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113 Cards in this Set

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  • Back
What are some key points of Pre-op nursing care?
identify treatment risks, pt teaching, including diagnostic tests, safety, medication administration, nutrition, elimination, metabolic
What are some intra-op key points of nursing care?
SAFETY
What are some key points of post-op nursing care?
prevention of post-op complications, pain control, wound care, patient teaching
What are some increased risk factors for complications of perioperative?
chronic illness, age (young or old), urgency, meds, pulmonary (COPD, asthma), anemia, blood problems, hypertension, seizures, steroids
What are some interventions for the elderly perioperative?
think of system related illnesses and how it will affect the pt going to surgery, (example: CV- previous MI = decreased contractility of the heart due to stress of anaethesia OR Pulmonary- COPD risk with oxygen levels with anaesthesia)
What are some parts of preoperative period?
assessment: history, age, medications, allergies, past medical history, discharge planning, blood donations if needed
How long must you be off coumadin before surgery?
a few days
What are some meds to consider during pre-op?
antiarrhythmics, antihypertensives, steroids, anticoagulants, ASA, NSAIDS, Vitamin E, anti seizure, hypoglycemics, herbal, OTC
What are parts of the physical exam for pre-op?
CV, respiratory, renal, neurological, musculoskeletal, nutritional status, psychosocial
What are some assessments for pre-op related to the elderly?
chronic illness (arthritis, renal, CV, pulmonary, sensory), malnutrition, more allergies, decreased ability for self care, support systems?, ability to tolerate stress? (decreases with aging), increased complications, comorbidity
What are some diagnostic tests that may be done pre-op?
CBC, UA, T AND C, PT, PTT, INR, BUN/CR, CXR, PFT, ECG, pregnancy tests, electrolytes
What is the difference between PT and PTT?
measures different parts of cascade process

PT= INR and coumading
PTT= heparin
Why will BUN and Cr be tested pre-op?
deals with the metabolism and excretion of anaesthetics and meds
What are some problems/ nursing diagnoses for pre-op?
knowledge deficit, anxiety, powerlessness
What must you get before surgery?
informed signed consent
Who describes the surgery to the pt?
surgeon
When must the consent be signed?
prior to sedation
Who signs it?
the patient if over 18 or emancipated, if under 18 and not emancipated, the legal guardian
What does the nurse provide pre-op?
teaching for tests, drains, tubes, exercises, pain management, etc
What do use for elimination prep if needed?
enemas, laxatives
What are some parts of nutrition to remember pre-op?
NPO, IV, TPN
What are some parts of skin prep pre-op?
cleanse, remove hair (based on hospital policy NO shaving, use clippers) shaving causes risk for infection
What is some info that is in the pre-op checklist?
ID band, allergy band, consent, History and physical, EKG, CXR, remove jewelry, contacts, nail polish, etc. document last set of vitals and last time pt voided and other info, preop meds given after and time given recorded
What are some pre-op meds given for?
to decrease anxiety, promote relaxation, reduce oral secretions, decrease amount of anaesthesia needed, on call, AFTER CONSENT SIGNED
When do you empty bladder pre-op?
right before giving meds, then put side rails up and keep pt in bed
What types of meds are given in the pre-op?
sedative, opiod analgesic, and anticholinergic
What does anaesthesia cause?
partial or total loss of sensation with or without loss of consciousness
What does anesthesia do?
block transmission of nerve impulses, suppresses reflexes, and promotoes muscle relaxation
Where is anesthesia metabolized and excreted?
metabolized in teh liver and excreted in the kidneys
What are some points about general anaesthesia?
reversible, loss of consciousness, CNS depression, amnesia, pain relief, loss of muscle tone and reflexes
What are routes of general anaesthesia
inhalation, IV
4 stages of general anaesthesia
analgesia sedation, excitement, operative, and DANGER
What are some ways to inhale general anaesthesia?
