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134 Cards in this Set
- Front
- Back
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When Perioperative nursing care is implemented? (p.1366)
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Nursing care given before (preoperative) , during (intraoperative) and after surgery (postoperative)
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What kind of asepsis the nurse should use when caring for surgical client?
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Surgical Asepsis
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What kind of surgeries does Ambulatory surgery center provide?
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outpatient surgery
short stay surgery or same day surgery |
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Which distinct benefits that client can get from Ambulatory surgery center?
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Anesthetic drugs act fast
Fast recovery Cost saving by eliminating Reduce possibility of acquiring health care - associated infection |
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Laparoscopic?
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Surgery involves the use of minimally invasive techniques such as small incisions for performing of the surgery as opposed to a large incisions required for an open surgergy
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Benefit(s) of laparoscopy when it is done @ the Ambulatory Surgery center? (0.1366)
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Involves small incisions that requires 24-hr stay and a week recovery
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Classification of surgery (p.1366)
Surgical removal of scar falls into what categories? |
Minor in seriousness, elective in urgency, and reconstructive in purpose
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Classification for Surgical Procedure?
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Seriousness
Urgency Purpose |
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Explain serious procedure. Give examples(p.1367)
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Two types: Minor and Major
major: involves extensive reconstruction or alteration in body parts. Example: coronary artery bypass, colon resection, removal of larynx.... Minor: minimal alteration in body parts such as to correct deforminities, minimial risks. Examples: cataract extraction, faical plastic surgery, tooth extraction |
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Explain Urgency procedures and Give example (p. 1376)
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Three types:
a. Elective: perform on basis of client's choice, not always necessary. Examples: facial plastic surgery, hernia repair, breast recontruction Urgent: Necessary for client's health to prevent additional problems, not necessray emergency. Examples: excision of canceriour tumor, removal of gallbladder for stones, vascular repairt for obstructed artery Emergency: must be done immediately to save life or preserve body part. Examples: repair of perforated appendix, repair of traumatic amputation, control of internal hemmorrhaging |
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Explain PURPOSE procedure. Give examples (p.1367)
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4 types (Russo's ppt):
Diagnostic: Surgical exploration that allow healthcare providers to confirm diagnosis (remove tissue). Examples: breast mass biopsy, exploratory laparotomy (incision into peritoneal cavity to inspect abdominal organs) Ablative: excision or removal of diseased body part. Examples: amputation, removal of appendix, chleccystectomy |
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Explain reconstructive/restorative and examples (p.1367)
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internal fixation of fractures, scar revision
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Explain cosmetic and examples (p.1367)
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Blepharoplasty to correct eyelid deformities, rhinoplasty to reshape nose
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Gastrectomy may be performed with which surgical procedure?
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Urgency: Emergency
Resect a bleeding ulcer or as an urgent procedure to remove a cancerous growth |
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What is moribund client?
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Client who is not expected to survive without the operation
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Most testing occur before or after surgery (p. 1368)?
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Before day of surgery
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Which test normally done on the day of surgery?
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Glucose monitoring for client with DM
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Why is it so important for the nurse to obtain pt's medical history information before the surgery (p.1369). Give example
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the information influences the choice of anesthetic agents, the client's ability to tolerate surgery and reach full recovery.
Example: CHF pt may experience a further decline in cardiac function both intraoperatively and postoperatively |
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What are the interventions for the client with CHF in the preoperative period?
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Beta blocker medications
IV @ a slower rate or administer diuretic after blood transfusion |
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What are the medical conditions that increase the risks for Surgery?
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Bleeding disorder (thrombocytopenia, hemophilia), DM, Heart disease (recent MI, dysrhythmias, CHF), and peripheral vascular disease
URI, liver disease Fever, Chronic respiratory disease (emphysemia, bronchitis, asthma) Immunology disorders (leukemia, AIDS, bone marrow depression) Abuse street drugs Chronic pain |
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Risk of bleeding disorder during surgery?
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Hemorrhage during and after surgery
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Why DM increases risk of surgery?
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Increase susceptibility to infection and impairs wound healing fro altered glucose metabolism and associalte ciruclatory impairment
Also stress of surgery causes increases in blood glucose levels |
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Why client with heart disease has higher risk of surgery complication?
