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107 Cards in this Set
- Front
- Back
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Stage 1 of ANesthesia
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close dorrs
control traffic position with safety strap limit convo- hearing is last to got |
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Stage 2
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avoid auditory and physcial stimuli
assist anesthesia provider stay at bedside |
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Stage 3
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Assisit with intubation- Apply cricoid pressue
position patient skin prep |
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Skin Prep
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betadine--alcohold--betadine paint
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Stage 4
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antiicipate cardiac or pulmonary arrest
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Propofol
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hypnosis- eliminated rapidly
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Anesthesia
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high levels in the blood--developes in liver and kidneys
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Hyponotics
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sedatives
muscle relaxant amnesic effects |
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Opiods
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pain
depress respiration control vitals for those experiencing pain |
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NM Blocking Agents
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relax jaw and vocal cord
muscle relaxation nondepolarizing and depolarizing blocking agents |
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Pharm triggers for Malig. Hyperthermia
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Succinylcholine
- Desflurane |
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SS of Malignant Hyperthermia
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muscle rigidity
tachy cardia tachypenea temp elevation hyperkalemia *Rhabdomyalysis |
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TX for Malignant Hyperthermia
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Call for HELP!
discontinute trigger DANTROLENE send to ICU treat heat |
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Hypertensives
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alter metabolism--> effect how they handle anesthetics
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Post-Op Immediate
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1-4 hours
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Hypoxia SS
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dyspnea
tachycardia diaphoretic cyanosis |
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TX hypoxia
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treat the cause
monitor lung sounds O2 deep breathing, repositioning, incentives spirometer switch positions!!! |
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Pulmonary Embolism
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embolus blocking the pulmonary artery and disrupting blood flow to one or more lobules of the lung
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SS Pulm. Emb.
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Sharp, usdden chest pain
dyspnea, tachycardia, drop in BP |
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TX of Pulm. Emb>
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NOTIFY PHYSICIAN!
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HEmorrhage
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loss of large amounts of blood externally or internally in a short period of time
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SS of Hemorrhage
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Restless ( hypoxia)-loss in volume carrying o2
weak, rapid pulse, hypotensive, breathing will speed skin is cool and clammy urine output redution |
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TX of Hemorrhage
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PRESSURE!
notify MD IMMEDIATELY! IV/o2- ISOTONIC NS |
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Shock
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loss of circulatory fluid volume that is usually caused by hemorrhage
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SS of Shock
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BP DOWN
URINE DOWN PULSE UP - elevate the legs! |
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TX of Shock
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elevate legs
02 IV- NS ( Isotonic) FLUID CHALLENGE LOC |
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Thrombophlebitis
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inflammation of a vein, accompanied by a clot
-- result of clot or immobility--veins of lower legs |
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SS of Thrombophlebitis
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Inflammation of verin
-HARD AND CORDLIKE cramping in back of calf tender warm |
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Implementation of THrombophlebitis
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NO SWELLING!
elevate extremity by 30 degrees anti-embolism stockings Ambulation- but once prescribed will be put on bedrest HEPARIN NA, WARFARIN |
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Urinary Retention
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involuntary accumulation of urine in the bladder from loss of muscle tone
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SS of Urinary Retention
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unable to void
restless bladder distention/ discomfort **Drum |
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TX of Urinary retention
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monitor
ambulate fluid increase techniques to stimulate - change position, privacy, wamr water, cathetarize |
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Constipation
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no eating until bowel sounds present
abdominal distention absence of bowel movements anorexia, eadache, nausea |
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TX of Constipation
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fluid increase
ambulation diet- fiber increased fluid stool softners/laxative no in 48 hours = concern! |
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Paralytic Ileus
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failure of appropriate movement forward of bowel contents
- manipulation of bowel in surgery |
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SS of Paralytic Ileus
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EXTREME NV
abdominal distention no bowel sounds/ not making gas |
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TX of Paralytic Ileus
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IV fluids- TPN
NPO Ambulation NG Tube- decompress stomach *potential surgery |
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Wound Infection
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caused by poor asceptic technique or contaminated wound before surgical exploration
3-6 days POST op |
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SS of wound infection
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pyrulent drainage
separate wound edges fever/chills pain,wamr,tender sweeling red, pink WBC increased Emematous skin- well circumscribed |
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TX of wound infection
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skin edges together
minitor temp abx |
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Wound Dehiscence
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separation of the wound edges at the suture line
6-8 days post op * abdominal incisions |
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SS of wound dehiscence
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open wound egde
drainage serousanguenous= normal |
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patients with poor wound healing ability
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steroids, diabetics, obese
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IMplementation of dehiscence
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NOTIFY MD IMMEDIATELY!
