Surgical Nursing Exam Revision

Surgical Nursing

• Definition: Surgery is an invasive medical procedure performed to diagnose or treat illness, injury, or deformity.

Perioperative Journey

• Consists of 3 phases:

  Preoperative

  • Discussion between healthcare team and patient about benefits, risks, and alternatives to surgery
  • Instructions on how to prepare for surgery
  • Physical, mental, and social assessments conducted prior to surgery

  Intraoperative

  • Patient transported to operating room
  • Surgical team prepares for operation
  • Anesthesia used to sedate or control unconsciousness
  • Surgical procedure performed
  • Nurses' role: monitoring patient's vital signs throughout the operation

  Postoperative

  • Patient moved to Post Anesthesia Recovery Unit (PACU) room until stable
  • Transferred to regular nursing unit for recovery
  • Nursing care: managing pain, monitoring vital signs, and preventing infections and complications

Preparing a Patient for Surgery

• Preoperative checklist:
  • Patient identification
  • Consent
  • Allergies
  • Fasting time
  • Diagnostic test results
  • History and physical exam
  • Vital signs
• Patient preparation:
  • Hospital gown
  • Dentures and glasses removed
  • Jewelry locked

Legal Considerations/Rights for Care

• Ensuring patient has been legally prepared and consent is gained and documented
• Patient and family members clearly understand what is happening
• Complete medical records
• Advance care or goals discussed

Roles of Perioperative Nursing

• Aesthetic Nurse:

  • Greets patient and ensures preparation
  • Verifies patient ID and consent
  • Checks allergies and fasting status
  • Monitors vital signs
  • Assists anaesthetist during induction, maintenance, and reversal of anesthesia

• Scout (Circulating Nurse):

  • Manages Operating Room (OR) and monitors activities of the surgical team
  • Maintains OR environment and documentation
  • Ensures sterile environment maintained

• Scrub (Instrument Nurse):

  • Sets up sterile tables and equipment
  • Prepares instruments and sutures
  • Assists surgeon by passing instruments and setting up drains
  • Accounts for all items during surgery

• Recovery/PACU Nurse:

  • Monitors patients' ABCs
  • Conducts assessments relevant to patient (neurological, neurovascular, etc.)
  • Provides care postoperative care until patient recovers from anesthesia

Pharmacology

• Definition: Study of how drugs interact with biological systems

• Pharmacodynamics: Study of how drugs interact with and exert their effects on the body

  Affinity

  • Refers to the strength of the binding between a drug and its target receptor
  • Higher affinity indicates a stronger and more specific binding leading to a greater pharmacological effect

  Antagonist vs Agonist Drugs

  • Antagonist: Drug binds to receptor without eliciting a response or blocks the activation of the receptor
  • Agonist: Drug binds to a receptor and causes a response

Anaesthetics

Depolarising vs Non-Depolarizing Anaesthetic Agents

• Depolarizing: Anaesthetic agents, like succinylcholine, briefly stimulate muscle contraction by mimicking acetylcholine at neuromuscular junctions
• Non-Depolarizing: Anaesthetic agents, like rocuronium, block acetylcholine from binding to neuromuscular receptors, leading to muscle paralysis

Antipyretics and Analgesics

• Analgesics: Medications used to relieve pain by acting on the CNS or peripheral pain pathways
• 3 types:
  • Non-Opioids: Paracetamol, aspirin, ibuprofen
  • Opioids: Morphine, oxycodone
  • Adjuvant analgesics: Medication used to enhance the effects of analgesics

Antiemetics

• Definition: Medications used to prevent or alleviate nausea and vomiting
• Work by targeting various pathways in the body involved in the sensation of nausea and the reflexes that lead to vomiting
• Examples: Ondansetron, promethazine, metoclopramide, and dimenhydrinate

Body System Responses

• Immune Response:

  • Innate/Non-Specific Immune Response:
    • First line of defence: surface barriers (skin, mucous, tears, gastric acid)
    • Second line of defence: nonspecific natural killer cells (phagocytes, dendritic cells, NK cells, macrophages)
  • Adaptive Immune Response:
    • Humoral Immunity: involves the production of antibodies by B cells
    • Cellular Immunity: involves the direct action of immune cells to recognize and destroy infected or abnormal cells

• Inflammation:

  • Definition: Nonspecific defence mechanism, involving a complex series of events to eliminate the cause of cell injury, clear out damaged cells and tissues, and initiate tissue repair
  • Acute inflammation: Rapid and short-term response to injury or infection
  • Chronic inflammation: Prolonged and persistent state that can lead to tissue damage

• Fever:

  • Definition: Temporary increase in body temperature, usually in response to an infection or illness
  • Helps to inhibit pathogen growth, enhance immune response, mobilize immune response, and increase metabolic rate

Principles of Fluids and Electrolyte

• Compartments:

  • Intracellular Fluid (ICF): 80% of fluid in the body, inside cells
  • Extracellular Fluid (ECF): 1/3 of fluid weight in the body, outside cells
    • Plasma
    • Lymph
    • Transcellular fluid (e.g., cerebrospinal fluid, GIT secretion, synovial fluid)

• Transport mechanisms:

  • Active Transport: net movement from low concentration gradient to high concentration gradient, requires energy
  • Passive Transport: net movement of molecules from high concentration gradient to low concentration gradient, no energy required
  • Osmosis: movement of water solvent
  • Diffusion: movement of molecules down concentration gradient
  • Facilitated Diffusion: uses protein carrier, glucose transport
  • Filtration: movement of water and solutes through a membrane

Nutrition and Metabolism

• Definition:

  • Macronutrients: carbohydrates, fats, proteins
  • Micronutrients: vitamins, minerals
  • Water: essential for bodily functions

• Assessing for Malnutrition:

  • Insufficient energy intake
  • Weight and muscle mass loss
  • Loss of subcutaneous fat### Sudden or Unexplained Deaths

• Deaths that occur suddenly or unexpectedly, with unclear or unknown causes, may require investigation by the coroner.

