Surgical Team and Preoperative Assessment

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Questions and Answers

What potential complication can occur with the sudden discontinuation of corticosteroids during the preoperative period?

Renal failure

Respiratory depression

Cardiovascular collapse (correct)

Increased risk of infection

Which medication can cause hypo or hyperglycemia during the intraoperative period?

Insulin (correct)

Thyroid medications

Erythromycin

Anticoagulants

Which special consideration applies to geriatric patients undergoing surgery?

Healing time is generally shorter.

They require higher doses of anesthetics.

The natural aging process increases surgical risks. (correct)

They have fewer comorbidities.

What is a significant risk factor for bariatric patients during the perioperative period?

Airway complications due to anatomy Signup and view all the answers

Which of the following is NOT a part of patient education prior to surgery?

Informed consent procedures Signup and view all the answers

What is the primary purpose of the universal time out procedure in the operating room?

To confirm patient identity and surgical site Signup and view all the answers

Which of the following is a characteristic of the semi-restricted zone in an operating room?

Only surgical staff are allowed Signup and view all the answers

Which type of anesthesia involves the patient being unconscious and their airway supported?

General anesthesia Signup and view all the answers

What indicator is NOT typically associated with hypovolemic shock?

Excessive sweating Signup and view all the answers

In maintaining cardiovascular stability postoperatively, what should be continuously monitored?

Cardiovascular status Signup and view all the answers

Which of the following is NOT part of maintaining asepsis in the operating room?

Wearing casual attire Signup and view all the answers

Which complication is indicated by cool, moist skin and rapid, weak pulse post-surgery?

Hypovolemic shock Signup and view all the answers

What role does the anesthesiologist play in the operating room?

Managing the patient's anesthesia during surgery Signup and view all the answers

What is a primary characteristic of unstable angina?

Occurs at rest Signup and view all the answers

What is a common outcome of left-sided heart failure if untreated?

Backflow of blood in the lungs Signup and view all the answers

Which of the following is a characteristic of chronic heart failure?

It is a progressive condition Signup and view all the answers

What are the primary symptoms of right-sided heart failure?

Backflow of blood to peripheral areas Signup and view all the answers

What is one of the structural or functional causes of heart failure?

Coronary artery disease Signup and view all the answers

Which of the following describes the relationship between heart failure and its management?

Lifestyle changes and medications are vital for management Signup and view all the answers

Which statement about myocardial infarction (MI) types is accurate?

STEMI indicates a complete blockage of a coronary artery Signup and view all the answers

What is the primary physiological effect of heart failure?

Ineffective pumping of a ventricle Signup and view all the answers

Study Notes

Members of the Surgical Team

Surgeon
Anesthesiologist
Registered Nurse
Surgical Technician
Certified Registered Nurse Anesthetist
Other medical professionals

Preadmission Testing

Initiates the nursing assessment process
Begins prior to the patient arriving at the hospital
Allows healthcare providers to identify potential risks or issues that may affect surgery

Preoperative Assessment

Vital signs
Medical history
Surgical history
Medication history
Allergies
Social history (smoking, alcohol, drug use)
Family history
Physical exam

Medications that Potentially Affect Surgical Experience

Corticosteroids: Sudden discontinuation can lead to cardiovascular collapse
Diuretics: Can cause respiratory depression, fluid volume deficit, and dysrhythmias
Antipsychotics: Increase the risk of hypotension
Opioids & Benzodiazepines: Abrupt discontinuation will lead to withdrawal symptoms
Insulin: Can cause hypoglycemia or hyperglycemia intraoperatively
Erythromycin: Can cause apnea and respiratory paralysis
Anticoagulants: Increase the risk of bleeding
Antiseizure medications: May require continued administration for seizure prevention
Thyroid Medications: Metabolic collapse may occur without proper dosage

Special Considerations During the Perioperative Period:

Geriatric patients: Often have multiple comorbidities, increased sensitivity to surgical medications, longer healing times, and higher risk of complications.
Bariatric (Obese) patients: Increased risk of infections, surgical complications, longer healing times, and positioning challenges due to weight and body size
Informed consent: Ensures the patient understands the procedure, risks, benefits, and alternatives. Requires a witness.