cover wound position in low-fowlers/bring knees up Antiemetics- if they see it |
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Wound Evisceration
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protrusion of the internal organs and tissues though an opening in the wound edges
** dehiscense gone bad** |
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Wound Evisceration
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MEDICAL EMERGENCY
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SS of Evisceration
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serosanguinous fluid- previously dry
popping sensation |
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Ambulatory Surgery Cx for Discharge
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Alert and Oriented
voided no repiratory distress able to ambulate, swallow, cough minimal pain driver no NV |
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Supplies
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48 hours worht
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EDUCATE on DISCHAGE
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signs and symptoms of diseases and risks after surgery
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self-tolerance
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prevent healthy cells from being destroyed along ith invaders
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Universal Product Code
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cellular fingerprint= protein that ids all your cells as belonging to you
serves as antigen to toher foreign cells can stimulate immune response |
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HLAs ( Human Leukocyte Antigens)
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make up UPC
everytime something enters body--cells looks for HLA ( if it matches will leave it alone) |
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Organ Transplant
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act as antigen when entering another body
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THings that affect Immune system
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nutrition
environment medication drugs disease age ( best function 20-30s) |
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Bone MArror
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immune system cells are made here
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Leukocytes
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primary protection from invasion
- recog. non-self - phagocytic destruction lytic destruction produce antibodies |
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Cytokines
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mediate and regulate imunity/impact inflammation and stimulate formation of more leukoctes in the bone marrow
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3 ways we acquire immunity
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INflammation
Antibody-Mediated CEll-Mediated |
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Inflammation
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immediate protection against the effects of tissue injury and foreign protein
*DOES NOT ALWAYS MEAN INFECTION IS PRESENT* |
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STage 1- inflamm
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vascular
change in blood vessels tisue injury - phase 1- constriction -phase 2- edema |
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stage 2- inflamm-
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Cellular Exudate
- neutrophilia, pus |
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Edema
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protecting area from further damage- toxins will be diluted
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Neutrophils
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attck and destroy foreign or damaged cell BUT infection is overwhelming ( SEGS produced)
LEFT SHIFT= OMINOUS |
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Stage 3- Inflamm
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Tissue repair and replacement
- last stage to finish, starts at tage 1 WBC tell healthy cells to start dividing--> scar tissue |
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Antibody Mediated Classificiation
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blood and body fluids
identify and netralize foreign objects |
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Antibody Functions
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1. prevent pathogens from entering by binding to them
2. stimulate removal of pathogen by triggering macrophages and other cells to coat 3. trigger destruction of pathogen by stimulating other immune response |
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Innate- Native Immunity
( Natural) |
response to an exposure
"attack dog" |
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Adaptive Immunity
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acquired
body makes or receives in response to foreign protein |
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Active Adaptive Immunity
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Antigen enters body---body makes antibodies
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Natural Active Immunity
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without human assistance=
MOST EFFECTIVE FORM won't get illness again LONGEST LASTING |
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Artifical Active
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immunizations/vaccinations
small amounts of antigen injected and immune will make antibodies LASTS YEARS --will need booster |
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Natural Passive Immunity
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antibodies are passed from mom-fetus
short term protection |
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Artifical Passive Imm/
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inject with antibodies that are produced in someone else
days- weeks |
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SPleen
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Lymphocyte and antibody maturation site
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CEll_mediated Imunity
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protects body by differentiating self from non-self cells
CANCER and metastisis! no antibodies involved |
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CEll Mediated Immunity
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MOST EFFECTIVE WAY OF REMOVING VIRUS INFECTED CELLS
transplant rejection |
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Helper/Inducer T-Cells
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secrete lymphokines--> increase bone marrow production--> stimulate WBC--> inflammation--more antibodies to destroy antigen
= ORGANIZER |
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Suppressor T Cells
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regulate CMI
prevent hypersensitivity nd prevent formation of auto-antibodies ( start attacking self cells) Keeps a balance |
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NK Cells
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MOST EFFECTIVE with cancer
seek and destroy mission look for in a apatient with cancer |
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Transplant Rejection
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NK cells responsible for...
