NRS 322 Lecture Notes - Lecture 2: Sensorium, Valvular Heart Disease, Nerve Block

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28 Jul 2015
Topic 2
The Surgical Experience
1. Define and describe the following terms.
Ambulatory surgery: also called same-day surgery; refers to surgery performed so that
the patient can be discharged on the same day
Elective surgery: surgery that is planned
Emergency surgery: surgery that is unexpected and urgent
Informed consent: an active, shared decision-making process between the provider and
the recipient of health care; this process protects the patient, the surgeon, and the hospital
and its employees
Same-day admission: admission to hospital on the same day that surgery will take place
Surgery: the art and science of treating diseases, injuries and deformities by operation
and instrumentation
Procedural/conscious sedation: moderately depressed level of consciousness used for
managing patient pain and anxiety but which maintains the patient’s protective airway
reflexes. Patient may be monitored by a nurse with appropriate rescue training
Epidural anesthesia: injection of a local anaesthetic into the epidural (extradural) space
via either a thoracic or a lumbar approach
General anaesthesia: the loss of sensation with loss of consciousness, skeletal muscle
relaxation, analgesia, and elimination of the somatic, autonomic, and endocrine
responses, including coughing, gagging, vomiting, and sympathetic nervous system
Local anaesthesia: the loss of sensation without loss of consciousness
Malignant hyperthermia: a rare metabolic disease characterized by hyperthermia with
rigidity of skeletal muscles that can result in death
Regional anaesthesia: the loss of sensation to a region of the body without loss of
consciousness when a specific nerve or group of nerves is blocked with the
administration of a local anaesthetic
Spinal anaesthesia: the injection of a local anaesthetic into the cerebrospinal fluid found
in the subarachnoid space, usually below the level of L2
Airway obstruction: a blockage of the patient’s airway, most commonly caused by the
patient’s tongue
Hypoxia: the state in which the PaO2 has fallen sufficiently to cause signs and symptoms
of inadequate oxygenation
Hypoventilation: deficient ventilation of the lungs, characterized by a decreased
respiratory rate or effort, hypoxemia, and an increasing arterial partial pressure of carbon
dioxide (PaCO2)
Patient-controlled analgesia (PCA): self-administration of predetermined doses of
analgesia by the patient, with the goals of providing immediate analgesia and maintaining
a constant blood level of the analgesic agent
Post anaesthesia care unit (PACU): where the patient’s immediate recovery period
2. Define the following suffixes:
ectomy: excision/removal
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lysis: breaking down, loosening, decomposition
orrhaphy: suturing; repairing
oscopy: looking into
ostomy: creation of opening into
otomy: cutting into/incision
plasty: repair/reconstruction
3. Describe the purpose and components of a preoperative nursing assessment
including lab and diagnostic tests.
All patients coming to the OR must have a comprehensive physical assessment
completed by a physician and recorded on their chart. Before surgery, the nurse is
required to do a focused preoperative assessment and each hospital or facility will have a
concise preoperative checklist for the nurse to complete. This helps identify risk factors
and plan care to ensure patient safety throughout the surgical experience. Goals of the
assessment are the following:
1. Determine the psychological status of the patient and reinforce coping strategies.
2. Determine physiological factors related and unrelated to the surgical procedure
that may contribute to operative risk factors.
3. Establish baseline data for comparison in the intraoperative and postoperative
4. Identify prescription medications, over-the-counter drugs, and herbal medications
taken by the patient that may affect the surgical outcome.
5. Ensure that the results of all preoperative laboratory and diagnostic tests are
documented and communicated to appropriate personnel.
6. Identify cultural and ethnic factors that may affect the surgical experience.
7. Determine whether the patient has received adequate information from the
surgeon to make an informed decision to have surgery, and ensure that the consent
form is signed by the patient and physician.
8. Identify any psychosocial needs of the patient, and assess the patient’s ability to
cope with stressors and change to lifestyle. Ensure that the patient has supports in
place for the postoperative period.
9. Confirm that appropriate preoperative consultations with members of the health
care team such as cardiologists, internal medicine, physiotherapists and
occupational therapists, or wound care nurses have been done.
Subjective Data
Psychosocial Assessment
oIf stressors/response to the stressors is excessive, the stress response can
increase anaesthetic risk, postoperative pain, and wound healing
oThe nurse must assess and plan interventions in order to provide
information support and interventions during the perioperative period so
the patient can manage stress.
oMost common psychological factors experienced by a patient about to
undergo surgery include anxiety, fear, and loss of hope
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oSituational changes (support systems, religious and spiritual orientation;
current degree of personal control, decision making and independence;
impact of surgery and hospitalization on family and dependents and
financial impacts related to recovery time and medical expenses; presence
of hope and anticipation of positive results)
oConcerns with the unknown (anxiety and fears; expectations of surgery,
changes in current health status, and effects on daily living)
oConcern with body image (current roles/relationships and view of self,
perceived/potential changes in role/relationships and their impact on body
oPast experiences (previous surgical experiences, hospitalizations, and
treatments; responses to those experiences – positive/negative; current
perceptions of surgical procedure in relation to the above and information
from others)
oKnowledge deficit (amount/type of preoperative information this specific
patient wants to receive; understanding of the surgical procedure,
including preparation, care, interventions, preoperative activities,
restrictions and expected outcomes; accuracy of information the patient
has received from others, including the health care team, family, friends
and the media)
Past Health History
oDiagnosed medical conditions in the patient’s past as well as current
health problems
oHospital guidelines for preoperative review of the patient’s past health
history and other subjective data will be available to assist in asking the
patient about specific problems
oThe nurse should determine whether the patient understands the reason for
oDetailed information on past hospitalizations should be documented
oAny previous surgeries and dates of the surgeries should also be
oAny problems with previous surgeries or reactions to previous
anaesthetics should be identified
oWomen- menstrual and obstetrical history (include: date of the patient’s
last menstrual period and the number of pregnancies and deliveries the
patient has had) – if the patient states that she might be pregnant,
information should be immediately given to the surgeon to avoid maternal
and subsequent fetal exposure to anaesthetics during the first trimester
oPossible inherited conditions may be identified by asking about the
patient’s family health history
oA family history of cardiac and endocrine disease should be recorded
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