective. |
| ALCOHOL | interacts with many drugs, may need a higher dose of anesthetic agent because of increased drug tolerance |
| HEALTH HISTORY | ID DATA, HISTORY OF PRESENT ILLNESS, PAST MED HISTORY, ALLERGIES |
| REVIEW OF SYSTEMS | collect data abt each body system, noting any abnormal. Record disabilities or limitations. Doc problems that may be significant during surgical experience, such as vision/hearing loss, partial paralysis/joint stiffness, weakness or cognitive impairment. |
| FUNCTIONAL ASSESSMENT | describe usual activity pattern, including occupation, roles & responsibilities. Determine the usual diet and fluid intake as well as the use of tobacco & alcohol. Note exercise & rest patterns. Ask abt sources of stress & support, usual ways of coping |
| PHYSICAL EXAMINATION | ht & wt, VS, Skin, Thorax |
| SURGICAL TEAM | surgeon, asst surgeon, rn who circulates, rn 1st asst, rn lpn or surgical tech, anesthesia care provider, other specialized tech personnel |
| STERILE MEMBERS | surgeon, asst surgeon, rn 1st asst, scrub nurse: RN, LVN or Tech, surgical tech |
| NON STERILE MEMBERS | circulating nurse: RN, CRNA, Anesthesiologist, other |
| ANESTHESIA- REGIONAL | using local anesthetics that block the conduciton of nerve impulses in a specific area |
| ANESTHESIA- LOCAL | may be administered topically, by local infiltration, and by nerve blocking techniques |
| ANESTHESIA- TOPICAL | applied directly to the area to be anesthesized |
| ANESTHESIA- LOCAL INFILTRATION | agent is injected into and under the skin around the area of treatment |
| ANESTHESIA- NERVE BLOCK | injecting an anesthetic agent around a nerve to block the transmission of impulses |
| ANESTHESIA- NERVE BLOCK (IE) | epidural and subarachnoid anesthesia |
| ANESTHESIA- preanesthetic agents | antianxiety agents, sedative-hypnotics, antichol & opiod analgesics; red anxiety wo causing excessive drowsiness, induce perioperative amnesia & red amt of anesthesia req. Reduce risk of adverse effect such as salivation, bradycardia, couging & vomiting |
| ANESTHESIA- General | acts on the CNS causing loss of consciousness, sensation, reflexes, pain perception and memory |
| ANESTHESIA- General -MALIGNANT HYPERTHERMIA | complications - rare but life threatening complication. Pt will have cyanosis, muscle rigidity. Surgery is interrupted and pt will have cooling measures sch as IV solution or ice packs |
| ANESTHESIA- General hypothermia | complications - body temp lower than normal |
| ANESTHESIA- conscious sedation | IV drugs reduce pain intensity or awareness w/o loss of reflexes. Complication: resp depression & apnea, hypotension, excessive sedation, agitation and combativeness |
| TERMINATION OF SURGERY | specimen handling, closing counts, wound closure: sutures, staples, steri strips, glue, drains/dressing; procedure doc |
| INTRAOP NURSING CARE PLAN | risk for injury; impaired gas exchange, decrease cardiac output, risk for deficient fluid volume |
| SURGICAL COMPLICATIONS | shock, hypoxia, injury, pneumonia & atelectasis |
| SHOCK | effect of anesthesia or loss of blood |
| HYPOXIA | inadequate oxygenation of body tissues |
| INJURY | because of decreased level of consciousness assoc w general anesthesia or other sedatives |
| PNEUMONIA & ATELECTASIS | drug effects and immobility place pt at risk |
| WOUND COMPLICATIONS | Dehiscense, evisceration and infection |
| DEHISCENSE | reopening of surgical wound; risk of this increased by wound infection, malnutrition, obesity, dehydration, & extensive abdominal wounds and injuries |
| EVISCERATION | body organs protrude through open wound |
| INFECTION | greatest in traumatic injuries, wounds not treated promptly and wounds were infected before surgery |
| GASTROINTESTINAL DISTURBANCES | nausea, vomiting, impaired peristalsis and constipation; causes: anesthesia, pain, opiods, decreased peristalsis and resuming oral intake too soon |
| URINARY RETENTION | kidneys produce urine but the pt is unablke to empty the bladder |
| RENAL FAILURE | kidneys are unable to produce enough urine to remove wastes from body |
| THROMBOPHLEBITIS | inflammation of veins; formation of blood clots; most often in legs after a period of immobility |
| THROMBI | clots that cling to the walls of blood vessels |
| EMBOLI | thrombi that break loose and flow with the blood |
| IMMEDIATE POSTOP NURSING CARE IN PACU | assess pt's status(level of consiousness, vs), and inspect the wound of dressing; check & set up equipment (suction devices, oxygen, urinary drainage, IV lines; |
| IMMEDIATE POSTOP NURSING CARE IN PACU - INTERVENTIONS | decreased cadiac output, ineffective breathing patterns, acute oain, disturbed though process, risk for injury,pt's family |
| IMMEDIATE POSTOP NURSING CARE IN PACU - DISCHARGE WHEN | vs are stable, resp and circ functions are adequate, pt has minimal pain, pt is awake or can be wakened easily, complications are absent or under control, gag reflex is present. Most pts are in PACU in 1 to 2 hrs |
| HOMAN'S SIGN | dorsiflex the foot to assess for pain in the calf. Positive sign means thrombophlebitis. Do not massage; put pt on bed rest |
| 1st INTENTION | clean sutured incisions |
| 2ND INTENTION | infected wound is left open to heal from the bottom up |
| TERTIARY INTENTION | wound initially left open and later closed |
| DRAINS - STAB WOUND | PENROSE DRAIN |
| DRAINS - HEMOVAC AND JACKSON PRATT | create negative pressure when they are compressed |
| preventing dehiscence and eviseration | avoid strain on the suture line; teach pt to support incision when coughing & getting in & out of bed; cover the wound with sterile dressings saturation w normal saline & notify the physician |
| s/s of pneumonia | dyspnea, fatigue, fever, cough,purulent or bloody sputum, wet breath sounds. |
| impaired gas exchange prevention | doc resp status every hr for the 1st 24 hrs. s/s pnemonia, freq position changes and coughing & deep breathing exercises most impt, incentive spirometer: to promote lung expansion |
| risk for infection | s/s of wound infection, pain fever redness swelling and puss |
Created by:
jekjes
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