ET tube, gas agents
What is balanced anaesthesia?
combinations of inhaled and IV
Why to use balanced anaesthesia
safe adn controlled, especially for elderly and high risk patients
complications from anaesthesia
sore throat, N/V, overdose, hypoventilation, malignant hypertension
How is Malignant hyperthermia (MH) acquired?
usually genetic and it is a skeletal muscle defect triggered by anaesthesia and deals with calcium and muscles
Why are people NPO before anaesthesia
prevent aspiration
What is a genetic disorder that is a skeletal muscle defect and you cannot regulate Ca++ properly?
malignant hyperthermia
What are the symptoms of a patient with MH?
rapid elevation of temp, sudden tachycardia (unexplained), muscle rigidity in jaw and upper chest, hypotension, tachypnea, skin mottling, cyanosis, myoglobinuria (cola colored urine), increased end tidal CO2 and decreased O2 saturation levels, extremely elevated temp
What is a late sign of MH?
extremely elevated temp
Page in book to look for MH
330
What can cause tachycardia during surgery?
blood loss
How do you treat a pt with MH?
first thing is to STOP ANAESTHERIA IMMEDIATELY!!!, then give Dantrolene 2-3 mg/kg IV
After stopping anaesthesia and giving dantrolene, how do you deal with MH?
maintain airway, give O2 100%, cool pt with iced IV normal saline, apply cooling blanket, lavage stomach, bladder, open body cavity, treat any other symptoms, check ABG and K levels
What IV of iced IV normal saline do you use for MH?
15 ml/kg every 15 minutes x 3
What are some contraindications of regional/local anaesthesia
severe arthritis or recent back surgery
Types of regional/local anaesthesia
topical, local, field block, nerve block, spinal anaesthesia, epidural
What are some local/regional complications of anaesthesia
anaphylaxis, incorrect technique, systemic absorption, overdose, toxic reaction
What is conscious sedation
IV administration of sedative, hypnotic and opiod to produce a depressed LOC but can maintain airway
What is needed for conscious sedation
consent
What are some meds given for conscious sedation
valium, versed, fentyl
What has a rapid recover and usually discharged
conscious sedation
What do you give IV for conscious sedation
sedative, hypnotic, and opiod
What are some problems with conscious sedation
injury from positioning, immobilization, and anaesthesia, skin integrity, pg 337, SAFETY, sharps count, sponge count
How often do you count sharps and sponges?
at least 3 times each
What are you at risk for in post op?
airway, allergic rxn, hypothermia, hypo/hypertension, shock, renal failure, 'lyte imbalance, dysrhythmias, CHF, ileus, urinary retention, DVT, PE, atelectasis/pneumonia, larygeal edema, GI bleed, DIC anemia, wound dehis/evis
When does post op start?
close patient and begin reversal of anaesthesia
What do you check in post op
LOC, VS, dressing, drains and other tubes, gag and cough reflexes, tsf to room, stable conditions
What may the pt be like when coming out of anaesthesia
restless
What do you do when transferring a pt to room post op
airway, breathing, LOC, surgical site, VS, IV, other tubes
What are some post op complications that can occur with the respiratory system
atelectasis, pneumonia, aspiration
What do you do post op for respiratory?
listen to lung sounds, vitals, check for use of accessory muscles, O2 levels, pulse ox, incentive spirometry, turn, cough, deep breathe
What do you evaluate in respiratory post op?
pulse ox 95+, clear breath sounds, RR within normal limits, no use of accessory muscles
What are some post op CV complications
pulse deficit, dysrhythmia, evidence of bleeding/ hemorrhage/shock, evidence of hypovolemia, IV fluids infusing, labs (BUN, Cr, CBC)
What will dysrhythmia cause
risk for decreased CO
Signs of hypovolemia
tachycardia, decreased BP, restless, decreased urinary output
What are some signs of a DVT
complaints of calf pain, swelling, warmth and tenderness, pulses palpable, can also use venous doppler or Homans sign (not accurate), use TEDs adn sequentials
Why are pulses palpable with DVT
in a vein NOT artery
What are some risk factors for CV?
obesity, immobility, smoking, cancer, oral contraceptives, trauma to blood vessels
When should the pt void post op?
within 8 hours
What do you monitor in renal post op?
