Agent that produces states such as loss of consciousness, analgesia, relaxation, and loss of reflexes.
Incomplete expansion or collapse of a part of the lungs.
Deep Vein Thrombosis (DVT)
Formation of a blood clot ("thrombus") in a deep vein.
Surgery that is recommended but can be omitted or delayed without catastrophe.
Blood clot, foreign body, or air in the circulatory system, plural form is emboli.
Surgery that must be performed immediately to save the person's life or a body organ.
Excessive blood loss due to escape of blood from blood vessels.
Low body temperature.
Concious sedation or procedural sedation. Used for short term and minimally invasive procedures.
Surgery that is not critical to survival or function.
Wide variety of nursing activities carried out before, during, and after surgery.
Three phases of peri-operative patient care including the preoperative, intraoperative, postoperative phases.
Inflammation or infection of the lungs.
Bodys reaction to acute peripheral circulatory failure due to an abnormality of circulatory control or to a loss of circulating fluid.
Inflammation of a vein associated with thrombus formation.
Surgery that is not an emergency, but must be done within a reasonable short time frame to preserve health.
When does the preoperative phase begin?
When the patient and surgeon mutually decide that surgery is necessary and will take place. It ends when the patient is transferred to the operating room (OR) or procedural bed.
When does the intraoperative phase begin?
Beginning when the patient is transferred to the OR bed, also called a table, until transfer to the postoperative recovery area.
When does the postoperative phase begin?
Lasting from admission tot he recovery area to complete recovery from surgery and the last follow up physician visit.
To make or confirm a diagnosis. e.g., breast biopsy.
To remove a diseased body part. e.g., Appendectomy.
To relieve or reduce intensity of an illness; is not curative. e.g., Colostomy.
To restore function to traumatized or malfunctioning tissue. To improve self-concept. e.g., Plastic Surgery.
To replace organs or structures that are diseased or malfunctioning. e.g., Kidney.
To restore function in congenital abnormalities. e.g., Cleft palate repair.
Involves the administration of drugs by the inhalation or intravenous (IV) route to produce central nervous system depression.
Desired outcomes of General Anesthesia:
Loss of consciousness, analgesia, relaxed skeletal muscles, and depressed reflexes.
What are the three phases of General Anesthesia?
Induction, maintenance, and emergence.
Begins with administration of the anesthetic agent and continues until the patient is ready for the incision.
Continues from this point until near the completion of the procedure.
Starts as the patient begins to awake from the altered state induced by the anesthesia and usually ends when the patient is ready to leave the OR.
Occurs when an anesthetic agent is injected nerve or nerve pathway in or around the operative site, inhibiting the transmission of sensory stimuli to central nervous system receptors.
Accomplished by injecting a local anesthetic around a nerve trunk supplying the area of surgery such as the jaw, face, and extremities.
Achieved by injecting a local anesthetic into the subarachnoid space through a lumbar puncture causing sensory, motor, and autonomtic blockage. e.g., lower abdomen, perineum, and legs. Hypotension, headache and urine retention may occur.
The injection of the local anesthetic into the epidural space through the caudal canal in the sacrum; it may be used for procedures on the lower extremities or perineum.
Involves the injection of anesthetic through the intervertebral spaces, usually in the lumbar region (although it may be used in the thoracic or cervical regions). It is used for surgeries in the arms, shoulders, thorax, abdomen, pelvis and legs.
Used on mucous membranes, open skin surfaces, wounds, and burns. Cocaine in 4% to 10% solution is most commonly used; lidocaine and bupivicaine. May be sprayed, spread, or applied with a compres of drug saturated gauze or cottontipped applicators.
Injection of an anesthetic agent such as lidocaine, bupivicaine, or tetracaine to a specific area of the body. It is administered by the surgeon in minor, short term surgical or diagnostic procedures such as tissue biopsy.
What should the patient be aware of by the procedural physician:
Informed consent/advanced directives. Description of the procedure, along with potential alternative therapies. The underlying disease process and its natural course. Name and qualifications of the person performing the procedure or treatment. Explanation of the risks involved, including risk for damage, disfigurement, or death, and how often they occur. Explanation that the patient has the right to refuse treatment and that consent can be withdrawn. Explanation of expected outcome, recovery, and rehabilitation plan and course.
