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53 Cards in this Set

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Pre-op assessment should contain:
Past medical history
Cardiac history
Previous surgeries
Allergies
Medications
Physical assessment
Contraindications (pregnancy, use of anticoag meds, electrolyte imbalance)
why is EKG done prior to surgery?
Baseline
Alert MD to possible cardiac complications
Informed consent contains:
Reason for surgery
Risks assoc. w/surgery and anesthesia
Who will perform surgery
Who is responsible for consent prior to surgery?
physician
Nurse's role in surgical consent
witness to patient's signature
when should pt be taught about post op procedures such as drains, foleys,NG tubes?
Pre-op to reduce anxiety levels of patient and family
Incentive spirometry
promotes lung expansion and prevents pulmonary complications
Prevention of DVTS
TED hose, early ambulation, ROM
Preop chart checklist
verify order
verify procedure
informed consent
all labs, xrays, EKG's on chart-abnormal notify MD
blood type
preop client prep
hosp gown on
jewelry off
dentures, glasses, wig, toupe, nail polish, prosthetics off
empty bladder
preop meds
may be ordered "OCTOR" on-call to OR
sedative, opiod analgesic, prophylactic ABT, anticholinergic
General anesthesia-def.
Reversible loss of consciousness by inhibiting neuronal impulses in several areas of the CNS-results in amnesia and analgesia
Stages of general anesthesia
I-analgesia and sedation
II-excitement and delirium, LOC
III-operative anesthesia
IV- danger! depressed VS
Malignant Hyperthermia
acute, life threatening complication
increased calcium levels in muscle leads to acidosis, cardiac disrhythmia and high body temp
Early signs of Malignant Hyperthermia
decreased ETCO2
sinus tachycardia
(extremely increased temp is a LATE sign)
Complications of intubation
broken or lost teeth, swollen lips, vocal chord trauma
Local anesthesia complications
edema, inflammation, abscess, infection, tissue necrosis, gangrene
less common-anaphylaxis, CNS depression
Nurse's role in conscious sedation
monitor response to drugs
Airway, LOC, o2 sat, EKG
VS q15 to 30 min
NPO until 30 min p sedation
Post Op report from OR to PACU staff
type of procedure, anesthesia, tolerance, allergies, VS, IV fluids and meds given, complications
Post op resp assessment
q 4 hours x24 h then q shift
Post op resp <10 indicate:
anesthetic or opiod induded depression
Post op rapid, shallow resp indicate:
cardiac complications, increased metabolic rate or pain
Post op left sided lung sounds decreased or absent indicate:
ET tube may have advanced to right mainstem bronchus
Post op snoring and stridor indicates:
airway obstruction
Post op Cardiovascular assessment
upon admit to floor, then q15 min until stable
report changes >25% to MD
Post op decreased BP, HR and RR indicate:
cardiac depression, fluid volume deficit, shock, hemorrhage or drug effects
post op increased HR indicates:
hemorrhage, shock or pain
Post op pulse defict (difference in apical and peripheral pulses) indicates:
dysrhythmias
Post op Neuro assessment
q4-8 hours
Order of return to consciousness from general anesthesia
Muscular irritablity, restlessness and delirium, recognition of pain, ability to reason and control behavior
Order of return to motor and sesory function after local or regional anesthesia
sense of touch, sense of pain, sense of warmth, sense of cold, ability to move
Post op sensory/motor assessment
important after epidural or spinal anesthesia, test strenth of each limb
post op renal assessment
inspect, palpate, percuss lower ABD for distention
retention requires catheterization
Post op urine output <30ml/hr indicates:
hypovolemia or renal complication, report to MD
post op skin assessment
q 8 hrs and PRN
post op healing time
skin level-2 weeks
all tissue-2 years
post op signs of infection
DUH!!!
redness, warmth, swelling, tenderness, pain, purulent drainage
Serous
serum like
serosanguineous
pink-tinged, blood and serum
sanguineous
bloody
post op serosanguineous drainage continuing beyond the 5th day indicates?
possible wound dehiscence
notify surgeon!
Dehiscence
partial or complete separation of the outer wound layers
Evisceration
total separation of all wound layers and proturusion ofn internal organs through the open wound. Medical emergency! Apply sterile moist gauze and call MD!!
Post op pain assessment
0-10 scale
s/s-increases BP, HR, RR, sweating, restlessness, confusion, wincing, moaning, crying
Drug of choice to reverse Malignant hyperthermia
Dantrolene sodium
Complications of intubation
broken or injured teeth
swollen lips injured vocal cord
Complications of local anesthesia
anaphylaxis
edema and inflammation
abscess, necrosis, gangrene
CNS and cardiac depression are s/s systemci toxic reaction
Nurse's role in conscious sedation
monitor response to drug
airway, LOC, O2 sar, EKG
vs q 15 to 30 min until awake
NPO until 30 min P sedation
post op respiratory assessment
Q4h x 24h, the q shift
post op resp rate <10
indicates anesthetic or opioid induced depression
post op Left side lung sounds decreased or absent
indicated ET may have advanced down R mainstem bronchus
post op snoring or stridor
indicates airway obstruction
Post op cardiovascular assessment
assess upon admit to floor, then q 15 min until stable
report BP changes >25% to MD