NCM 112: Perioperative Phase

Surgery

Surgery

Any procedure performed on the human body that used instruments to alter tissue or organ integrity

Goals of Perioperative Nursing

Assist clients through surgery; Promote positive outcome; Achieve optimal level of wellness

Preoperative Phase

Begins when the decision to proceed with surgery is made and ends when patient is transferred to OR bed

Intraoperative Phase

Period when patient is admitted in the OR until they are brought to the recovery room or PACU

Postoperative Phase

Begins when patient is admitted to the PACU/RR and ends with ff up evaluation

Diagnostic

Purpose of surgical procedure: is to know if a disease is malignant or benign. To establish the presence of a disease

Exploratory

Purpose of surgical procedure: to determine the extent of disease condition

Curative

Purpose of surgical procedure: to treat the disease / condition

Palliative

Purpose of surgical procedure: to relieve distressing s/sx

Cosmetic

Purpose of surgical procedure: to alter or enhance personal appearance

Prevention

Purpose of surgical procedure: to reduce to the risk of developing a condition

Emergent

Urgency of surgical procedure: requires immediate attention, life threatening condition

Urgent

Urgency of surgical procedure: requires prompt treatment to avoid permanent disability or death

Required

Urgency of surgical procedure: patient needs to have surgery but is not urgent of emergent

Elective

Urgency of surgical procedure: patient should have surgery, can be scheduled in advance

Optional

Urgency of surgical procedure: surgery rests on the patient’s decision

-ectomy

excision of removal

-lysis

destruction of

-orrhaphy

repair or suture of

-ostomy

creation of opening into

-oscopy

looking into

-otomy

cutting into or incision of

-plasty

repair or construction

Possible effects of vitamin E, ginkgo, and fish oil to patient for surgery

Excessive bleeding

Possible effects of kava to patient for surgery

Reduced effects of anesthesia

Possible effects of valerian to patient for surgery

May cause excess sedation

Vitamin A, B and C Complex

Vitamins essential for wound healing

Malnutrition and fluid volume deficit

Older adults are often at risk for __________

ASA 1

ASA Classification System: Healthy patients

ASA 2

ASA Classification System: Mild to moderate systemic disease caused by surgical condition or other pathological processes

ASA 3

ASA Classification System: Severe disease process which limits activity but not incapacitating

ASA 4

ASA Classification System: Severe incapacitating disease; constant threat

ASA 5

ASA Classification System: Moribund patient not expected to survive 24 hours

ASA 6

ASA Classification System: Declared brain-dead patient; organ donor

10 minutes each hour while awake

Incentive spirometer exercise must be done every _______________

2 hours

Minimum fasting period for clear liquids

6 hours

Minimum fasting period for non-human milk and light meals

8 hours or more

Minimum fasting period for fried foods, fatty foods, or meat

Opioids (Nalbuphine, Fentanyl, Meperidine, Morphine SO4)

Relieve pain during preoperative procedures

Histamine (H2) - Receptor Antagonists (Cimetidine, Ranitidine, Famotidine, Omeprazole)

Decreases HCL acid secretions, Increase pH, Decrease gastric volume

Anticholinergics (Atropine Sulfate)

Decrease oral and respiratory secretions

Antibiotics (amoxicillin, cefazolin, ampicillin)

Prevent postoperative infections

Circulating Nurse

Manages personnel equipment, supplies, and the environment

Circulating Nurse

Ensures all equipment are working and guarantees sterility

Scrub Nurse

Assists with room preparation

Scrub Nurse

Scrubs, gowns, and gloves self and other members of the team

Scrub Nurse

Prepares instrument table and organizes sterile equipment

Scrub Nurse

Maintain accurate counts of sponges, needles, and instruments on the sterile field

Type 1

Category of Break in Sterile Technique: break is recognized immediately

Type 2

Category of Break in Sterile Technique: break is recognized shortly after

Type 3

Category of Break in Sterile Technique: break is recognized later

Type 4

Category of Break in Sterile Technique: break is not recognized at all

Dorsal Recumbent

Position for hernia repair, bowel resection, Bartholin’s Cyst removal

Supine

Position for surgeries of abdomen, chest, neck, ear, abdomino-thoracic, lower extremity

Prone

Position for surgeries of the spine / posterior surface of the body

Trendelenburg

Position for lower abdominal or pelvic surgeries

Lithotomy

Position for perineal repair, vaginal repair, D & C

Lateral

Position for hemothorax, kidney surgery, hip surgery

Jack Knife

Position for rectal procedures

Reverse Trendelenburg

Position for thyroidectomy, upper abdominal surgery, head and neck surgery, facial surgery

Sim’s Position

Position for rectal procedures

Sitting

Position for NGT insertion, bronchoscopy, thoracentesis, head and neck procedures

Initial Count

Taken when instrument tray is assembled

Partial or additional count

Indicates intraoperative addition of sponges and miscellaneous itemts

First Closing Count

Taken before the closure to deep body cavity or a deep or large incision

Final Count

Taken during skin closure

Kocher incision

Incision for open cholecystectomy

Midline

Incision for laparotomy and various abdominal surgeries

McBurney’s incision / Lanz incision

Incision for appendectomy

Pfannenstiel incision

Usual choice for CS and abdominal hysterectomy

Rutherford-Morrison incision / Oblique-muscle cutting incision

Incision used for right or left sided colonic resection, caecostomy or sigmoid colostomy

Stage 1: Beginning anesthesia

Stage of anesthesia where px is drowsy / dizzy with possible hallucinations

Stage 2: Delirium

Stage of anesthesia where there is an increase autonomic activity, irregular breathing and may struggle. Loss of consciousness to loss lid reflex

Stage 3: Surgical anesthesia

Stage of anesthesia where client is unconscious, relaxed muscles, blink and gag absent

Stage 4: Medullary Depression

Stage of anesthesia where client is not breathing and heartbeat may or may not be present

Inhalation Anesthesia

Type of anesthesia used to maintain client in stage III anesthesia

Dissociative Anesthesia

Type of anesthesia that interrupts associative brain pathways while blocking sensory pathways

Dantrolene (2.5 mg/kg)

Used to treat malignant hyperthermia by reducing muscle contraction

Fluid and blood loss

Common cause of postop hypotension

Emergence Delirium

Short term neurologic change manifested by: restlessness, agitation, disorientations, trashing, and shouting

Dehiscence

Separation of Suture Lines

Eviscerence

Extrusion of internal organs

Hemovac

Used to drain blood under skin

Jackson Pratt

Used to remove fluids that build up in the area after surgery

T-Tube Cholangiogram

Used as temporary post-operative drainage common bile duct

Penrose Drain

Soft and flexible surgical drain that empties into absorptive dressing material

Chest tube

Used to drain hemothorax, pneumothorax, pleural effusion, chylothorax, and empyema. Put in the 4th intercostal space

Davol drain

Has a rubber bulb on top that acts as a pump to inflate the balloon in the drainage bottle.

Pigtail drain

Type of catheter that has the sole purpose of removing unwanted body fluids from an organ. Inserted by radiologist