What does assessment involve in preoperative care?
Obtaining a health history and performing a physical assessment to establish a baseline data base, identifying risk factors and allergies that could pose surgical complications. Identifying medications and treatments the patient is currently receiving. Determining the teaching and psychosocial needs of the patient and family. Determining post-surgical support and referral needs for recovery.
What are diseases and associated risk for surgery?
Cardiovascular diseases - increase the risk for hemorrhage and hypovolemic shock, hypotension, venous stasis, thrombophelmbitis, and overhydration with IV fluids. Respiratory disorders - increase the risk for respiratory depression from anesthesia as well as postoperative pneumonia, atelectasis and alterations in acid-base balance. Kidney and liver diseases influence the patients response to anesthesia, affect fluid and electrolyte as well as acid-base balance, alter the metabolism, and excretion of drugs, and impair wound healing. Endocrine diseases, esp DM, increase the risk for hypoglycemia or acidosis, slow wound healing and present an increased risk for postoperative cardiovascular complications.
What are medications that can create a surgical risk?
Anticoagulants - may precipitate hemorrhage, diuretics - may cause electrolyte imbalances with resulting respiratory depression from anesthesia, tranquilizers - may increase the hypotensive effect of anesthetic agents, adrenal steroids - abrupt withdrawl may cause cardiovascular collapse in long term use. Antibiotics in the mycin group when combined with certain muscle relaxants used during surgery, may cause respiratory paralysis. Oral antidiabetic meds such as metformin hydrochloride may react with radiologic iodinized contrast dyes, and cause acute renal failure.
What information do you assess in a health history?
Developmental considerations, medical history, medications, previous surgeries, nutritional status, use of alcohol, illicit drugs, or nicotine, activities of daily living and occupation, coping patterns and support systems, sociocultural needs.
How do you prepare the patient psychologically through teaching about surgery?
Teach about surgical events and sensations, teach about pain management, teaching about physical activities.
What physical activities does the patient need to be taught?
Deep breathing, coughing, incentive spirometry, leg exercises, turning in bed.
What is the function of deep breathing post-operatively?
During surgery the cough reflex is suppressed, mucus accumulates in the tracheobronchial passageways and the lungs do not ventilate fully. After surgery, respirations often are less effective as a result of the anesthesia, pain medications, and pain from the incision. Alveoli do not inflate and may collapse, and secretions are retained, increases the risk for atelectasis and respiratory infection. Deep-breathing exercises hyperventilate the alveoli and prevent them from collapsing again, improve lung expansion and volume, and help to expel anesthetic gases and mucus, and faciliate oxygenation of tissues.
What is the function of coughing post-operatively?
Coughing helps remove retained mucus from the respiratory tract and usually is taught in conjunction with deep-breathing. Especially important for patient at risk for respiratory complications. Splinting should be taught along with coughing.
What is the function of Incentive Spirometry?
The device helps to increase lung volume and inflation of alveoli and facilitates venous return. A gauge on the incentive spirometry device allows the patient to measure his or her progress and provides immediate positive reinforcement for the breathing effors.
What is the function of leg exercises post-operatively?
During surgery, venous blood return from the legs slows; in addition, some surgical positions, such as having the legs elevated in the lithotomy position decrease venous return. With circulatory stasis in the legs, thrombophlebitis and resultant emboli are potential complications. Leg exercises increase venous return through flexion and contraction of the quadriceps and gastrocnemious. Leg exercises must be individualized to patient needs, physical conditions, physician preferences, and agency protocol.
What is the function of turning in bed post-operatively?
Improved venous return, respiratory function, and intestinal peristalsis and prevents the unrelieved skin pressure that would occur if the patient were to remain in only one position.
What is the correct way to turn in bed?
The patient should raise one knee, reach across to grasp the side rail on the side toward which he or she is turning, and roll over while pushing with the bent leg and pulling on the side rail. A small pillow is useful in splinting the incision while turning. Should be done q2hr.