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Stress of surgery causes increased demands on nyocardium to maintain CO and general anathetic agetns depress cardiac function
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Why does client with obstruct sleep apnea has higher risk of surgery complication?
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Administration of opioids increases risk of airway obstruction postoperatively
Drop in O2 level |
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Why does client with liver disease has higher risk of surgery complication?
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Alters metabolism and eliminatio of drugs administered during surgery and impairs wound healing and cloting time because of alterations in protein metabolism
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Why does client with fever has high risk of surgery complication?
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Fever predisposes client to fluid and electrolyte imbalances
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Why does client with chronic respiratory disease has high risk of surgery complication?
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Reduces client's means to compensate for acid-base alterations, and anesthetic agent reduce respiratory function, increasing risk for severe hypoventilation
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Why does client with immunological disorders has high risk of surgical complication?
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Increase risk of infection and delayed wound healing after surgery
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Why does client with abuse street drug has high risk of surgical complication?
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The client may have underlying disease such as HIV, hepatitis that effecting healing
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Why does client with chronic pain has high risk of surgery complication?
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Regular use of pain medications often results in higher tolerance. Increase doses of analgesics sometimes necessary to achieve postoperative pain contol.
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What are the risk factors that increase a person's risk in surgery?
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Age, nutrition, obesity, obstructive sleep apnea, immunocompromise, fluid and electrolyte imbalance, pregancy
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How does age increase a person's risk in surgery?
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Young and old clients at risk during surgery because of immature or declinging physiological status
Infant has difficulty maintaining a normal circulatory blood volume during surgery and also their blood volume is small, and small amount loss is already very serious |
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What is the nursing implication when caring surgical child?
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airway management, management of temperature alterations, treatment of delirium or delayed emergency from anesthesia
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Why is nutrition so important for surgical clients?
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Normal tissue repair and resistance to infection depend of adequate nutrients
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How much kcal a surgical client need after surgery to maintian energy reserves?
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1500kcal/day
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To increase wound healing after surgery, a client needs to increase the intake of what? (1369)
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Protein, Vitamin A and C and zinc
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What are the complications that may put a malnourished client at risk for surgery? (1369)
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Poor tolerance to anesthesia, negative nitrogen balance from lack of protein, delayed blood-clotting mechanism, infection, poor wound healing, and potential for multiple organ failure
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If a client has elective surgery, attempt to correct nutritional imbalances before or after surgery? (1369)
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Before surgery
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If a client who is malnourished must undergo an emergency procedure, nutritional restore occurs before or after the surgery?
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After surgery
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How does obesity increase surgical risk?
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by reducing ventilatory and cardiac function
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What are the postoperative complications in the client who is obese?
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Embolus, atelectasis, and pneumonia
Has difficult resuming normal physical activity more susceptible to poor wound healing and wound infection and wound infection because of the structure of the fat tissue which does not contain much blood vessels --> lead to slow the delivery of essential nutrients, antibodies, and exnymes needd for wound healing Difficult to close the surgical wound At risk for wound dehiscence and evisceration |
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Obstructive sleep apnea increase risk of surgical complication after or before surgery or during?
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Before, during and after = perioperative
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What are nursing interventions for client with Obstructive sleep aprea?
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Use of continuous positive airway presure (CPAP), noninvasive postivie pressure ventilation (NIPPV) or apnea monitoring
Instruct client using CPAP or NIPPV to bring their machine to the hospital or ambulatory surgery center |
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What are the two electrolyte imbalance occuring with surgery?
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Severe protein breakdown (--> negative nitrogen balance) and an elevation in blood glucose level
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The complications of negative nitrogen balance and high glucose level?
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Decrease tissue healing and increase risk of infection
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What is the effect of adrenal stress response to the body?
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The body retains sodium and water and loses potassium
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Pregnancy woman often has what kind of surgical procedure?
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Emergency and urgent procedure
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As a nurse, why we have to assess client's previous experiences with surgery?
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Foundation for teaching, addressing fears, and clarifying concerns
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Smoking habits increase surgical complications, how?
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Increase risk for posteroperative pulmonary complications
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How smoking interfere with anesthesia? Intervention?
