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Chapter 17 Surgical care

Terms in this set (93)

Purposes of surgery
1.Diagnostic
2.Ablative
3.Palliative
4.Reconstructive
5.transplant
6.Constructive
7.Cosmetic
Diagonostic
Removing and study of tissue to make a diagnosis

example( Biopsy of lump in breast)
Exploratory Surgery
requires opening a body cavity to diagnose disease process.

(example :opening abdomen to find cause of pain)
Curative Surgery
Remove diseased tissue or to correct defects
Ablative Surgery
Removes diseased tissue
Palliative Surgery
Relieves symptoms without correcting the basic problem

(example: removal of a tumor even though cancer has already spread in the patient)
Reconstructive/Restorative Surgery
Restores function or structure to damaged or malfunctioning tissue
Cosmetic Surgery
Corrects serious defects that affect appearance.

(something the patient WANTS to change)
Variables affecting Surgical outcomes
1.Age
2.Nutritional status
3.Fluid and electrolyte balance
5.Medical diagnosis
6.Drugs
Habits
What are characteristics related to age that put a patient at greater risk for surgical complications
People older than age 70 who are frail, have cardiovascular disease or diabetes
Older adults respond differently to drugs because:
of age-related changes in liver and kidney function and drug interactions
What is a post operative risk factor for a patient who is malnourished?
At risk for poor wound healing and infection
What affects does obesity have on a patient when they have surgery?
obese patients are Generally in surgery longer and more likely to have postoperative respiratory and wound complications
What effects can excess fluid have on the body
fluid can overload the heart, aggravating the stress of surgery
Sudden changes in fluid volume are especially dangerous for what age group?
older patients
Electorolyte imbalances may predispose a patient to
dangerous cardiac dysrhythmias
Bleeding disorders make a patient at risk for
excessive bleeding (must be closely monitored)
In the post operative period Heart disease makes a patient at risk for
cardiac complications related to anesthesia/stress of surgery
In the post operative period Chronic respiratory disease makes a patient at risk for
Pulmonary complications due to anesthesia or hypoventilation
In post operative periods Liver disease puts a patient at risk for
Impaired wound healing and drug toxicity from the inability to metabolize drugs effectively
In post operative periods Diabetes mellitus puts a patient at risk for
Healing more slowly and at greater risk for infection
Effects of surgery or additional drug therapy may require
dosage adjustments in drugs the patient had been taking routinely
Smoking increases the risk of
Pulmonary complications because secretions are more copious and tenacious
A patient who drinks alcohol may need
A higher dose of anesthetic agent because of increased drug tolerance
Health History includes
Identifying data(patients age)

History of illness(problem being treated surgically)

Medical history

Allergies
The nurse should document about the body systems especially noting
abnormalities
Durring the functional assesment the nurse should asses:
1. usual activity(occupation,life roles)

2.Usual diet

3.tobacco or alcohol use

4.Exercises and rest patterns

5.Coping strategies
Physical Exam Includes
1.Height/weight

2. Vitals

3.Skin(color texture turgor moisture)

4.Thorax (respiratory rate,breathing patterns,lung sounds,apical heartbeat)
What should a nurse assess the abdomen for?
1.Distention
2.scars
3.bowel sounds
What should a nurse assess the extremities for?
1.skin color
2.hair distribution
3.deformities
4.range of motion(note pain/weakness)
What intervention should a nurse perform related to anxiety?
Determine presence and level of anxiety, the contributing factors, and the need for intervention
what is the benefit of written consent?
1.protects from unwanted procedures

2.protects the health care facility and caregivers
when getting a patient written consent what is mandatory in regards to the patient at that time?
Patient must be fully alert and aware of what it contains when signing
What are the 3 purposes for preparation of the digestive tract?
1.Reduces risk of contamination from fecal matter during the operation

2.Helps prevent postoperative distention until normal bowel function returns

3.Avoids constipation and straining in the postoperative period
Preoperative checklist
Must be completed and signed before the patient leaves the unit
what should a nurse make sure is done before a patient has surgery?
1.lab/ radiology reports are with the chart;

2.jewelry, prostheses, and nail polish removed;

3.make sure the patient has voided;

4. premedication has been given;

5.vitals recorded;

6. consent form has been signed
Regional anesthesia
block the conduction of nerve impulses in a specific area
Local anesthesia
may be administered topically, by local infiltration, and by nerve-blocking techniques
Topical Anesthesia
applied directly to the area to be anesthetized
Local infiltration
agent is injected into and under the skin around the area of treatment
Nerve block anesthesia
injecting an anesthetic agent around a nerve to block the transmission of impulses
epidural anesthesia and subarachnoid anesthesia are examples of
regional nerve blocks
What are some examples of preanestheic agents?
Anti-anxiety agents, sedative-hypnotics, anticholinergics, and opioid analgesics
what is the function of a preanesthetic agent?
Reduce anxiety without causing excessive drowsiness, induce perioperative amnesia, and reduce amount of anesthesia required
preanesthetic agents reduce the risk of
adverse effects of anesthetic agents, such as (salivation, bradycardia, coughing, and vomiting)
General anesthesia acts on the CNS causing
1.loss of consciousness