What are deep-breathing teaching techniques?
Place the patient in semi-fowlers position with the neck and shoulders supported. Ask the patient to place the hands over the rib cage, so he or she can feel the chest rise as the lungs expand. Ask the patient to exhale gently and completely, inhale through the nose gently and completely, hold his or her breath for 3 - 5 seconds and mentally count. Exhale as completely as possible through the mouth with pursed lips, repeat 3 times. Should be done q 1 - 2 hours for first 24 hours post-operatively.
What are effective coughing teaching techniques?
Place the patient in semi-fowlers position, leaning forward. Provide a pillow or folded bath blanket to use in splinting incision. Ask the patient to inhale and exhale deeply and slowly through the nose three times, take a deep breath and hold if for three seconds, hack out for three short breathes, cough deeply once or twice, taken another deep breathe. Repeat q 2 hr.
How long does it take for peristalsis to return after GI surgery?
24 - 48 hours after the bowel is handled.
What are directions for leg exercises to increase venous return?
Lie in a semi-fowlers position, bend the knee, raise the foot and keep it elevated for a few seconds. Extend the lower leg. Lower the leg to the bed. Do this 5 times with one leg, then repeat with the other leg. Point toes of both feet toward the foot of the bed, relax both feed. Pull toes toward the chin, relax both feet. Make circles with both ankles. First circle to the right, then the left. Repeat 3 times. Relax both feet.
What are the pre-operative patient care checks on the day of surgery?
Check consents are signed, witnessed and correct, advanced directives, and patients chart. Gather needed equipment and supplies, perform hand hygiene. CHECK VITAL SIGNS. Notify of any changes. Provide hygiene and oral care. REMIND PT OF FOOD AND FLUID RESTRICTIONS. Instruct pt to remove all personal clothing. Ask pt to remove all cosmetics, jewelry etc. Give valuables to family member or hospital safe. HAVE PT EMPTY BLADDER. Attend to any pre-operative orders. Complete pre-op checklist. ADMIN PRE-OP MEDS AS PRESCRIBED. Raise side rails, place bed in lowest position. Instruct pt to remain in bed. Help transport pt. Tell family of pt where pt will be taken after surgery and location of waiting room. Prepare room with post-op bed for pt. Anticipate any necessary equipment.
What is the average PACU stay?
What is immediately assessed post-operatively?
Respiratory status, cardiovascular status, CNS status, fluid status, wound status, pain management and general condition.
What are the steps in conscious return?
1. unconciousness, 2. response to touch and sounds, 3. drowsiness, 4. awake but not oriented, 5. awake and oriented.
What factors are assessed individually post-operatively?
Vital signs and oxygen saturation, color and temperature of skin, LOC, IV, surgical site, other tubes, comfort, position and safety.
How do you promote post-operative rest and comfort with Nausea and Vomiting?
Avoid giving pt large fluids or fluid at one time, esp after being NPO. Admin prescribe meds. Provide oral hygiene, as needed. Maintain clean environment. Avoid use of a straw. Avoid strong-smelling foods. Assess for possible allergy to meds, such as antibiotics or analgesics. Maintain bowel elimination.
How do you promote post-operative rest and comfort with Thirst?
Offer sips of water or ice chips when NPO (if permitted). Maintain oral hygiene.
How do you promote post-operative rest and comfort with hiccups?
Have the patient do the following: take several shallows of water while holding the breathe (if not NPO), rebreathe into a paper bag, eat a teaspoon of granulated sugar.
How do you promote post-operative rest and comfort with Surgical Pain?
Assess pain frequently, admin prescribed analgesics q 2 - 4 hours or reg schedule during the first 24 - 36 hours. Reinforce preoperative teaching for pain management. Offer nonpharmacologic measures to supplement meds: massage, position changes, relaxation, guided imagery, meditation, music.
How often do you do VS post-operatively?
q 15 min for first hour, q 30 min for next 2 hours, q 1 hour next 4 hours, then every 4 hours.