The six purposes for performing surgery

1. Diagnoses- Determination of the presence and/or extent of pathology (e.g., lymph node biopsy, bronchoscopy).
2. Cure- Elimination or repair of pathology (e.g., removal of a ruptured appendix, benign ovarian cyst).
3. Palliation- alleviation of symptoms without cure (e.g., cutting a nerve root [rhizotomy] to remove symptoms of pain, creating a colostomy to bypass an inoperable bowel obstruction).
4. Prevention- Examples include removal of a mole before it becomes malignant or removal of the colon in a patient with familial polyposis to prevent cancer.
5. Exploration- Surgical examination to determine the nature or extent of a disease (e.g., laparotomy).
6. Cosmetic improvement- examples include repairing a burn scar or breast reconstruction after a mastectomy.

Elective surgery

Emergency surgery

Suffixes describing surgical procedures

-ectomy: Excision or removal of (e.g.,appendectomy)

-lysis: Destruction of (e.g., electrolysis)

-orrhaphy: Repair or suture of (e.g., Herniorrhaphy)

-oscopy: Looking into (e.g., endoscopy)

-ostomy: Creation of opening into (e.g., Colostomy)

-otomy: Cutting into or incision of (e.g., Tracheotomy)

-plasty: Repair or reconstruction of (e.g., Mammoplasty)

Same-day admission

Ambulatory surgery

• Also called same-day surgery or outpatient surgery, the majority of surgical procedures are performed as this. 
• Many of these surgeries use minimally invasive techniques (e.g., laparoscopic techniques)
• May be conducted in emergency departments, endoscopy clinics, physician offices, freestanding surgical clinics, and outpatient  surgery units in hospitals.
• Procedures can be performed using general, regional, or local anesthestetic; have an operating time of less than 2 hours; and require less than a 24-hour stay postoperatively.
• Many patients go home within hours of surgery accompanied by a responsible caregiver.
• generally preferred by patients and physicians.
• Insurers may mandate it.
• Generally involves minimal laboratory tests, requires fewer preoperative and postoperative medications, and reduces the patient's susceptibility to hospital-acquired infections.

What are the nurses duties for preoperative surgery

• Nurse must have knowledge of the nature of the disorder requiring surgery and any coexisting disease processes.
• Nurse must identify the individual patient's response to the stress of surgery.
• Nurse must identify potential risks and complications associated with the surgical procedure and any coexisting medical problems that should be incorporated into the plan of care.
• The nurse caring for the patient preoperatively is likely to be different from the nurse in the operating room (OR), postanesthesia care unit (PACU), surgical intensice care unit (SICU), or surgical unit.

The primary purposes of the preoperative patient interview

1. Obtain the patient's health information.
2. Provide and clarify information about the planned surgical experience, including anesthesia.
3. Assess the patient's emotional state and readiness for surgery, including his or her expectations about the surgical.

• You should ensure that the patient's consent form for surgery has been signed and witnessed.

The overall goals of the preoperative assessmest

1. Determine the psychologic stautus of the patient in order to reinforce the use of coping strategies during the surgical experience.
2. Determine psychologic factors that are directly or indirectly related to the surgical procedure that may contricute to operative risk factors.
3. Establish baseline data for comparison in the intraoperative and postoperative period.
4. Identify and document the surgical site and/or side (of body) on which the surgical procedure will be performed.
5. Identify prescription medications, over-the-counter drugs, and herbal supplements taken by the patient that may result in drug interactions affecting the surgical outcome.
6. Document the results of all peroperative laboratory and diagnostic tests in the patient's record and communicate this information to appropriate health care providers.
7. Identify cultural and ethnic factors that may affect the surgical experience.
8. Determine if the patient has received adequate information from the surgeon to make an informed decision to have surgery and that consent form is signed and witnessed.

Herb or supplement perioperative considerations

• Echinacea- May cause inflammation of the liver if used with certain medications.
• Feverfew- May inhibit platelet activity and increase bleeding.
• Garlic- May increase bleeding, especially in patients taking anticoagulants.
• Ginger- May increase bleeding, especially in patients taking anticoagulants.
• Ginkgo biloba- May increase bleeding, especially in patients taking anticoagulants.
• Ginseng- May increase bleeding, espcially in patients taking anticoagulants; may cause increased heart rate or elevated blood pressure (BP).
• Goldenseal- May cause increased BP; may increase swelling.
• Kava- May prolong the effects of certain anesthetics or antiseizure medications; may cause liver injury.
• Licorice- Certain preparations may cause elevate BP, swelling, or electrolyte imbalance.
• Saw palmetto- May have additive effects with other hormone therapies.
• St. John's wort- may prolong the effects of anesthetic agent.
• Valerian- May prolong the effects of certain anesthetics or antiseizure medications; may cause liver injury.
• Vitamin E- May increase bleeding, especially in patient's taking anticoagulants; may effect thyroid gland function; in high doses may cause increased BP in patients who already have high BP.

What lab tests/diagnostics may be run preoperatively

• A patient on a diuretic therapy will have serum potassium levels drawn preoperatively.
• A patient with a history of hypertension may have vasoactive drugs administered by the ACP to maintain adequate BP during surgery.
• If patient has a history of congenital, rheumatic, or valvular heart disease, antibiotic prophylaxis will often be given before surgery to decrease risk of bacterial endocarditis.
• Postoperative venous thromboembolism (VTE), a condition that includes deep vein thrombosis and pulmonary embolism, is a concern for any surgical patient.
• Patients at high risk for VTE include those with a history of previous thrombosis, blood-clotting disorders, cancer, varicosities, obesity, smoking, heart failure, or chronic obstructive pulmonary disease (COPD).
• Immobilty and positioning during the operative procedure are also causes of VTE.

