Purposes & Classifications of Surgery
What are the seven purposes of surgery?
Diagnostic, ablative, palliative, reconstructive, curative, preventive, and cosmetic.
What needs to be removed prior to surgery?
Anything that the patient wasn't born with!
An unconscious patient should be positioned how? For what reason?
When would you use a wet-to-dry dressing?
To provide mechanical debridement of the wound.
The patient asks what they can eat to best promote healing. You educate them saying:
Plenty of protein, vitamin C, and zinc. These are all important to tissue healing.
How are surgeries classified and give an example of each?
Emergent, Urgent, Elective
Emergent cannot wait, life or death
Urgent needs to happen ASAP, but patient fairly stable
Elective can be scheduled as wished
What can we include in pre-op teaching so the patient has a better post-op recovery?
TCDB, incentive spirometer, splinting, leg exercises, etc.
When should patients ambulate after surgery and what does this help prevent?
It can depend on the surgery and the patient of course, but typically first day. This helps prevent complications of immobility such as clot formation, infection, atelectasis.
Describe the types of wound drainage.
Serous, sanguineous, and serosanguineous. Purulent indicates infection.
The patient said they felt a "pop" and when you go to examine them, you see their wound has opened and abdominal contents are protruding. This is called ____ and ____?
Dehiscence and evisceration.
What does preoperative nursing include?
pre-op, intra-op, post-op
What are common post-op complications and what age group is more concerning?
Clots, pneumonia, infection
Elderly patients
What should definitely be included in discharge teaching?
Wound care, medications, follow-up, what necessitates a trip to the ER or a call to the doctor.
What patient would most benefit from a binder and why?
Patients who have abdominal surgery because of the risk of dehiscence
The patient complains of new pain at the surgical drain site. You go to assess, and don't see any drainage in the tube. What is the first step?
See if the tube is kinked as this can prevent drainage.
What are the main goals of perioperative nursing?
maintain patient safety, prevent complications, promote recovery
Describe the 3 types of anesthesia
General, local, regional
In the PACU, what is the nurse closely monitoring?
The patient's vital signs, oxygenation, IV site, incision, and pain.
What is the technique for irrigating a wound?
Clean from the least contaminated to the most, and position the patient on the side to allow the irritant to flow away from the wound.
The patient calls five days post-op and says their "little bandages" are starting to come off of the wound. You review the chart and see that steri strips were applied. The patient asks if they can "just pull them off". What is your response?
NO. Steri strips should stay in place until they come off on their own, typical in 7-10 days.
Describe informed consent
The provider must educate the patient on aspects of the procedure, risks, what will happen if they don't get the procedure, etc. It will be signed by the provider and witnessed by the nurse.
What does the nurse monitor during surgery?
Vitals, oxygenation, and patient positioning
What is the priority nursing assessment in the PACU?
AIRWAY!
The patient has their surgical dressing in place and it has been four hours since their surgery. You see a lot of serous drainage and decide to change it. Is this the proper thing to do?
NO. Never remove a surgical dressing without an order. Reinforce the dressing, apply pressure if possible, and call the surgeon.
You are taking care of an infant who recently had abdominal surgery. When you go to change them, you see that they have abdominal contents protruding through the incision. What should you do immediately?
Cover the contents and site with saline-soaked sterile dressings and call the surgeon immediately. Stay with the patient.