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meta

answer

beyond, change

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micro

answer

small

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mono

answer

one

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morph (o)

answer

shape

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multi

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many

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olig(o)

answer

few, little

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par(a)

answer

near, beside, accessory to

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peri

answer

around

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poly

answer

much, many

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post

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behind, after

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pre

answer

before, in front

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pro

answer

favoring supporting, substitute for, in front of

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pseudo

answer

false

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re

answer

back, contrary

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retr(o)

answer

backward

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semi

answer

half

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sub

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under

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super

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above

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supra

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above, upon

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tetra

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four

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trans

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across, through

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Surgical Proceedure Classifications

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Based on Urgency - elective, (choice), urgent (24-48 hrs), emergent (immediate) Based on degree of risk, - major - high risk, minor - less risk Based on purpose - diagnostic (removal of cancer), Ablative (removal of diseased part melanoma), Palliative (soothing symptoms, comfort), Reconstruction (nose job), Transplantation (kidney), Constructive, (cleft palate)

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Preoperative Nursing Care

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-Nurses role to identify factors that affect surgical risk -Assessment of physical and psychosocial needs -Establish a plan of care -Desired Outcomes: free from injury & infection; maintain body temp, adequate fluid/electrolyte balance; maintain skin integrity; free from DVT's; pain management; Pt understanding of physiologic and psychological response to surgery; participate in post operative rehabilitation

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Health History

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Factors that increase risk of surgery -developmental considerations -medical history -medications -previous surgeries -nutrition -use of alcohol, illicit drugs or nicotine -ADL's and occupation -coping patterns and support systems -sociocultural needs

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Physical Assessment

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-baseline vital signs -baseline assessment -Focused Preoperative Assessments (ambulatory surgery centers) a. General Survey b. Skin c. Chest and lungs d. Cardiovascular system (perfusion) e. Abdomen (bowel sounds) f. Musculoskeletal system g. Neurological system (eyes)

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Presurgical Screening Tests

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Clotting Factors -Hct - hematocrit Hgb - hemoglobin PT - Prothrombin time INR - International Normalized Ration PTT - Partial thromboplastin time Electrolytes - specifically K+, Na+, Ca+

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Prepare Pt Psychologically

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-establish therapeutic rapport -use active listening -validate concerns -use touch (when appropriate) to convey empathy and caring -Respond to pts questions and concerns

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Preoperative Patient Education

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1. General Principles about the surgery Provide teaching for each phase of the surgical experience. Individualize teaching to include information applicable to the pt's surgery PREOPERATIVE PHASE a. exercises and physical activities b. pain management (timing for best effect, PCA pump, Non-pharmacological pain mgmt options) c. visit by the anesthesiologist d. physical preparation - NPO, Sleeping meds the night before, Preop check list. e. Visitors and waiting room f. transported to OR by stretcher

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Intraoperative pjase

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-holding area (medications, skin prep, IV line & fluid -Operating room - type of bed, what is happening, safety belt, sensations, staff

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Postoperative Phase

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Proanesthesia care unit Transfer to unit (on stretcher) Frequently take VS, pain meds, diet, exercise, pain, ambulation, family visits, sensations

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Day of Surgery

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Informed consent Remove jewelery Check VS Empty bladder Complete pre-op check list Inform family Remind pt of food/fluid restrictions Pt safety (side rails up, bed in lowest position, prep room with supplies that maybe needed after surgery)

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Intraoperative Nursing Care

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Types of anesthesia a. General b. Regional - spinal c. Local (lidocaine, novacaine) d. Conscious sedation (Airway is maintained, side effects - respiratory depression, specifically trained nurse monitors pts when this is used.

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Nurses Role in OR

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1. positioning 2. draping 3. documenting 4. transferring to post-anesthesia care unit (PACU)

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Postoperative Nursing Care

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Immediate 1. transfer pt to room on unit 2. check general condition 3. check drs. orders on chart 4. airway 5. vital signs and o2 saturation 6. level of consciousness 7. skin color and temp 8. IV fluids 9. Inspect dressing/wound 10. Inspect tubes and drains 11. Comfort 12. Position (eg. eye surgery) 13. Safety

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Ongoing Postoperative Care

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Vital signs checked frequently according to institutional policy Complete a full baseline assessment ASAP Check wound with each vital sign check Monitor pts pain level and keep pain under control

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Cardiovascular Complications

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Hemorrhage 1. Signs and Symptoms a. restlessness, anxiety b. bleeding (check for dependent bleeding) c. Increasing heart rate (body is compensating) d. Falling BP (low blood volume) e. Thirst f. Shock

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Treatment of Cardiovascular Complications