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smoking incease amount and thickness of mucous secretion. The administration of anethesia increase airway irritation and stimulate pulmonary secretions
Therefore, after surgery, smoking client has greater difficulty clearning the airways of mucous secretion Intervention: postoperative deep breathing and coughing |
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How does alcohol and substance abuse affect the dose of anathesia and analgesis??(1373)
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Higher dose of anathesia and analgesics needed
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Clients having ambulatory surgery often express 3 concerns, list them (1374)
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Fear
Knowledge Caregivers' presence |
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Preoperative assessment - Self-concept:
How do you assess client's self concept? (1374) |
By asking clients to identify personal strengths and weaknesses
(a positive self-concept more likely to approach surgical experiences appropriately |
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Preoperative assessment - Body Image:(1374)
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Assess for body image alteratios that client perceive will result from the surgery
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Preoperative assessment - coping resources (1374)
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from the assessment of feelings and self-concept reveals whether the client is able to cope with the stress of surgery
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Preoperative assessement: Physical Examination: Indication of dry mucous membrane (1375)
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Level of dehydration
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Preoperative assessement: Physical Examination: Indication of sinus drainage (1375)
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Respiratory or sinus infection
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What are the normal RBC ranges in men and women?
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Men: 4.7-6.1million/mm3
Women: 4.2-5.4million/mm3 |
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What are the normal Hemoglobin and Hemotocrit level in men and women?
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Hgb:
Men: 14-18g/100mL Women: 12-16g/mL Hct: Men: 42-52% Women: 37-47% |
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What is the normal WBC range in adult and children?
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5,000-10,000/mm3
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What is the normal level of sodium?
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136-145mEq/L
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What is the normal value of potassium?
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3.5-5.0mEq/L
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What is the normal value of Chloride?
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98-106mEq/L
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What is the normal value of Bicarbonate?
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21-28mEq/L
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Coagulation:
PT |
11-12.5second
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Coagulation:
INR |
0.76 - 1.27
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Coagulation:
APTT |
30-40seconds
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Coagulation:
Platelet |
150,000-400,000/mm3
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Serum creatinine level in men and women
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Men: 0.6-1.2mg/mL
Women: 0.5-1.1mg/mL |
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Blood urea nitrogen (BUN)
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10-20mg/mL
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Fasting glucose level
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70-105mg/mL
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Physical assessment: Thorax and lung. Reason for ausculation
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Auscultation of breath sounds will indicate whether the client has pulmonary congestion or narrowing of airways
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Which client's informaiton used to determine the diagnostic tests to be performed preoperatively? (1377)
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Client's history, physical assessment and surgical procedure
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IMPLEMENTATION:
The importance of informed consent |
Surgery can't be legally or ethically performed until a client understands the need for a procedure, the steps involved, risks, expected results, and alternative treatments
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IMPLEMENTATION: informed consent form
Who is responsible to explain the procedures and obtain the informed consent? |
Surgeon
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IMPLEMENTATION: What is the benefits of giving a rationale for preoperative and postoperative procedures for the client? (1380)
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The client is better prepared to participate in care
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IMPLEMENTATION: What are postoperative excerises?
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Diaphragmatic breathing, incentive spirometry, coughing, turning and leg exercise
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IMPLEMENTATION: Who is responsible to inform the client about the length of surgery?
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Surgeon
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IMPLEMENTATION: What are included in the informed consent?
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Need for procedure
Steps involved Risks Expected results Alternative treatment |
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IMPLEMENTATION: Who is responsible to have the client signed to informed consent?
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Nurse
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IMPLEMENTATION: As a nurse, what should you do when your client refuse to take pain medication after surgery for fear of becoming dependent?