• Examples include:

  • Violent or suspicious deaths (e.g., homicide, suicide, accidents)
  • Deaths in custody (e.g., prison, police cell, detention facility)
  • Industrial or occupational deaths (e.g., workplace accidents)
  • Deaths resulting from medical procedures (e.g., medical malpractice, negligence)
  • Deaths due to notifiable diseases (e.g., infectious diseases)
  • Deaths due to environmental factors (e.g., exposure to extreme temperatures, chemicals)
  • Deaths of unknown identity

Phases of Haemostasis

• Haemostasis is the process of stopping blood loss from damaged vessels.
• The four phases of haemostasis are:
  • Vascular phase: vasoconstriction of blood vessels to reduce blood flow
  • Platelet phase: platelets stick to the injured blood vessel wall, aggregating and plugging the hole
  • Coagulation phase: chemical reactions lead to the production of a thrombus (blood clot)
  • Fibrinolysis phase: the breakdown of the thrombus by plasmin

Blood Transfusion

• Blood must be matched with the patient before administration.
• Main blood groups are:
  • ABO (A, B, AB, O)
  • Rhesus (Rh-positive, Rh-negative)
• Important blood types:
  • O negative: universal donor
  • AB negative: universal recipient

Transfusion Reactions

• Types of transfusion reactions include:
  • Febrile reactions: fever, chills, and malaise in response to a rise in temperature
  • Allergic reactions: immune response to a substance, leading to symptoms such as rash, itching, or difficulty breathing
  • Haemolytic reactions: life-threatening destruction of red blood cells, often due to incompatible blood transfusions or autoimmune conditions

Venous Thrombosis Embolism (VTE)

• Arterial thrombi: composed of rich platelets and fibrin, forming rapidly in high-flow, high-pressure arterial circulation, often leading to ischemic events like heart attacks or strokes
• Venous thrombi: composed primarily of fibrin and red blood cells, forming more slowly in low-flow, low-pressure venous circulation, commonly causing conditions such as deep vein thrombosis or pulmonary embolism
• Virchow's Triad: indicates the development of DVT, with factors including:
  • Stasis (blood stasis)
  • Hypercoagulability (excessive blood clotting)
  • Endothelial damage (damage to blood vessel walls)

Anticoagulants and Fibrinolytic Drugs

• Antiplatelet drugs: used to treat white thrombi (arterial thrombi), examples include:
  • Aspirin: inhibits platelet enzyme COX-1, reducing platelet aggregation
  • Risks: bleeding, Ryes syndrome, chronic overdose, acute salicylate poisoning, and interaction with warfarin
• Anticoagulants: used to treat red thrombi (deep vein thrombi), examples include:
  • Heparin: enhances antithrombin III activity, inhibiting thrombin and factor Xa, preventing blood clot formation
  • Warfarin: inhibits vitamin K epoxide reductase, reducing synthesis of vitamin K-dependent clotting factors
  • Enoxaparin: inhibits factor Xa and, to a lesser extent, factor IIa, preventing clot formation

Integumentary System

• Functions of the integumentary system include:
  • Protection: forming a barrier against physical, chemical, and microbial damage
  • Temperature regulation: controlling heat loss through sweating and heat retention through vasoconstriction or vasodilation
  • Sensation: perceiving tactile sensations, temperature changes, and pain
  • Excretion: eliminating waste products through sweat secretion
  • Immune function: detecting and responding to pathogens, allergens, and other foreign substances
  • Synthesis of vitamin D: essential for calcium absorption and bone health
  • Water regulation: maintaining proper hydration levels
  • Blood reservoir: serving as a reservoir for circulating blood volume

Wound Healing

• The four stages of wound healing are:
  • Haemostasis: blood vessels constrict, and clotting begins to stop bleeding
  • Inflammation: white blood cells move to the wound to fight infection and clear debris
  • Proliferation: new tissue forms as cells multiply, filling the wound and creating new blood vessels and collagen
  • Maturation/Remodelling: the wound contracts and strengthens as collagen is remodelled, and new tissue gains strength and flexibility

Types of Wound Healing

• Primary intention: wound edges are brought together (e.g., with sutures, staples), healing occurs quickly with minimal scarring
• Secondary intention: wound is left open and heals naturally from the bottom up, resulting in more scar tissue and a longer healing process
• Tertiary intention: wound is initially left open to allow for debridement or infection control, then closed surgically, combining features of both primary and secondary healing

Antibiotics and Infections

• Antibiotics target specific sites in bacterial cells, including:
  • Cell wall
  • Inhibiting bacterial enzymes
  • Disrupting bacterial protein synthesis
  • Inhibiting bacterial DNA or RNA synthesis
• Types of antibiotics include:
  • Penicillins: inhibit bacterial cell wall formation
  • Cephalosporins: work similarly to penicillins, inhibiting bacterial cell wall synthesis
  • Macrolides: inhibit bacterial protein synthesis
  • Tetracyclines: interfere with bacterial protein synthesis
  • Fluoroquinolones: inhibit bacterial DNA replication
• Antibiotic resistance occurs when bacteria change in response to the use of antibiotics, rendering the drugs ineffective against them.