Funds Ch. 18, 26, 33 complete update A+
graded
aesthetic surgery (cosmetic) surgery may be performed to change or improve one's physical
appearance; ex. face lift or breast augmentation
curative surgery is done to treat or cure a disease
diagnostic surgery is completed with a scope or to remove tissue to identify the presence of a
disease; ex. removal of a skin nodule to test for cancer
exploratory surgery done to provide further data and determine a diagnosis for a problem; ex.
abdominal pain sometimes requires this surgery to determine the cause
palliative surgery alleviates symptoms and provides comfort but does not necessarily cure
the disease or heal the injury; ex. removing as much of a tumor as possible, known as debulking
a tumor; this type of surgery can decrease pain and relieve pressure, but it will not cure the
cancer
preventative surgery done to remove tissue before it becomes diseased; ex. removal of a
calcification from breast tissue to prevent breast cancer
reconstructive surgery(corrective) surgery done to repair an anatomical or congenital defect; ex.
repair a cleft palate so that a child can nurse or eat normally
elective surgery any surgery that is voluntary and scheduled a week or more in advance;
those surgeries intended to improve a patient's quality of life, either physically or
psychologically; ex. cataract surgery (medically indicated) or breast augmentation in which it is
sometimes referred to as optional surgery
cholecystectomy removal of the gallbladder to treat inflammation and gallstones
urgent surgery surgery required within 24 hours of diagnosis to prevent complications that may
occur with waiting; ex. open reduction internal fixation of a fracture after an injury
,emergency surgery surgery that cannot be delayed and usually is scheduled within 2 hours to
prevent serious complications or death; ex. appendectomy (removal of an inflamed appendix
before it ruptures in the peritoneal cavity)
outpatient surgery performed on patient who is not admitted to the hospital as an inpatient;
the patient arrives at the site before surgery, has the procedure, spends hours after surgery
recovering, and returns home the same day
stand alone surgery center
medical office
hospital outpatient surgery dept examples of outpatient surgery locations
stand alone surgery center designed only to provide perioperative care for minor surgical
procedures during the day; is generally open for a specified length of time each day;
perioperative teaching and assessment are often completed before the day of the surgery; pt
arrives 1-2 hours before surgery; ex. knee arthroscopy on a young adult; day surgeries
medical office location where procedures that do not require anesthesia other than an injection of
a local anesthetic; ex. vasectomy
hospital outpatient surgery dept patient comes to this facility for the surgical procedure but
is not admitted as an impatient and generally does not spend the night; ex. tonsillectomy on an 8
yr old whom there is a high risk of bleeding between 6 and 8 hours after surgery
inpatient surgery (hospital based surgery) performed on patients who have been admitted to
the hospital on the morning of surgery, going directly to a preoperative staging unit and are not
sent to the inpatient unit until after surgery; other patients may require hospitalization before
surgery to stabilize a preexisting or acute condition; ex. pt admitted for abdominal pain who
required insertion of NG tube and IV therapy - once NG tube was inserted, the pt was diagnosed
as having a gastrointestinal bleed, which required surgical intervention to prevent hemorrhage
a reduction in fear and anxiety and increased compliance with postop care the more thorough the
preop teaching, the better the patient generally does postop because why
preoperative assessment includes a preliminary process of assessment and preop testing to
ensure that the patient is healthy enough to undergo surgery and anesthesia; also helps the
surgeon determine whether the patient should or can be scheduled for surgery at a freestanding
surgical center or medical office or if the patient would be better cared for in a hospital setting;
1. exploring the pt's understanding of the need for surgery to be performed
2. asking about any previous surgeries and anesthetics
3. asking about the pt's family health hx
4. asking about current medication use, including prescription medications, over the counter
medications, and herbal medications
5. asking about medication allergies and intolerance