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Encourage the client to use analgesics as needed and explain to the client that unless the pain is controlled it will be difficult for the client to participate in postoperative therapy
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IMPLEMENTATION:
New fasting guideline before elective procedures requiring general anesthesia, regional anesthesia, sedation? (1386) |
Light meal or nonhuman milk: 6hrs or more
Breast milk: 4 hrs or more hours Clear liquids for 2-3hours |
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IMPLEMENTATION: Preparation on the Day of Surgery
Recognize s/s of latex allergy (1389) |
Urticaria, flat or raised red patches to vesicular, scaling or bleeding eruptions
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IMPLEMENTATION:
IMPLEMENTATION: Preparation Day of Surgery: What is AANA (the American Association of Nurse Anesthetists) recommendation for client with latex allergy |
This client will be scheduled as the first case of the day in the operation room
All latex products need to be removed |
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IMPLEMENTATION: Preparation Day of Surgery:1387,88,89
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Hygiene: provide additional comfort before surgery, can offer pt mouthwash, toothpaste, but caution the pt not to swallow water
Hair and cosmetics: Remove hairpins or clips --> may be source for electricity and cause burn. During and after surgery, anesthesia nurse assess skin and mucous membrane to determine the client's level of oxygenation and circulation, remove contact lense, eyelashes, makeup Removal of Prostheses: may be lost during surgery (dentures, artificial limbs, artificial eyes, hearing aid) Safeguarding Valuable: give family patient's valuable items or secure them for safekeeping Prepare the Bowel and Bladder: If the procedure requires the client to empty the stomach, give client at least 1 hr before the client will leave and allow time for the client to defecate without rushing, empyting bladder reduce discomfort and reduce the risk of inctontinence during surgery. If pt can't void, record on the operation checklist Vital signs: baseline for intraoperative VS, check for abnormality before procedure Documentation: check consent form for accuracy, check the nurse's notes to make sure information is current Performing Special Procedure: IV infusion or NG tube Administering Preoperative medication: Latex allergy: assess for latex allergy Eliminating Wrong site and Wrong Procedure Surgery: Mark the operating site |
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IMPLEMENTATION: What are the post-operative exercises to teach patient preoperatively so that the pt can do them after surgery?
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Diaphragmatic breathing
Incentive spirometry Cough/turning/deep breathing Leg exercises Sequential compression device Anti-thrombolytic Stocking |
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Explain "Time Out"
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Just before starting the procedure for final verification of the correct client, procedure, site, and any implants
All members of the surgical/procedure tam perform the time out Include active client or legally desginated representive involvement in the entire process |
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INTRAOPERATIVE SURGICAL PHASE:Nurse's two roles of the operating room
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Circulating Nurse and scrub nurse
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INTRAOPERATIVE SURGICAL PHASE: Role of circulating nurse
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Review of the preoperative assessment:
a. Assist with intubation, blood administration b. Monitor sterile technique c. Assist surgeon in operation of non-sterile equipment c. Verifies sponge and instrument count d. Conduct "Time Out" |
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INTRAOPERATIVE SURGICAL PHASE: Role of scrub nurse
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a. Maintains sterile field during the procedure
b. Applies sterile drapes c Hands instruments to the surgeon d.Counts the sponges and instruments |
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INTRAOPERATIVE SURGICAL PHASE: Circulating nurse vs. Scrub nurse
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Circulating nurse: must be RN
Scrub nurse: either an RN, a license practical nurse or a surgical technologist |
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INTRAOPERATIVE SURGICAL PHASE: Preoperative (Holding) Area
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Preanesthesia care unit or presurgical care unit (PSCU), outside the OR
PSCU: a. explain steps to be taken to the client b. Verifies assessment data -Confirms right patient, allergies, - Site marking is completed between patient and surgeon - Large Bore IV (18 gauge) is inserted - Blood Pressure Cuff all time - Indwelling catheter inserted - EKG Electrodes - Anti-embolism Stockings - Pulse Oximetry - Nurse in the PSCU are member of the OR staff and wear surgical scrub suits, hats, and footwear |
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INTRAOPERATIVE SURGICAL PHASE-Implementation: What is the primarily focus of intraoperative care? 1392
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To prevent injury and complications related to anesthesia, surgery, positioning and equipment use
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INTRAOPERATIVE SURGICAL PHASE - Implementation: Physical Preparation (1392)
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Attaches monitor devices
Continuous ECG with Anesthesia Pulse Ox Antiembolism stocking Documnetation device application, capillary refill and client tolerance to procedures For limbs surgeries, assess peripheral pulse distal to the operative site Measure temperature continuously via bladder, esophageal or rectal probes |
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Situation: During intraoperative, you will assess the client's pulses who has lower extremity surgery, which pulse site you should assess? (1392)
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Distal to the operative site
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Situation: Intraoperative phase: where should you monitor the client's temperature and for how long? (1392)
