foundations Perioperative 1 (exam 3)

what is the AORN Patient Focused Model

4 domains that surround the patient for outcomes: safety, interventions, behavior, and health system

what is preoperative care

•Begins with decision to have surgery

•Lasts until patient is transferred to operating room or procedural bed

•Might be minuets if your in the ER or weeks if you need a transplant

what is intraoperative care

begins when the patient is transferred to the OR bed until transfer to the post anesthesia care unit (PACU)

what is postoperative care

•Lasts from admission to recovery room to complete recovery from surgery and last follow-up physician visit

•Can last a long time

•Recovery room, ICU, hospitals, short stay unit, rehab, or at home

what is a major classification

more body/tissue exposure, a higher rate of complication, and a longer recovery. Like a knee surgery

what is a minor classifcation

less tissue exposure, less risky, and shorter recovery. Like a wisdom tooth removal

what is an elective surgery

it satisfies the patients desire, they choose to have surgery, not needed to preserve life

what is an urgent surgery

requires urgent attention usually within a week to preserve life or function. Like repair of a fracture or removal of a diseased organ

what is an emergent surgery

necessary to complete the surgery to preserve the life of a person or body part and consent is not necessary

what is diagnostic used for

to identify a problem and often called exploratory

what is ablative used for

to remove a diseased body part

what is palliative used for

to alleviate pain or other distressing symptoms, slow the progression of disease, but the surgery does not cure it. Like if the location of the tumor is in a hard part and all of it cannot be removed but most of it can

what is reconstructive used for

repairing of physical deformities or approve appearance. Like rhinoplasty

what is transplantation used for

when the diseased organ or tissue is replaced with doated organ or tissue . Like heart, blood, bowel, bones ,kidney

what is constructive used for

has to do with birth defects. Like correction of cleft pallet

what are the types of assessments

•History and Physical (H&P)

•Identification of risk factors and allergies

•Medication and treatment assessment - they can interact with anesthetics

•Facilitating/reviewing diagnostic tests

•Identification of teaching and psychosocial needs

•Assessing for postsurgical support and referral needs

why are some developmental considerations imporant

the very young and the very old have the highest risk for surgical mortality

why are some medical history (comorbidities) important

decreased wound healing, increased risk for infection, respiratory issues

why is surgical history important

important to know if they need surgery, had it, or never did

why are allergies & medications history important

•some medications may need to be discontinued or adjusted

•Substance use (ETOH, illicit drugs, nicotine)

•People who smoke or use nicotine maybe be declined surgery because it will impair their ability to heal by less cardiac/respiratory output

•ETOH/alcohol can give reverse interacts to anesthesia

why is nutritional status history important

people who are malnourished are not going to heal well

why is the ADL and occupation history important

after surgery there maybe restrictions so its good to know their daily lifestyles

why is the sociocultural needs history important

be careful about assumptions and instead ask who did you bring here with you

why is the support system history important

•support people need time and attention due to pre-op teaching

•Learning and discharge needs

Use a medical interpreter if needed

why is the general survey important

height and weight because of anesthesia is based off of weight

why is the integumentary exam important

check for immobility, if it was there before, do I need extra precautions

why is the respiratory exam important

simple infection or cold can cancel your surgery

why is the cardiovascular exam important

surgery causes stress so we want to make sure the heart can handle the stress

why is the neurological exam important

are the A&O and can make their own decisions

why is the GI/GU exam important

can be nausea and vomiting we need to look out for

why is the musculoskeletal exam important

check for movement limitations to see positioning in the OR or even after care

what are some comorbidities

•CV: HTN, MI, HF, Arrhythmias, CVA, Thrombocytopenia(low platelets), anemia

•Respiratory: COPD, Asthma, Pneumonia, Bronchitis, URI

•Renal or Hepatic Disease - how the metabolize medications

•Diabetes - may require surgical clearance by a provider

why is nutritional status a risk factor

•Malnutrition - poor nutrition is worse than obesity

•Obesity - have poor tissue circulation, increased cardiac stress, decreased respiratory capacity, wound healing due to tissue stress(dehiss) and longer operative time

•For wound healing and resistance to infection

why is fluid & electrolyte imbalance a risk factor

surgery causes cells to be broken, fluid, electrolytes to move

why is pregnancy a risk factor

any one with child potential surgery will need a pregnancy test the day before

what types of bloodwork are needed

•Complete Blood Count (CBC)