6. asking about alcohol and recreational drug use, abuse, and addiction
7. asking about tobacco and nicotine use
, 8. asking females about the date of the pt's last menstrual period to determine the possibility of
pregnancy steps of taking patient's history
review of systmes is designed to identify the presence or absence of preexisting diseases that
may affect either the surgical procedure or the administration of anesthesia
ask about preexisting arrhythmias, chest pain, and myocardial infarction; ask about hypertension
and if present, ask about medications used and compliance; a pt with poorly controlled
hypertension may have begun to develop end stage renal damage, meaning the kidney function
has deteriorated to minimal functioning; this would clue you to the need for preop testing of
renal function; if the pt has a hx of heart failure, you would be clued to assess for edema in the
extremities, auscultation of heart sounds, noting muffled s1 and s2 and auscultation of breath
sounds; if symptoms of heart failure, surgery may be postponed until the pt's symptoms are
controlled review of cardiovascular systems
ask pt about dyspnea, both exertional and at rest; can provide clues about pulmonary and cardiac
disease; if pt has hx of asthma or other chronic obstructive pulmonary disease (COPD), inquire
about an inhaler review of the respiratory system
assess if your patient is alert and oriented x 4, able to follow commands, and understand your
teaching; if pt does not follow simple commands or answer your questions, make certain that the
lack of response is not because of a hearing loss or language barrier; evaluate any neurological
deficit so that you have a clear understanding of adjustments that need to be made in delivering
care; ex. a pt with dementia might benefit from having a family member remain at bedside in the
preop holding area and immediately after surgery in the PACU; normally this might not be
allowed, but for a pt with sever dementia or intellectual deficiencies, it might make the
difference in reducing stress, confusion, or lack of cooperation review of the central nervous
system
it is important to assess for preexisting renal disease because failure to eliminate medications can
result in toxicity; in addition, the pt with renal dysfunction is often anemic, which has the
potential to compromise oxygen; coagulation deficits also may be present in pts who are on
dialysis; tests that will help determine the health status of the kidneys are the creatinine and
estimated glomerular filtration rate review of renal system
arthritis is the most common musculoskeletal disease found in older surgical patients; arthritis
can compromise positioning; medications taken for arthritis, such as aspirin and NSAIDs, affect
platelet function , which increases the risk of bleeding review of musculoskeletal system
malnutrition and anemia can compromise wound healing, while obesity increases risk of
pulmonary and cardiac compromise; malnutrition is characterized by several lab test, including
low serum prealbumin, albumin, transferrin, hemocrit and hemoglobin; the liver is the primary
organ for drug metabolism, so any preexisting hepatic disease, such as hepatitis, cirrhosis, or
alcoholism, has the potential to decrease the rate and efficacy of drug clearance; the liver is
responsible for the production of clotting factors to assist with clotting of blood and bile for
digestion review of gastrointestinal system
graded
aesthetic surgery (cosmetic) surgery may be performed to change or improve one's physical
appearance; ex. face lift or breast augmentation
curative surgery is done to treat or cure a disease
diagnostic surgery is completed with a scope or to remove tissue to identify the presence of a
disease; ex. removal of a skin nodule to test for cancer
exploratory surgery done to provide further data and determine a diagnosis for a problem; ex.
abdominal pain sometimes requires this surgery to determine the cause
palliative surgery alleviates symptoms and provides comfort but does not necessarily cure
the disease or heal the injury; ex. removing as much of a tumor as possible, known as debulking
a tumor; this type of surgery can decrease pain and relieve pressure, but it will not cure the
cancer
preventative surgery done to remove tissue before it becomes diseased; ex. removal of a
calcification from breast tissue to prevent breast cancer
reconstructive surgery(corrective) surgery done to repair an anatomical or congenital defect; ex.