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1. control bleeding (pressure dressing) 2. monitor vital signs closely 3. restore blood volume 4. prevent shock or treat symptoms of shock 5. may need to return to OR to stop bleeding

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Signs and Symptoms of Shock

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1. Same as for hemorrhage 2. cold, clammy skin 3. weak, thready, rapid pulse 4. cool, mottled extremities 5. deep, rapid respirations 6. decreased urine output 7. apprehension

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Treatment of Shock

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1. maintain airway 2. flat position with legs elevated 30-45 degrees 3. administer oxygen 4. maintain body warmth with blankets 5. restore tissue perfusion with fluids and meds 6. restore blood volume

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Signs & Symptoms Orthostatic Hypertension

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1. becoming light headed or fainting when rising from a reclined position

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Prevention Orthostatic Hypertension

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Implement leg exercises and turn Q2/ROM

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Nursing Interventions Orthostatic Hypertension

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1. Have pt move legs in bed prior to sitting on edge of bed 2. Put the head of the bed up and allow pt to adjust to new position 3. Have pt move legs back and forth as they sit on the edge of the bed before standing (dangling) 4. Allow pt to stand prior to walking 5. If pt experiences dizziness he/she should be returned to bed and placed in a supine position which restores blood flow to the brain

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Signs and Symptoms DVT

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1. pain and cramping in the calf or thigh of the involved extremity 2. Redness, swelling or warmth in the affected area

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Prevention of DVT

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1. Implement leg exercises and turn Q2/ROM 2. Ambulate with assistance at least 3-4X/day 3. Anti-embolism stockings (TEDS), SCD (sequential pneumatic compression devices) 4. Avoidance of leg massage 5. Avoid positions that impede circulation 6. Monitor fluid balance (maintain hydration) 7. Administer prophylactic anticoagulants if ordered.

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Treatment/Interventions for DVT

answer

1. Administer anticoagulants (IV/PO) 2. Maintain bed rest (with limb elevated) as ordered 3. Use external heat application as ordered 4. Measure bilateral calf or thigh circumference daily 5. Increase fluid 6. Increase O2 7. Check INR - should be 2-3 for therapeutic levels

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Signs and Symptoms of Pulmonary Embolism

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1. Dyspnea 2. Chest pain 3. Cough 4. Cyanosis 5. Rapid respirations 6. Tachycardia 7. Anxiety 8. Decreased Pulse-ox Prevention- prevent DVT

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Nursing Interventions for PE

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1. Maybe life threatening - contact physician immediately 2. Maintain bed rest with pt in semi-fowlers position 3. Administer O2 4. Maintain IV fluids 5. Administer anticoagulants 6. Avoid Valsalva's maneuver

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Signs and Symptoms Atelectasis

answer

Respiratory Complication (incomplete expansion or collapsed alveoli) 1. Decreased lung sounds over affected area 2. Dyspnea 3. Cyanosis 4. Crackles 5. Restlessness 6. Apprehension

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Prevention for Atelectasis

answer

1. Cough and Deep Breath (C&DB) 2. Incentive Spriometer every 2 hours 3. Ambulate with assistance at least 3-4 times/day 4. Avoid positions that decrease ventilation 5. Maintain hydration 6. O2 PRN

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Treatment/Nursing Interventions Atelectasis

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1. Position pt in semi-fowlers or full fowlers position (COPD high fowlers) 2. Administer O2 as ordered 3. Maintain fluid and nutritional status 4. Continue deep breathing and incentive spirometer 5. Ensure rest and comfort

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Signs and Symptoms of Hypostatic Pneumonia

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1. Elevated temperature 2. Chills 3. Productive cough (rust or purulent sputum) 4. Crackles or wheezing 5. Dyspnea 6. Chest Pain

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Prevention Hypostatic Pneumonia

answer

Prevention is Key! 1. C&DB, incentive spirometer Q2 2. Ambulate with assistance at least 3-4 times/day 3. Avoid positions that decrease ventilation 4. Maintain hydration

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Treatment/Nursing Interventions Hypostatic Pneumonia

answer

1. Position pt in semi-fowlers or full fowlers position 2. Administer O2 as ordered 3. Maintain fluid and nutritional status 4. Administer antibiotics 5. Administer expectorants 5. Continue deep breathing treatments & incentive spirometry 6. Provide frequent oral care 7. Teach proper disposal of tissues & sputum 8. Ensure rest & comfort

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Nutritional Complications Signs & Symptoms

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1. Limited intake of fluids and food 2. Nausea 3. Vomiting

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Prevention of Nutritional Complications

