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The Surgical Patient
Transcript of The Surgical Patient
The Surgical Patient
What is surgery?
Why is it necessary?
What is perioperative nursing care?
What are common fears of surgery?
Know what language your patient speaks
Assess what your patient knows prior to teaching
Know the information yourself
Evaluate the effectiveness of the teaching
Permission to perform procedure
must indicate the specific procedure and include list of possible complications without abbreviations
contains patient signature, person performing the procedure and permission specifically if photographs are to be taken or blood to be transfused
Risk factors associated with poor outcomes
chronic diseases such as:
Review preop labs:
What would you do...
A two year old is having a myringotomy procedure for insertion of tympanostomy tubes. The 17 year old mother and the grandmother are present. Who signs the consent?
What would you do......
A patient has received his preop medications when the nurse realizes that the consent hasn't been signed. What does the nurse do?
There are many risk factors for clients needing surgery. Diabetes increases a client's risk for complications because it:
a. predisposes the patient to wound infection and delayed healing
b. impairs excretion of drugs and other toxins
c. impedes blood circulation required for wound healing
d.predisposes the patient to postoperative infections
Types of Anesthesia
The nurse is caring for a perioperative patient who has undergone a vasectomy. The nurse knows that a common nursing diagnosis for this patient would be:
a. body image disturbance
b. anxiety and deficient knowledge
c. ineffective individual coping
d. impaired gas exchange
What if the patient had a mastectomy?
CBC with diff
CMP or BMP (electrolytes)
A 77 year-old patient with a history of COPD has undergone a hernia repair. Which of the following expected outcomes should be the priority focus for the nurse:
a. the patient has normal auscultated breath sounds
b. the patient ambulates 10 feet with assistance
c. the patient tolerates a clear liquid diet
d. the patient rates his pain as 2 to 3 on a 10 point scale
The nurse has just finished explaining the necessity of coughing and deep breathing following surgery to a perioperative patient. Which of the following responses by the patient indicate his understanding an acceptance of what he has been taught?
a. "It really hurts too much to do that. Deep breathing and coughing are impossible"
b. "I guess I'll try to remember to take a couple of deep breaths once in a while"
c. "When I do the coughing and deep breathing, I reduce my chances of getting pneumonia"
d. "I thought that spirometry thing was supposed to do the job"
A patient tells the nurse, "I think my surgical incision opened up." When the nurse assesses the incision, it is apparent that the distal edges are open and no longer approximated. The nurse knows this condition is known as:
The physician has ordered sequential compression devices (SCDs) for a patient going to surgery. The best rationale for use of SCDs is to:
a. keep the legs warm
b. induce relaxation
c. maintain balanced fluid volume
d. promote venous return
When caring for a patient with a large surgical incision, the nurse would expect to administer which of the following vitamins necessary for wound healing:
a. vitamin B12
b. vitamin E
c. vitamin C
d. vitamin K
What would it be called if part of an internal organ is protruding through the wound?
A sutured surgical wound heals by:
a. homeostatic intention
b. primary intention
c. secondary intention
d. inflammatory healing
The physician has ordered preoperative atropine for a patient undergoing surgery. Which of the following provides the best rational for the use of this medication:
a. it is used to reduce anxiety and ease anesthetic induction
b. it induces general calmness and sleepiness
c. it reduces gastric fluid volume and gastric acidity
d. it reduces oral and pulmonary secretions and prevents laryngospasm
general--inhalation and IV routes
spinal anesthesia (subarachnoid space)
epidural (epidural space--outside subarachnoid space)
IV regional anesthesia (lidocaine in IV in arm with bp cuff)
local (injection or topical)
The preop medication is ordered "on call"
Ceftriaxone 1 gram IV. The medication may be diluted in 50 ml of NS and infused over 30 minutes. What is the IV pump rate?
Mark site preoperatively
Before procedure, take a "time out" and verify consent matches marked patient
preop prep, times, places
postop expectations (including tubes, dressing, therapy, discharge)
PREVENTION OF COMPLICATIONS:
Turning, coughing, deep breathing, prevention of DVT
Patient Teaching for:
a total knee arthroplasty
a total thyroidectomy
an open colecystectomy
a double barrel colostomy for colon cancer
What if the 17 year old mother needs an appendectomy? Who signs the consent?
Some medications may be stopped prior to surgery:
be added prior to surgery:
Some Peri-op Medications:
H2 receptor antagonists
Your assignment for the day:
a 26 year old MVA with fractured tib/fib awaiting surgery, a 82 year old with dementia and a UTI, a 76 year old s/p right hip arthroplasty, a 44 year old with c-diff.
What do you do?
What would you do if.....
The nurse is preparing to send the patient to the OR for a total hip arthroplasty when the patient says "I can't wait for today to be over. I need to be at my niece's wedding Saturday"
What should the nurse do?
58 year old male who used smokeless tobacco since he was 14 developed painless white spots on his gums. He was diagnosed with oral cancer. Today he is having surgery --neck dissection. Make a care map with three diagnoses for this patient.
The older patient:
Slower to heal (slower skin cell growth, more scarring)
More prone to dehydration
Kidneys function slower--slower to get rid of anesthetic agents
Bone marrow functions slower for CBC to recover
weak, rapid pulse
cool, clammy skin
reduced urine output
How to take care of dressing/wound
When to call provider
When to follow up
The activities that are NOT recommended (ie driving until...)