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Measure temperature continously via bladder, esopahgeal or rectal probes
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INTRAOPERATIVE PHASE: Implementation: Introduction of Anesthesia: Types
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General anesthesia
Regional Anesthesia Local Anesthesia Conscious sedation |
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INTRAOPERATIVE PHASE: Implementation: General Anesthesia (1392)
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Client:
- Immobile - Does not recall the procedure - Through IV and inhalation routes - Occurs in 3 phases:induction (administration of anesthetic agents and endotracheal intubation), maintenance phase (positioning the pt, preparation of skin for incision, and the surgical procedure), emergency phase (anesthetics decreased and client begins to awaken) |
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INTRAOPERATIVE PHASE: Implementation: Regional Anesthesia (1392)
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Induction phase: loss of sensation in an area of the body (spinal, epidural or a peripheral nerve block influences the portion of sensor y pathways that are anesthetized
No loss of conscious, but client sedated Provided through infiltration and local application |
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INTRAOPERATIVE PHASE: Implementation: Risk of Regional Anesthesia (1293). Preventation
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Involved with infiltrative anesthetics because the level of anesthesia can rise which mean that the anesthetic agent moves upward in the spinal cord --> affecting breathing --> may lead to respiratory paralysis
==> resuscitation Fall in BP --> extensive vasodilation caused by the anesthetic block the sympathetic vasomotro nerves and pain and motor nerve fibers Burn and trauma Prevention: Elevation of the upper body prevent respiratory paralysis Prevention of BP: carefully monitor during and immediately after surgery Observe the position of extremities and the condition of the skin |
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INTRAOPERATIVE PHASE: Implementation: Use and Effects of Local Anesthesia.
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Loss of sensation of the desired site
Example: Lidocaine inhibits nerve conduction Lidocaine, Novocaine (cornea, dental work) Injected locally or apply topically Loss in pain and touch sensation and in motor and autonomic activities (bladder emptying) Use: minor procedures performed in ambulatory surgery |
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INTRAOPERATIVE PHASE: Implementation: Conscious Sedation. Examples
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Does not requires complete anesthesia but rather a depressed level of consciousness
Client retain a patent airway and adequate ventilation and able to respond to appropriately to verbal stimuli or light tactile stimulation Midazolam - short acting intravious sedatives |
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INTRAOPERATIVE PHASE: Implementation: Advantages of Conscious Sedation
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Adequate sedation
Reduction of fear and anxiety, amnesia, relief of pain, and noxious stimuli, mod alteration, elevation of pain threshold, enhanced client cooperation, stable VS and rapid recovery |
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INTRAOPERATIVE PHASE: Implementation: Use of conscious Sedation
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Burning dressing changes, cosmetic surgery, pulmonary biopsy,bronchoscopy, colonoscopy
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POSTOPERATIVE PHASE:
Where is the client with regional and general anesthesia and the client with local anesthesa transferred after surgery? |
General and regional anesthesia client: Transfer to PACU to be stabilized before d/c
Local anesthesia client: transfer to nursing unit or back to the ambulatory surgery center |
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POSTOPERATIVE PHASE: How long the client have to stay at PACU?
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At least 1 hour
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POSTOPERATIVE PHASE: 2 phases
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Immediate recovery and postoperative convalescence
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POSTOPERATIVE PHASE: Who is responsible to describe the client's status, the results of surgery, and any complications that occured?
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Surgeon
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POSTOPERATIVE PHASE: Who are the valuable resource to the family if complications have arisen in the operative phase?
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Nurses
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POSTOPERATIVE PHASE: What does "hand off" communication provide?
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Provide accurate information about a client's care, treatment and services, current condition, and any recent or anticipated change
INTERACTIVE |
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POST OPERATIVE PHASE: What does nursing care in the PACU focus? (1394)
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Monitoring and maintaing airway, respiratory, circulatory, and nuerological status and on managing pain
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POST OPERATIVE PHASE: List outcomes for discharges
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Stable VS compared to preoperative date
Body temperature control good ventilatory function Oxygenation status, orientation to surroundings, absence of complications, minimal pain and nausea, controlled wound drainage, adequate urine output, and fluid and electrolyte balance |
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POST OPERATIVE PHASE: What is postnesthesia recovery score (PARS)?
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A score tool to determine if the client can be discharge
A score of 8-10 must be received in order to be discharged |
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POST OPERATIVE PHASE: What happen if the client's condition is stil poor after 2-3hours?
