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Chapter 17 Surgical Care

Terms in this set (61)

Postop nursing care in nursing unit- Interventions
The pain is most severe during..
the first 48 hours
When post op patients complain of pain what do you want to ask them?
determine exact nature of pain, location, severity, use numeric pain scale (Flak Scale)
What is a source of discomfort in the post op patient?
singultus (hiccups)
What else do you want to look out for when a patient is in pain that can help ease?
anxitey; seems to intensify discomfort
Pain management in ____ can pose special challenges
older adults
good management of post op pain in an older person can often be obtained with...
NSAIDS
IMPAIRED TISSUE INTEG
-Primary intention
clean saturated incisions heal because the wound edges are closed, tissue bods with little scarring
healing by secondary intention
an infected wound is left open to heal from the bottom up
tertiary intention
when wound is left opened and later closed
if dressing becomes saturated...
reinforce; do not change. surgeons do first dressing change
purpose of drains in incision cites
"stab" remove fluids from the site. Fluid interferes with the process of healing
Sanguieous
bright red fluid
serosanguineous
pinkish fluid
serous
straw colored and clear
RISK FOR INFECTION
What are the classic signs of wound infection?
pain, fever, redness, swelling, and purulent drainage
IMPAIRED GAS EXCHANGE
What are the signs and symptoms of PNA?
dyspnea, fatigue, fever, cough, purulent or bloody sputum, and wet breath sounds
Important nursing measures to prevent PNA & atelectasis?
frequent position changes, coughing, deep breathing exercises, turn pt q2h, out of bed, ambulating
incentive sperometer
promotes lung expansion
pulmonary emboli
usually arise from the thrombi that develop in veins, esp ones in legs, and pelvis
S&S of PE
dyspnea, tachypnia, chest pain, hemoptysis If the PE is large the patient becomes cyanotic and goes into shock
URINARY RETENTION
How long can the patient go before intervening with urinating?
6-8 hours
CONSTIPATION
Inspect the abdominal for..
distention, and auscultate for bowel sounds, document flatus, and first bowel movement
You are NPO until...
peristalsis returns
What do you do for the patient when they have a paralytic ilius?
make patient npo, ng tube, patient should have a bowel movement within a few days after resuming intake of solids
Malignent hyperthermia
life treating complication that occurs in response to certain drugs, characterized by increasing temp, metabolic rate, tachycardia, hypotension, cyanosis, and muscle rigidity. measures to cool the patient. o2 is administered and the patient is given dantrium, furosemide, mannitol, and NA bicarb
Local and Regional Anesthesia
block the conduction of nerve impulses to a specific area; do not cause the patient to loose consciousness (lidocaine etc)
local anesthetics are administered
topically, injected
a complication of spinal anesthesia is
post spinal headache, which is caused by the leaking of CSF at the puncture site. It can be relieved by lying flat
severe spinal headache is sometimes treated by..
injecting a small amt of blood into the epidural space
General Anesthesia
acts on the CNS, causing loss of consciousness, sensation, reflexes, pain perception, and memory; combination of drugs are used; most often given via IV or inhalation; after finished the anaste. reverses effects
inhalation agents
include meds like Forane, Ultane, Suprane, and nitrous oxide. An ET tube is inserted to maintain airway. another option then ET an LMA alternative
Thrombophlebitis
the inflammation of veins with the formation of blood clots; occurs most often in legs after a pd of immobility. Patients come with SCDs to PACU. (blood clot that can be come embolytic)
PREOP NURSING CARE INTERV.
most patient have
anxious about surgery; mite have to call MD if anxiety gets bad and poss no surg.
Informed consent
before surgery patient must sign this legal document; includes information, alternative tx, risks, and patient agrees; Patient must be fully alert, witness must sign
Shaving is..
not recommended only by the nurses because it causes tiny nicks in the skin
have patient remove..
jewelry and keep in safe place, remove hairpins, clips, dentures, nail polish, makeup, prosthesis, hearing aids
pre op medications can include
anticholinergic, antiemetics, and meds for anxiety
SURGICAL TEAM
surgeon, surg assistant, circulating RN WHO....
responsible for assessing the patient, planning, patient advocate, safety, this person oversees the operating room
RNFA- registered nurse first assistant
works with the surgeon and has advanced training for specific duties such as suturing and handling tissue with instraments
nurse ACP
nurse anesthetist (advanced practice rn) special training in giving anesthesia
surgical complications
...
Shock
surgical complication that is inadequate tissue perfusion; low blood volume, bleeding, dehydration
Hypoxia
inadequate oxygenation of body tissues; immediate post op phase due to response depression, tongue may fall back and depress airway, Anastasia depresses cough and swallowing refluxes, bronchospasm, patients with sleep apnea may be tx with cpap in PACU
INJURY
risk for injury because LOC associated with general anesthesia or other sedatives
Pneumonia and Atelectasis
older adults more prone, obese, pul disease, and those who have gone thru chest or abd surgury
Patient Teaching Box
Topics to include in the discharge plan...
take meds as prescribed
wound care
do not lift anything heavy
if need assistance community resources
follow specific fluid and diet orders
specialized equipment and supplies
if you need anything in home for self
keep doc appts
Moderate Sedation
prev called conscious sedation
IV drugs to reduce pain intensity or awareness without loss of reflexes
complications include: resp depression, apnea, hypotension, excessive sedation, agitation, combativeness
Vitals, o2, airway, LOC, EKG are monitored
Diagnostic Surg
to make an accurate diagnosis, involves removal and study of tissue (exploratory lap)
Ablative Surg
remove diseased tissue such as gallbladder
Palliative Surg
relieves symptoms or improves fx without correcting the basic problem
Reconstructive
restores function or structure
Procurment for transplant
removal of organs for transplant into another person
constructive surg
restores fx lost because of congenital defects such as a cleft palate
cosmetic surg
improve persons appearance
variables affecting surgical outcomes
age, nutritional status, fluid and electrolyte balance, medical diagnosis, drugs, habits
age
patients quality of life; ppl over the age of 70 that are more frail are prone to more complications; they may respond differently to drugs because of age related changes
nutritional status
pts who are underweight or malnourished is at his risk for poor wound healing and infection. Obese pts are in surg for longer and are more likely to have post op respiratory and wound complications. Addipose tissue has poor blood supply the healing process is slower then normal
fluid and electrolyte balance
adequate fluids are necessary to maintain blood volume and urine output
medical diagnosis
pts with bleeding disorders, excessive bleeding, chronic respiratory problems, liver disease impaired wound healing and clotting problems, diabetes
drugs
can interact with anesthetics and have sx adverse effects
habits
smoking, alcohol, increased risk of pulm complications, herbal meds can interact with meds, liver damage can affect the metabolism of drugs, pts with liver disease are increased risk for bleeding
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