2.sensation

3.reflexes

4.pain preception

5.memory
what drug combinations achieve the effect of general anesthesia without excessive depression?
1.Inhalation agent
2.intravenous agents
3.muscle relaxants
4. opioids
5.antiemetics
What are general anesthesia complications?
1.Malignant hyperthermia.

2.Body temp lower than normal
What is concious sedation
when iv drugs reduce pain intensity or awareness without loss of reflexes
Risk of shock is caused by
effects of anesthesia or loss of blood
risk of Hypoxia is caused by
inadequate oxygenation of body tissues
risk of Injury is caused by
decreased level of conciousness associated with general anesthesia or other sedatives
risk for pneumonia and atelectasis
Drug effects and immobility place a patient at risk
what are some wound complications related to surgery
1.dehiscence(repopening)

2.evisceration(organ protruding through open wound)
risk of dehiscence increased by
wound infection

malnutrition

obesity

dehydration

extensive ab wounds or injuries
infection occurs as a surgical complication when :
wounds are not treated properly

wounds are infected before surgery
infection after surgery is greatest in what type of injury?
traumatic injury
GI disturbances (surgical complications)
Nausea

vomiting

impaired paristalsis

constipation
GI disturbances from surgery are caused by
anesthesia

pain

opioids

decreased paristalsis

resuming oral intake too soon
Urinary retention and renal failure results as a complication when
kidneys produce urine but patient cant empty the bladder

or

kidneys cant produce enough urine to remove waste
thrombophlebitis is when
inflammation of the veins occur and forms blood clots
`Thrombophlebitis occurs mostly
in the 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
what are the first things a nurse should do immediately when a patient is in postoperative status?
assess the patients status(vitals,wound)

check equipment(oxygen,drainage,iv lines
what are some interventions postoperatively for a patient when it comes to cardiac output?
Be alert to the possibility of shock
what are some interventions postoperatively for a patient when it comes to ineffective breathing patterns?
Monitor patients respiratory status.
what factors determine if a patient will be discharged from pacu
1.stable vitals
2.adequate circulation and respiratory function
3.pt has minimal pain
4.patient can be awaken easily
5.complications are absent or controlled
6.gag reflex is present
acute pain is most severe
during the first 48 hours
when a patient is in the stage of acute pain you should ask them to
rate their pain on a scale of 1-10
pain is better if it is treated
before it gets worse
what can be soothing for acute pain
position changes and back rubs
first(primary) intention
clean sutured incisions
secondary intention
infected wound is left open to heal form the bottom up
tertiary intention
wound initially left open and later closed.
what kind of drian is used for a stab wound
penrose
what type of drains create negative pressure when they are compressed
1.hemovac
2.jackson-pratt
to avoid dehiscence, evisceration and infection
1.avoid strain on the suture line

2.teach the patient to support the incision when coughing and getting in and out of bed.

3.cover the wound with sterile dressings saturated with normal saline
signs and symptoms of wound infection usually do not develop until
the 3rd -5th day after surgery
sings of infection include
1.pain

2.fever

3.redness

4.swelling

5.purulent drainage
To prevent wound infection
: decrease exposure to microorganisms and maintain patient's resistance to infection
document respiratory status
every hour for the first 24hrs
signs and symptoms of pnuemonia include
dyspnea, fatigue, fever, cough, purulent or bloody sputum, and "wet" breath sounds
what are the most important measures for a patient to prevent pnuemonia
frequent position changes and coughing as well as deep breathing exercises
what promotes lung expansion
incentive spirometer
when should you catheterize a patient
if the patient does not void within 6-8 hours
when a patient is constipated after surgery
assess for ab distention

*gas means the digestive tract is working
if digestive function does not resume the patient has a paralytic ileus manifested by
abdominal pain

distention

tenderness

absence of bowels
patient should have a bowel movement within a few days after
resuming intake of solid foods
how are liquids introduced to a patient after surgery
clear liquids implemented first then full liquids
when is regular food given to a patient after surgery
if liquid is retained the patient moves to a soft diet then regular food
to promote healing diet must have adequate
1.carbs,
2.protein,
3. zinc,
4. iron,
5. folate,
6.vitamins C, B6, and B12
what should a patient be taught on discharge
Prescribed meds

wound care

home health

diet fluids
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