IV/PO intake adequate, I adn O, prevent renal calculia, prevent UTI
What can you do to get the pt to pee?
run water, put in natural position
How do you check if the bladder is full
palpate
What are some parts to assess when dealing with GI post op?
NPO, check bowel sounds, NG tube care, drain care, N/V, advance diet, suppository, paralytic ileus
What is a paralytic ileus?
section of the bowel that has lost peristalsis
What do you do with a paralytic ileus?
avoid narcotics and get the pt to ambulate and move
How long may it take for bowel sounds to return after surgery?
24-36 hour
What is good to hear post op
the client passing gas, means the bowel sounds are back
What may help increase peristalsis in early post op
chewing gum
What are some skin assessments post op?
wound care, dressing changes, drainage, SSX of infection, SSX of dihiscence/evisceration
What is eviseration
part of body sticking out of wound
What do you want when assessing surgical wound
want suture line well approximated, staples and sutures intact, no redness, warmth, or drainage
What are some parts of usual post op care
wound, nutrition, safety, pain, pulmonary, CV, elimination
What do you do for pain management in PACU?
1/2 ordered dose
What do you check for painwise in post op?
assessment, severity matches med, interventions to enhance med, PCA, or epidural
What do opiods do
block release of NTs in spinal column
What are some opiods?
hydrocodone (vicodin, lortab), oxycodone (oxycontin, percodan, percocet), hydromorphine (dilaudid- 8 times more potent than morphine), Fentanyl patch, Demerol (restricted use), ultram
What is 8 times more potent than morphine
dilaudid
What is main goal of intra op/
SAFETY
What are some opiod side effects?
respiratory depression with IV use, constipation with PO/longterm use
What do you give only IM/PO because of high mortality rate
Toradol
What are some parts of follow up care?
discharge planning, office visit, diet, ADL, activities, shower, meds, SSX infection/report, tell them when to call MD
In the salem tube, what part never suctions
blue
How do you measure an NG/Salem tube?
ear to nose then nose to sternum
What do you do before inserting NG tube?
check nares to see if clear
How do you insert NG tube
after checking nares, tilt forward, give water, and ask to swallow as you keep progressing it in
What is the blue part of salem tube?
vented to atmospheric air to rpevent the tip of tube from adhering to stomach
What do you do with suction on NG tube to listen?
turn off, but be sure to turn it back on
What are SSX that the NG tube is not tolerated?
cough and gag/blue
What do you do if NG tube not tolerated
withdraw, have the pt breathe a couple times and try again
What is the best way to check tube placement?
xray
What do you do to check placement of NG tube besides xray
inject air and listen with steth at LUQ or check for gastric return
What is the purpose of an NG tube?
gastic decompression (to withdraw/empty and prevent nausea), if overdose (lavage with saline), or to lavage feed
When can you irrigate an NG tube?
as long as the pt hasn't had gastric or esophageal surgery. If they have, you need an order to irrigate
What do you irrigate an NG tube with?
saline or water
What must you be very careful not to do with an NG tube if they've had gastic or esophageal surgery?
not to dislodge it
What is a Hemavac?
to promote drainage: must be held lower than suture but NOT dangling
How does a Hemavac work?
compressed to allow suction, it will expand, then you empty and measure the output, then squeeze, recap and it's ready for next time
What is a Jackson Pratt?
transparent bulb used to drain surgical drainage (PAGE 347)
How does a Jackson Pratt work?
same suction as Hemavac: wear gloves
What may drainage look like right after surgery?
more bloody in first few hours, then turn to serosanguineous (looks like punch)
What do you do with a penrose drain?
safety pin it so it doesn't slip back