repair a cleft palate so that a child can nurse or eat normally
elective surgery any surgery that is voluntary and scheduled a week or more in advance;
those surgeries intended to improve a patient's quality of life, either physically or
psychologically; ex. cataract surgery (medically indicated) or breast augmentation in which it is
sometimes referred to as optional surgery
cholecystectomy removal of the gallbladder to treat inflammation and gallstones
urgent surgery surgery required within 24 hours of diagnosis to prevent complications that may
occur with waiting; ex. open reduction internal fixation of a fracture after an injury
,emergency surgery surgery that cannot be delayed and usually is scheduled within 2 hours to
prevent serious complications or death; ex. appendectomy (removal of an inflamed appendix
before it ruptures in the peritoneal cavity)
outpatient surgery performed on patient who is not admitted to the hospital as an inpatient;
the patient arrives at the site before surgery, has the procedure, spends hours after surgery
recovering, and returns home the same day
stand alone surgery center
medical office
hospital outpatient surgery dept examples of outpatient surgery locations
stand alone surgery center designed only to provide perioperative care for minor surgical
procedures during the day; is generally open for a specified length of time each day;
perioperative teaching and assessment are often completed before the day of the surgery; pt
arrives 1-2 hours before surgery; ex. knee arthroscopy on a young adult; day surgeries
medical office location where procedures that do not require anesthesia other than an injection of
a local anesthetic; ex. vasectomy
hospital outpatient surgery dept patient comes to this facility for the surgical procedure but
is not admitted as an impatient and generally does not spend the night; ex. tonsillectomy on an 8
yr old whom there is a high risk of bleeding between 6 and 8 hours after surgery
inpatient surgery (hospital based surgery) performed on patients who have been admitted to
the hospital on the morning of surgery, going directly to a preoperative staging unit and are not
sent to the inpatient unit until after surgery; other patients may require hospitalization before
surgery to stabilize a preexisting or acute condition; ex. pt admitted for abdominal pain who
required insertion of NG tube and IV therapy - once NG tube was inserted, the pt was diagnosed
as having a gastrointestinal bleed, which required surgical intervention to prevent hemorrhage
a reduction in fear and anxiety and increased compliance with postop care the more thorough the
preop teaching, the better the patient generally does postop because why
preoperative assessment includes a preliminary process of assessment and preop testing to
ensure that the patient is healthy enough to undergo surgery and anesthesia; also helps the
surgeon determine whether the patient should or can be scheduled for surgery at a freestanding
surgical center or medical office or if the patient would be better cared for in a hospital setting;
1. exploring the pt's understanding of the need for surgery to be performed
2. asking about any previous surgeries and anesthetics
3. asking about the pt's family health hx
4. asking about current medication use, including prescription medications, over the counter
medications, and herbal medications
5. asking about medication allergies and intolerance
6. asking about alcohol and recreational drug use, abuse, and addiction
7. asking about tobacco and nicotine use
, 8. asking females about the date of the pt's last menstrual period to determine the possibility of
pregnancy steps of taking patient's history
review of systmes is designed to identify the presence or absence of preexisting diseases that
may affect either the surgical procedure or the administration of anesthesia
ask about preexisting arrhythmias, chest pain, and myocardial infarction; ask about hypertension
and if present, ask about medications used and compliance; a pt with poorly controlled
hypertension may have begun to develop end stage renal damage, meaning the kidney function
has deteriorated to minimal functioning; this would clue you to the need for preop testing of
renal function; if the pt has a hx of heart failure, you would be clued to assess for edema in the
extremities, auscultation of heart sounds, noting muffled s1 and s2 and auscultation of breath
sounds; if symptoms of heart failure, surgery may be postponed until the pt's symptoms are
controlled review of cardiovascular systems
ask pt about dyspnea, both exertional and at rest; can provide clues about pulmonary and cardiac
disease; if pt has hx of asthma or other chronic obstructive pulmonary disease (COPD), inquire
about an inhaler review of the respiratory system
assess if your patient is alert and oriented x 4, able to follow commands, and understand your
teaching; if pt does not follow simple commands or answer your questions, make certain that the
lack of response is not because of a hearing loss or language barrier; evaluate any neurological
deficit so that you have a clear understanding of adjustments that need to be made in delivering
care; ex. a pt with dementia might benefit from having a family member remain at bedside in the
preop holding area and immediately after surgery in the PACU; normally this might not be
allowed, but for a pt with sever dementia or intellectual deficiencies, it might make the
difference in reducing stress, confusion, or lack of cooperation review of the central nervous
system
it is important to assess for preexisting renal disease because failure to eliminate medications can
result in toxicity; in addition, the pt with renal dysfunction is often anemic, which has the
potential to compromise oxygen; coagulation deficits also may be present in pts who are on
dialysis; tests that will help determine the health status of the kidneys are the creatinine and
estimated glomerular filtration rate review of renal system
arthritis is the most common musculoskeletal disease found in older surgical patients; arthritis
can compromise positioning; medications taken for arthritis, such as aspirin and NSAIDs, affect
platelet function , which increases the risk of bleeding review of musculoskeletal system
malnutrition and anemia can compromise wound healing, while obesity increases risk of
pulmonary and cardiac compromise; malnutrition is characterized by several lab test, including
low serum prealbumin, albumin, transferrin, hemocrit and hemoglobin; the liver is the primary
organ for drug metabolism, so any preexisting hepatic disease, such as hepatitis, cirrhosis, or
alcoholism, has the potential to decrease the rate and efficacy of drug clearance; the liver is
responsible for the production of clotting factors to assist with clotting of blood and bile for
digestion review of gastrointestinal system