Hemoptysis

What postoperative pulmonary complications are patients with a history of COPD and asthma at risk for

• Hypoxemia
• Atelectasis
• The patient who smokes should be encouraged to stop at least 6 weeks preoperatively to decrease the risk of intraoperative and postoperative respiratory complications.
• The greater the patient's pack-years of smoking (packs smoked per day times years), the greater the patient's potential for pulmonary complications during or after surgery.

What alterations is renal dysunction associated with

• Fluid and electrolyte imbalances, coagulopathies, increased risk for infection, and impaired wound healing.
• Many drugs are metabolized and excreted by the kidneys. A decrease in renal function may contribute an alterered response to drugs and unpredictable drug elimincation.
• Renal function tests, such as serum creatinine and blood urea nitrogen, are commonly ordered preoperatively, and results should be available on the chart before the patient goes to surgery.

What processes is the liver involved in

• Glucose homeostasis, fat metabolism, protein synthesis, drug and hormone metabolism, and bilirubin formation and excretion.
• The liver detoxifies many anesthetics and adjunctive drugs.
• The patient with hepatic dysfunction may have an increased perioperative risk for clotting abnormalities and adverse responses to medications.

Postoperative pain is frequently due to

Risks and tests for diabetics (endocrine system)

• Diabetics are especially at risk for adverse effects of anesthesia and surgery.
• Hypoglycemia, hyperglycemia, ketosis, CV alterations, delayed wound healing, and infection are common complications of diabetes during the perioperative period.
• Serum or capillary glucose tests should be completed the morning of surgery to determine baseline levels.

Other risks with endocrine disorders

• It should also be determined if the patient has a history of thyroid dysfunction. Either hyperthyroidism or hypothyroidism can place the patient at surgical risk because of alterations in metabolic rate.
• The patient with Addisons's disease also require special consideration during surgery. Addisonian crisis or shock can occur if a patient abruptly stops taking replacement corticosteroids, cand the stress of surgery may require additional intravenous (IV) corticosteroid therapy.

What vitamins are essential for wound healing

American Society of Anestheiologists Physical Classification system

• P1- Normal healthy person
• P2- Patient with mild systemic disease
• P3- Patient with severe systemic disease
• P4- Patient with severe systemic disease that is a constant threat to life
• P5- Moribund patient who is not expected to survive without surgery
• P6- Declared brain-dead patient whose organs are being removed for donor purposes

Three types of information for preoperative teaching

1. Sensory- Patients want to know what they will see, hear, and feel during the surgery. You may tell them that the OR will be cold, but they can ask for a warm blanket; the lights in the OR are very bright; or there will be lots of sounds that are unfamiliar and there may be specific smells present.
2. Process- May not want specific details but desire the general flow of what is going to happen. This information woulf include the patient's transfer to the holding area, visits by the nurse and ACP before transfer to the OR, and waking up in the PACU.
3. Procedural- Patients desire details that are more specific. This information would include that an IV line will be started while the patient is in the holding area and the surgeon will mark the operative area with an indelible marker to verify site and side.

General surgery information

• Unless contraindicated, all patients should recieve instruction about deep breathing, coughing, and early ambulation (moving) postoperatively.
• Is essential because patients may not want to do these activities postoperatively unless they are taught the rationale for them and practice them preoperatively.

Why is there a restriction of fluids and food

Preoperative fasting recommendations

• Clear liquids (e.g., water, clear tea, black coffee, carbonated beverages, and fruit juice without pulp)- 2 hours minimum fasting time
• Breast milk- 4 hours minimum fasting time
• Nonhuman milk, including infant formula- 6 hours minimum fasting time
• Light meal (e.g., toast and clear liquids)- 6 hours minimum fasting time
• Regular meal (may include fried or fatty food, meat)- 8 or more hours minimum fasting time

Informed consent

• An active, shared decision-making process between the health care provider and the recipient of care.
• Three conditions must be met for consent to be valid.
• There must be adequate disclosure of the diagnosis; the nature and purpose of the proposed treatment; the risks and consequences of the proposed treatment; the probability of a successful outcome; the availability, benefits, and risks of alternative treatments; and the prognosis if treatment is not instituted.
• The patient must demonstrate clear understanding and comprehension of the information being provided before receiving sedating preoperative medications.
• The recipient of care must five consent voluntarily. The patient must not be persuaded or coerced in any way by anyone to undergo the procedure.
• The physician is ultimately responsible for obtaining the patient's consent for surgical treatment.
• A true medical emergency may override the need to obtain consent. When immediate medical treatment is needed to perserve life or to prevent serious impairment to life and the individual patient is incapable of giving consent, the next of kin may give consent. If reaching the next of kin is not possible, the physician may institute treatment without written consent.

Preoperative medications

• Benzodiazepines are used for their sedative and amnesic properties.
• Anticholinergics are sometimes given to reduce secretions.
• Opioids may be given to decrease pain and intraoperative anesthetic requirements.
• Antiemetics may be given to decrease nausea and vomiting.
• Other medications include antibiotics, eyedrops, and routine prescription drugs.