Nursing 307 Exam 1 Study Guide 1

• Art and science of treating diseases, injuries, and deformities by operation and instrumentation

• Perioperative nursing IS surgery

• Patient Safety --> always the number one priority of ALL members on the surgical team

• Patient advocate --> patient is the center of the whole process

• Educator --> it iis your job to know the patient’s procedure inside and out in order to give them information; validation, clarification, etc.

The perioperative period is the time period of a patient's surgical procedure. It commonly includes ward admission, anesthesia, surgery, and recovery. Perioperative may refer to the three phases of surgery: preoperative, peroperative, and postoperative, although it is better used for the first and third of these only, that is around the time of the surgery. The goal of perioperative care is to provide better conditions for patients before operation and after operation.

• Increased use of technology
  • Minimally invasive surgery --> no big incisions if we do not need to
  • Robotics --> allows for SMALL incisions
• Cost Reduction Measures:
  • Shortened stays-->shorter stays means less risk of infection
  • Ambulatory settings
• Surgical Care Improvement Project (SCIP)
  • Focus: reduce complications that occur from or during surgery
• Procedures done outside surgical sites
  • Interventional radiology
  • Endoscopy lab
  • Cardiac catheterization labs

• Perioperative experience --> begins as soon as the patient realizes they need surgery or decides to have surgery and ends when the patient is recovered and or discharged
• Preoperative--> begins with the decision to have the surgery, lasts until the patient is transferred to the OR
• Intraoperative --> extends from the admission to the OR to transfer to PACU
• Postoperative --> lasts from admission to PACU to complete recovery from surgery
  • PACU --> post anesthesia care unit
• You CANNOT put a time limit on the whole perioperative experience

• Ectomy --> excision or removal of; ex. Lumpectomy or appendecotomy

• Oscopy --> looking into; ex. Colonoscopy

• Ostomy--> creating an opening; ex. Colostomy

• Otomy--> cutting into; ex. Tracheotomy

• Plasty--> repair or restore; ex. Arthroplasty

• Lysis --> the destruction of; ex. Lysis of adhesions

• Diagnostic/exploratory --> done to make or confirm a diagnosis

• Curative --> repairs or removes the diseased parts or areas

• Palliative --> DOES NOT CURE; done to slow the disease or decrease the symptoms

• Cosmetic --> preserve or improve appearance

• Preventative --> to stop the onset of a disease before it happens

• Transplant--> replacement of organs

• Examples: an appendectomy is a curative procedure whereas a cleft palate surgery would be a cosmetic surgery

• Elective surgery vs. emergency surgery --> elective surgery is usually scheduled

• Inpatient (hospital)

• SDA/AM admission --> same day admission or morning admission

• Outpatient --> hospitals have centers where this can be done​
  • Ambulatory/same day
  • SPU --> short procedure unit
  • Free standing surgical centers
  • Physician’s offices

• Effected by:
  • Complexity of the surgery
  • Potential complications (pain, blood loss)
  • General health status of the patient

• Outpatient centers --> cheaper, decrease chance of infection, decreased anxiety
• Anywhere where surgery can be done SAFELY and EFFECTIVELY

• Assessment --> ALWAYS FIRST; interview and nursing history

• Anxiety --> can GREATLY effect decision making skills, coping and cognitive abilities, outcome

• Surgery is a frightening experience; EXPECT ANXIETY

• Anxiety has been shown to influence the outcome of a surgery

• Psychosocial Assessment --> excessive stress response can be magnified and affect recovery
• You MUST approach your patient with a positive attitude

• Anxiety can arise from:
  • Lack of knowledge
  • Unrealistic expectations

• Information lessens anxiety
  • Be as open as possible and offer solutions to their fears

• ALWAYS educate every opportunity you get

• Pain
• Mutilation
• The unknown
• Disruption of life
• Loss of control
• Death --> if they have a fear of this, tell the OR team about this; the surgery may be delayed to take care of this issue

• The small details can improve mood very easily

• Hope--> giving a patient hope can be their strongest method of coping

• Explain to the patient how involved we will be, comfort measures, etc.

• Pain and pain management must be addressed

• Let the patient know we will protect them

• Physiological/stress response​
  • Peripheral vasoconstriction--> constriction of the veins at the extremities
    • This is a good thing--> blood goes to the major organs, we need that to happen during surgery

• Increased blood coagulability --> blood clots; this helps to reduce hemorrhaging
• Tachycardia
• Hypertension
• Increased gastric acidity
• Decreased peristalsis--> anesthesia slows this down
• Increased blood glucose-->increases your energy and your body will heal better
• Increased metabolic rate
• Anti-inflammatroy response
• Anxiety will trigger the stress response
• All are needed--> they are good unless exaggerated
  • This will cause complications

• Assessmen--> Nursing interview

• Age factors--> Elderly and the young/newborn are extremely fragile and a higher risk​​
• Immune systems are not developed or are just too old

• Nurses MUST gather and obtain all information in order to allow the surgery to go as smoothly as possible

• Respiratory --> allergies, smoking, chronic conditions; we MUST know abnormalities

• Cardiovascular--> keeps the body MOVING; higher risk for complications

• Renal--> to assess drug metabolism, filtration of meds, excretion, fluid/electrolyte balance

• Hepatic --> blood glucose levels, metabolism of drugs, produces clotting factors

• Endocrine --> diabetic, thyroid issues, effects anesthesia, increases risks for complications

• Types --> ALSO ASK HOW MANY

• Reaction to anesthesia --> we need to ask this! This can effect coping

• Family history with anesthesia
  • Extremely important; ESPECIALLY with malignant hypothermia

• Unpleasant factors --> we want to avoid this experience