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Hyperacute Graft rejection
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IMMEDIATELY
clots-->ischemic organ--> necrosis REMOVE THE ORGAN |
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High Risk for Hyperacute
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ABO incompatibility
blood transfusions ( multiple) mult, pregnancies previous transplant |
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Acute Graft Rejection
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1 week to 3 months after implanting
NK cells enter organ--avasculitis--NO CLOTS can save organ if we move quickly |
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CHronic Rejection
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lining of vessels wil overgrow--occlusion--scar tissue--firbotic--
LEADING CAUSE OF DEATH ( > 1 year after operation) |
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TX of Transplant Rejections
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Immunosuppressant
Corticosteroids Kenoconidol |
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INtradermal Test
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suspected, but no allergy on skin shown
increased risk of anapylaxis small aount of solution injected intradermally |
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Oral Food Challenge
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Type Reaction with contact
eliminates suspected foods 1-2 weeks before- do not eat |
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Avoidance Therapy
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avoid contact with identified allergen
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Decongestant
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systemic, oral, nasal
reduce edema and secretions |
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Antihistamines
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block histamine action
Diphenhydramine |
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Corticosteroids
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decrease inflammatory response
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Mast Cells stabilizers
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prevent mast cells from breaking open--prevent release of histamine
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COmplementary and Alternative Therapy
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aromatherpay, unprocessed honey, case by case
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Desensitization therapy
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gradual increase
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Anaphylaxis
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Type 1 reaction
Fast, Systemic, Various degrees of sensitivity first feeling= uneasiness |
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Anaphylaxis Stages
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Uneasiness, IMpending doom
Pruritis and urticaria erythema angiodema-swelling bronchioconstriction- airway loss weak, rapid pulse SHOCK |
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Shellfish
Bananas Penicillin |
Betadine
Latex Cephalosporins |
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Anaphylaxis Interventions
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1. Respiratory
2. CPR? 3. Epi pen 4. Antihistamines- urticaria 5. o2- reduces hypoxemia 6. Suction |
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Cytotoxic Reactions
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body makes special autoantibodies directed against cells that have some form of foreign proteins attached to them. DESTROYS
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Immune Complex Reactions
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excess antigens cause immune complexes to form in the blood: these circulating complexes usually lodge in small blood vessels
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DElayed hypersensitivity reactions
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Type IV
T-Lymphocyte only Antibodies and complement not involved hours-> days after exposure |
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Collaborative Management
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INtervention
id of allergen client prep procedure follow-up care |
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Stiumlatory Reactions Type 5
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Innapropriate stimulation of a normale cell surface receptor by an autoantibody, resulting in a continuous "turned on" state
Grave's Disease |
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Autoimmunity
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innaporpriate immune response
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Sjogren's Syndrome
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dry eyes, mucous membranes, vaginal
insuffiecient tears NO CURE **dryness |
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Goodpasture's Syndrome
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SOB, hemoptysis, decreased urine output, weight gain, edema, hypertension, tachycardia
**Kidneys and Lungs |