Patient Education

Deep breathing and incentive spirometry
Early mobility and active body movement
Pain management
Cognitive coping strategies
Specific instructions for patients undergoing ambulatory surgery

Intermediate Preoperative Nursing Interventions:

Patient teaching
Preoperative medications
Preoperative skin preparation

General Preoperative Nursing Interventions:

Assessment of patient readiness
Emotional support
Dietary restrictions
Elimination interventions
Skin preparation
Pre-operative medications
Transportation to the operating room

Intraoperative:

Roles in the OR: Circulating nurse, scrub nurse, surgeon, anesthesiologist
Environment: Controlled temperature (cold and clean)
OR Zones: Unrestricted (street clothes), semi-restricted, restricted (full OR garb)
Asepsis: Sterilized equipment, prepackaged supplies, and sterile fields maintained
OR Environment: Music, talking may or may not be permitted, teaching may occur
Electrical Equipment Risks: Lasers and radiation
Anesthesia: General anesthesia (loss of consciousness, airway supported or intubated) - includes inhalation and/or IV medications
Know Surgical Positions
Universal Time Out: A process to ensure correct patient, procedure, site, and implants

Asepsis Principles

Sterile surfaces contact only sterile surfaces.
Any non-sterile surface contaminated with non-sterile contact renders the item non-sterile.
Sterile items become non-sterile if they remain exposed to the air for an extended period.
Any object below the waist or table level is considered contaminated.
Sterile persons must pass each other back to back.
Sterile persons must keep a distance of one foot apart.
Sterile persons may not speak in a way that causes air currents.
Sterile persons must keep gowns and gloves within the sterile field.
Any drape with tears or breaks is considered contaminated.
Fluid flows in the direction of gravity.

Types of Anesthesia

General
Regional
Local
Monitored Anesthesia Care (MAC)

Surgical Positions

Supine
Prone
Lateral
Lithotomy
Trendelenburg

Intraoperative Complications

Hemorrhage
Hypovolemia
Shock
Hypothermia
Malignant hyperthermia
Anaphylaxis
Nausea and vomiting
Pneumonia

Adverse Effects of Surgery and Anesthesia

Pain
Nausea and Vomiting
Difficulty breathing
Respiratory depression
Bleeding
Infection
Wound complications
Delayed wound healing

Postoperative

Assessment of recovery from anesthesia: Monitor vital signs, airway, circulation, mental status, and pain.
Pain management: Provide appropriate pain relief measures to ensure patient comfort and promote healing.
Comfort management: Promote comfort by adjusting the patient's environment (temperature, lighting, noise) and using appropriate positioning techniques.
Respiratory care: Encourage deep breathing, coughing, and incentive spirometry to prevent atelectasis and pneumonia.
Gastrointestinal function: Observe for bowel sounds and encourage early ambulation to prevent bowel obstruction.
Fluid balance: Monitor intake and output and provide appropriate I.V. fluids to prevent dehydration.
Wound care: Assess the surgical incision site, manage drainage, and apply appropriate dressings to promote healing and prevent infection.
Promote early mobility: Encourage patients to get out of bed as soon as possible to prevent complications such as pulmonary embolism, deep vein thrombosis, and constipation.
Discharge planning: Ensure patients understand their discharge instructions, medications, and follow-up appointments.

Outpatient Surgery/Direct Discharge

Discharge criteria: Patient must be alert, stable, and able to tolerate oral fluids, and demonstrate understanding of discharge instructions.
Postoperative education: Review discharge instructions, medication schedule, risks of complications, and follow-up appointments.

Maintain Patent Airway

Primary consideration: Necessary to maintain ventilation and oxygenation.
Assess for airway obstruction, signs of respiratory distress.
Provide supplemental oxygen as indicated.
Maintain head of bed elevation as necessary.

Maintaining Cardiovascular Stability

Monitor cardiovascular status, including vital signs, IV lines, potential hypotension, shock, hemorrhage, hypertension, and arrhythmias.

Indicators of Hypovolemic Shock/Hemorrhage

Pallor (pale skin)
Cool, moist skin
Rapid respirations
Cyanosis (bluish discoloration of the skin)
Rapid, weak, thready pulse.
Decreasing pulse pressure
Low blood pressure
Concentrated urine

Jackson Pratt (JP) Drain

Assess color, consistency, and amount of drainage.
Empty the drain as needed.
Monitor for signs of infection.

Hemovac Drain

Assess color, consistency, and amount of drainage.
Empty the drain as needed.
Monitor for signs of infection

Wound Complications

Dehiscence (wound separation)
Evisceration (protrusion of organs)
Hematoma (collection of blood)
Seromas (collection of fluid)
Infections

Postoperative Complications

Pulmonary: Pneumonia, atelectasis, pulmonary embolism
Cardiovascular: Heart attack, stroke, arrhythmias, deep vein thrombosis,
Gastrointestinal: Constipation, ileus, nausea and vomiting,
Renal: Acute kidney injury, urinary tract infections,
Neurological: Delirium, cognitive decline, stroke, seizures
Wound: Infections, dehiscence, evisceration

Three Layers of the Heart Wall

Epicardium: Outermost layer
Myocardium: Middle layer (muscle layer)
Endocardium: Innermost layer

EKG

A recording of the electrical activity of the heart
P wave: Atrial depolarization
QRS complex: Ventricular depolarization
T wave: Ventricular repolarization
ST segment: Isoelectric line (no electrical activity)

Assessment of the Cardiovascular System

History: Ask about chest pain, shortness of breath, fatigue, edema, dizziness, palpitations.
Physical Exam: Auscultate heart sounds, palpate peripheral pulses, assess for jugular vein distention, and any edema.