•BMP(basic metabolic panel) or CMP(comprehensive metabolic panel)

•Coagulation Studies

•Blood Type

•HCG

what are we looking for during the BMP(basic metabolic panel) or CMP(comprehensive metabolic panel)

•Electrolytes

•BUN & Creatinine

•Glucose

•Liver Function

what are we looking for during coagulation studies

•PT/INR

•PTT

•To see how fast blood clots

how many times do you need a blood sample

you need two separate samples

what is a HCG test

blood or urine pregnancy test

whats important about RBCS

•Men: 4.6-6.2 million/mm3

•Women: 4.2-5.4 million/mm3

•this is what hbg attaches to for oxygen, made in bone marrow, lives 120 days , if you lack it its going to be hard post-op

whats important about HbG

•Men: 13-18 g/dL

•Women: 12-16 g/dL

whats important about Hct

•Men: 42-52%

•Women: 35-47%

•Percent of total blood volume that is red blood cells

•About 3times higher than hbg

whats important about WBCs

•4500-11000/mm3

•To see if you have an infection or can fight one

•To many means infection

whats important about platelets

•150-450 x 109/L

•Necessary to stop bleeding

whats important about sodium (Na+)

•135-145 mmol/L

•Extracellular ion, has to do with fluid balance, goes together with water, osmotic pressure/hydration

whats important about potassium (K+)

•3.5-5.0 mmol/L

•Intracellular ion, homeostasis, nerve conduction, electrical signal, cardiac tissue is insensitive to changes in potassium

whats important about chloride (Cl-)

•95-105 mEq/L

•Goes with sodium for osmotic pressure and fluid balance

whats important about bicarbonate (HCO3-)

•22-26 mEq/L

•Chemical buffer that keeps ph of blood from becoming to acidic or basic

whats important about glucose

•70-110 mg/dL

•Make sure the person is not hypoglycemic

•Increased blood

sugar is normal to stress from surgery

whats important about creatinine

•0.7-1.4 mg/dL

•More sensitive to kidney function and shows amount of waste product

•More likely to see high volumes

whats important about blood urea nitrogen (BUN)

•10-20 mg/dL

•Amount of nitrogen of blood and shows amount of waste product

•People with HTN will see higher pressure in kidneys

what are the two renal function labs

•blood urea nitrogen (BUN)

•creatinine

whats important about international Normalized Ratio (INR)

•0.76-1.27 (when not anticoagulated)

•2-3 (when anticoagulated) for warfarin, risk for bleeding half life continues for about a week

•1 if not takin warfarin

whats important about Activated Partial Thromboplastin Time (aPTT)

•20-39 seconds

•Number of seconds to take to form a clot

•For heparin Iv for anticoagulation since half life is only 30 minuets

whats important about prothrombin Time (PT)

•9.5-12 seconds

•Number of seconds it takes for blood to form a clot

whats important about Anti-Factor Xa Assay

•0.3-0.7 units/mL (when anticoagulated)

•To expensive and is a anticoagulation test

what are the two diagnostic tests

•Imaging

•Cardiac Work-Up

what are the types of imaging tests

•CXR

•Joint or bone Xrays

•CT

•MRI

what are the types of cardiac work-up tests

•EKG

•Cardiac Stress Test - put you on a treadmill and see how heart reacts

•Sleep Study

what is verifying informed consent

is obtained by the person who is legally allowed to do the procedure which includes risk, alternatives, signatures, death, or over the phone

what is DME(durable , medical equipment)

do they need a walker or wheelchair

what are the post-op referrals

•Case Management/Social Work

•DME(durable , medical equipment)

•Homecare, Skilled Nursing Care

•Prescriptions

whats important about post-op appointments

appointments are already set up pre-op

what are the day of Surgery Interventions

•NPO status

•IV

•Bowel preparation/empty bowel & bladder

•Preoperative medications - if meds can alter awareness you have to be sure informed consent is signed

•Hygiene & Skin Preparation

•Removal of dentures, jewelry, hearing aids

•Documentation completion and review

•Provide directions and emotional support for patient and significant others

what is in the document review

•Consent

•Advanced Directives

•Preoperative Checklist