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The stay lengthens or the surgeon will transfer the client to an intensive care unit (ICU)
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POST OPERATIVE PHASE: when the patient is ready to discharge from PACU, another HAND OFF occurs between? What do they communicate?
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PACU nurse and the nurse on the nursing unit
Communication includes: VS, type of surgery, and anesthesia performed, blood loss, LOC, general physical condition, and presence of IV lines, drainage tubes, and dressings |
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Airway and Respiration: Anesthesia often cause respiratory depression, what should you do to assess surgical client's airway/respiration
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Be alert for shallow, slow breathing and a weak cough
Asses airway patency, respiratory rate, rhythm, depth of ventilation, symmetry of chest wall movement, breath sounds, and color of mucous membranes |
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Airway and Respiration:
Post operative confusion is often secondary to what? which population often experience this? |
Hypoxia
Aging adult |
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Airway and Respiration: How do you position your postanesthetic client to maintain sufficient airway/respiration?
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Side-lying position
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THE NURSING PROCESS IN POSTOPERATIVE CARE: (1396-97): Airway and Respiration: When caring for postanesthetic client, nurses should be alert to clien with?
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Short neck syndrome
Sleep apnea Severe obesity COPD |
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Airway and Respiration: Which part of the airway tract often cause the airway obstruction in postanesthetic client? (1396-97)
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tongue
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Circulation:
Postanesthetic client is at risk for CV complication due to? |
actual or potential blood loss from the surgical site, side effects of anesthesia, electrolyte imbalances, and depression of normal circulatory-regulating mechanisms
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Circulation:
How do you monitor postanesthetic client through out the recovering phase? |
Every 15 minutes
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Circulating:
How do you assess circulatory perfusion? |
Note capillary refill, pulses, color and temperature of the nail beds and skin
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Circulation:
What is the common early circulatory problem? |
Hemmorrhage thru a drain or incision or internally
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Circulation:
S/S of hemorrhage |
fall in BP, elevated HR and Repiratory Rates (tachycardia and tachypnea), thready pulse, cool, clammy, pale skin, and restlessness
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Temperature control:
The factors that affect postanesthetic client's body temperature? |
The operating room and recovery room environemtns are extremely cool
Anesthesia depresses client level of body function results in a lowering of metabolism and fall in body temperature The length of time spent in the OR and laminar flow rooms contributes to heat heat loss. Surgeries requires an open body cavity also contributes to heat loss |
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Temperature Control:
Explain malignant hyperthermia. |
A life-threatening complication of anesthesia
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Temperature Control: Malignant hyperthermia's complication
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Hypercarbia, tachypnea, tachycardia, premature ventricular contractions, unstable B, cyanosis, skin mottling and muscular rigidity
Increased temperature is a late sign |
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Temperature Control:
During which anesthetic phase, malignant hyperthermia occur? |
Induction
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Circulation:
What are the intervention of circulation complication? |
Continue oxygen therapy
Surgeon may consider medication and volume replacement Draw blood counts and coagulation studies |
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Airway/Respiratory: Intervention
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Client remains side-lying position until airways are clear
Assess the client for any signs of SOB or difficulty with endurance Check for airway patency |
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Temperature control: Intervention
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Monitor temperature closley in the acute care area
An elevated temperature may be the first indication of an infection, evaluate the client for a potential source of infection |
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THE NURSING PROCESS IN POSTOPERATIVE CARE: Fluid and Electrolyte Balance: The post surgical client is at risk for fluid and electrolyte imbalance, as a nurse, what are your intervention?
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Assess the hydration status
Moitor cardiac and neurological function for signs of electrolyte alteration Criticall to accurately monitor Intake/output Daily weights client to compare to preoperative weight Monitor and compare laborator values with the client's baseline values Because the only source of intake for postoperative client is IV solution, maintaining patency of IV infusions is very important by inspecting the client's catheter insertion site to ensure that the catheter is properly position within a vein so that fluid flows freely |
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THE NURSING PROCES IN POSTOPERATIVE CARE: Neurological functions: The Anesthetic metabloism is affected by:?
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Body fat
Liver function: Hepatitis and cirrhosis Renal function: RF (hemodialysis) |