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1. Maintain environment conducive to appetite (clean, neat and free of odors) 2. Encourage pt to sit while eating 3. Advance diet as tolerated (clear liquids, soft diet, regular diet on progression) 4. Provide small attractive meals 5. Encourage family to eat with pt 6. Bring foods pt is willing to eat

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Treatment/Nursing Interventions Nutritional Complications

answer

1. Monitor I & O 2. Treat nausea (medications) 3. Treat vomiting (clean area quickly, provide oral care etc.) 4. Continue prevention measures

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Signs and Symptoms Abdominal Distensions

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Due to decreased peristalsis 1. Described symptoms of bloating 2. Abdomen distended (soft or hard) 3. May experience nausea and vomiting

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Prevention Abdominal Distensions

answer

1. Assess fpr return of peristalsis Q4 while awake 2. Assess for ability to pass gas 3. Monitor pain meds (opioids decrease peristalsis) 4. Ambulate with assistance 3-4 times/day

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Treatment/Nursing Intervention Abdominal Distensions

answer

1. WALK, WALK, WALK - this is the most effective way to get peristalsis to return and help the pt pass gas. 2. Maintain privacy when toileting 3. Administer antigas medications as ordered

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Signs and Symptoms Paralytic Ileus

answer

1. Abdominal distention 2. Nausea and vomiting 3. Abdominal pain 4. Inability to pass stool or gas

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Prevention Paralytic Ileus

answer

1. Assess for return to peristalsis every 4 hours while awake 2. Assess for the ability to pass gas 3. Keep pt NPO until they are passing gas 4. Introduce fluids and foods slowly assessing for abdominal distention, nausea & vomiting 5. Ambulate with assistance at least 3-4 times a day

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Treatment/Nursing Interventions Paralytic Ileus

answer

1. Nasogastric tube placement to decompress abdomin 2. Assess for the return of peristalsis and the ability to pass gas.

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Signs and Symptoms Urinary Retention

answer

Incomplete emptying of the bladder (distended bladder) 1. Voiding small frequent amounts (<50ml each void) 2. Bladder distention/discomfort 3. More fluid intake than output

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Prevention Urinary Retention

answer

1. Provide privacy for voiding 2. Assist pt in assuming normal position when voiding 3. Monitor I&O frequency of urine 4. Ambulate with assistance 3-4 times/day

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Treatment/Nursing Interventions Urinary Retention

answer

1. Ultra sound may be used to measure residual urine after voiding to determine the extent of the urinary retention. 2. Report signs and symptoms & unsuccessful attempts to void 3. Typically an order for a foley is given if: *symptomatic for urinary retention and uncomfortable *If pt has had adequate intake but inadequate output in an 8 hour period *If no void in 12 hrs pt needs cathing and may have compromised kidney function.

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Dehiscence

answer

the partial or total rupturing of a sutured wound; usually involves an abdominal wound in which the layers below the skin also separate

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Signs & Symptoms of Dehiscence

answer

1. Increased flow of sero sanguineous fluid from wound between postoperative days 4 and 5 2. Patient states "something has suddenly given way."

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Treatment of Dehiscence

answer

1. If it is dehiscence only, cover with sterile moist dressing and notify physician 2. Would will be managed like any open wound 3. Wet to dry dressing change per orders or q4-q6

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Evisceration

answer

protrusion of visceral organs through a surgical wound Emergent

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Signs and Symptoms of Evisceration

answer

1. cover with sterile moist dressing and notify physician 2. Would will be managed like any open wound 3. Wet to dry dressing change per orders or q4-q6 4. Protrusion of viscera through incision area.

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Treatments of Evisceration

answer

1. This is a medical emergency 2. Position patient in low Fowler's position 3. Cover wound with sterile towels moistened with 0.9% sodium chloride (normal saline) solution 4. Have a nurse stay with the patient 5. Notify physician 6. Prepare pt for return to surgery

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Wound Infections

answer

A contaminated and infected wound

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Signs and Symptoms of Wound Infection

answer

1. Typically appear 2-7 days following surgery 2. Pain, redness, swelling around incision 3. Increased drainage 4. Purulent drainage (contains discharge) 5. Increased body temperature

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Prevention of Wound Infection

answer

1. Hand washing 2. Education to pt on care of wound and signs and symptoms to report to doctor 3. Educate pt on proper way to care for wound or dressing 4. Replace dressing if it becomes soiled or wet 5. Dressing changes as ordered 6. Good nutrition for wound healing - increase protein

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Treatment/Nursing Interventions for Wound Infection

answer

1. Dressing changes 2. Antibiotics 3. Treatment of fever

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Discharge Education

answer

Needs to be extensive but in simple terms so that the patient understands the pros and cons of taking care of the wound.

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