Common Symptoms

Chest pain
Shortness of breath
Fatigue
Edema
Dizziness
Palpitations

Physical Assessment of the Cardiovascular System

Auscultation of Heart Sounds: Listen for murmurs, gallops, and heart sounds.
Palpation of Peripheral Pulses: Assess the quality of the pulses and compare bilaterally.
Jugular Vein Distention: Assess for venous distention, which may indicate right heart failure.
Edema: Assess for edema, which may indicate fluid overload or heart failure.

Most Reliable Source for Pulse:

Apical Pulse

Laboratory Tests

CBC: Complete Blood Count assesses red blood cells, white blood cells, and platelets
Electrolytes: Measures the balance of electrolytes in the blood.
Kidney function: Checks kidney function
Cardiac enzymes: Measures the levels of troponin and creatine kinase (CK-MB) in the blood. These enzymes are released into the bloodstream whenever there is damage to the heart muscle.
Coagulation studies: To assess the ability of the blood to clot.
Lipid profile: Measures cholesterol and triglycerides in the blood.

CAD (Coronary Artery Disease)

Atherosclerosis (hardening and narrowing of the arteries), which is a major cause of heart disease
Angina is a common symptom
MI is a serious complication
Risk factors: Family history of heart disease, hypertension, high cholesterol, smoking, diabetes, obesity, physical inactivity, and certain medications.
Lifestyle modifications: A heart-healthy diet (low in saturated fat, cholesterol, and sodium) and regular exercise.
Medications: Used to treat high cholesterol, high blood pressure, and other risk factors.

Angina

Chest pain caused by a temporary lack of oxygen to the heart muscle
Angina usually occurs with exertion and subsides with rest.
Stable Angina: Predictable chest pain that occurs during exertion. Relieved within minutes with rest or nitroglycerin.
Unstable Angina: New or worsening chest pain that occurs at rest or with less exertion than usual, or lasts longer than usual.

Hypertension

High blood pressure
A major risk factor for heart disease, stroke, kidney disease, and other health problems.
Silent killer, as it often has no symptoms.
Lifestyle modifications
Medications: Used to lower blood pressure.

Myocardial Infarction (MI)

A heart attack
Caused by a complete blockage of a coronary artery
Symptoms include chest pain, shortness of breath, nausea, vomiting, and sweating
Immediate medical attention is needed.
STEMI: A type of MI that causes a complete blockage and visible (ST segment) changes on an EKG.
Non-STEMI: MI with a partial blockage and EKG changes.

Heart Failure

A complex syndrome characterized by the heart's inability to pump enough blood to meet the body's needs
Can be caused by several conditions, including coronary artery disease, hypertension, and valvular heart disease.
Some cases are reversible, depending on the cause.
Most HF is chronic, progressive, and managed with lifestyle changes and medications.

Chronic Heart Failure

Chronic heart failure develops over time, where the heart muscle is weakened and can no longer pump effectively.

Clinical Manifestations of Heart Failure

Right-sided Heart Failure: Ineffective pumping of the right ventricle causes backflow of blood to the body's periphery .
Left-Sided Heart Failure: Ineffective pumping of the left ventricle causes backflow of blood to the lungs. Left-sided heart failure can progress to right-sided heart failure without treatment.

Medical Management of the Patient with Heart Failure

Lifestyle modifications
Medications

Treatments

Diuretics: Reduce fluid retention
Vasodilators: Dilate blood vessels, reducing the workload of the heart.
ACE Inhibitors: Inhibit the conversion of angiotensin I to angiotensin II, which helps lower blood pressure.
Beta Blockers: Block beta-adrenergic receptors, which helps lower blood pressure and improve heart function.
Digitalis: Increases the force of heart contractions.

Medications used to Treat HF

Diuretics
ACE Inhibitors
Beta Blockers
Digitalis
Nitrates
Vasodilators

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Description

This quiz covers the roles of various members of the surgical team and the preoperative assessment process. It includes information on medications that may impact the surgical experience, as well as the importance of patient history and assessments before surgery. Test your knowledge of surgical protocols and practices.