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39 Cards in this Set
- Front
- Back
Describe surgery according to degree of urgency (3 categories)
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1. Emergency: immediate intervention to sustain life
2. Urgent: intervention to maintain health in situations that are not life threatening 3. Elective: nonemergent, nonurgent, prescheduled at convenience of client and the surgeon |
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What is ablative surgery?
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amputation of tissue (including
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Describe surgery based on expected outcomes (5 categories)
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1. Diagnostic (e.g, biopsy)
2. Reconstructive (correct a disease process or cosmetic) 3. Curative (repair or remove diseased organ or restore normal functioning) 4. Palliative (decrease the spread of disease to prolong life or alleviate pain) 5. Transplant |
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Describe the 4 stages of General Anesthesia Administration
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1. Induction: warm, detached floating
2. Excitement: the shakes, rapid pulse 3. Maintenance: unconscious, need to support respiratory system, where most of surgery occurs 4. Emergence: wearing off |
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What are the risks and side effects of general anesthesia?
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* mouth or throat pain, injury to mouth or teeth, injury to blood vessels, aspiration, pneumonia
* MEDULLARY DEPRESSION: big risk of general anesthesia--when person stops breathing |
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Name 2 common medications used in general anesthesia
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1. Nitrous Oxide (NO2)
2. Flourothane |
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Describe 8 parts of surgical asepsis
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1) sterile to sterile
2) all materials for 1 patient 3) scrubbed personnel cannot leave room 4) sterile parts of the body: front, waist shoulders 5) unscrubbed personnel stay at a distance 6) top of patient draped= sterile 7) pkages must be transported closed--edges of packages are unsterile 8) don't touch sterile field when pouring liquids |
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Common General Anesthetic Inhalation Agents (4 Volatile Liquids)
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1. Halothane (Flourothane, Somnothane)
2. Methoxyflurane (Penthrane) 3. Enflurane 4. Isoflurane (Forane) |
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Describe 4 topics to include in pre-op education
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1) What to expect intraoperative and post-op
2) mechanical devises they may require (such as incentive spirometer) 3)pain medications 4)resumption of activites (coughing, turning in bed, leg exercises, "splinting the incision") |
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Name 6 drugs that place surgical clients at risk
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1) ASPIRIN: increased risk of bleeding
2) ANTIDEPRESSANTS: may lower blood pressure during anesthesia 3) BROMIDE in medications (e.g., Sominex) may produce signs of dementia 4) DRUGS WITH ANTICHOLINERGIC EFFECTS: increase the potential for confusion 5) STEROIDS: suppress immunity 6) NSAIDS: increase risk of stress ulcers and displace other drugs from blood proteins |
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Describe 4 common respiratory complications after surgery and anesthesia
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ANESTHETIC AGENTS AND O2 HAVE A DIRECT DRYING EFFECT ON REPIRATORY MUCOSA, INCREASING THE VISCOSITY OF MUCUS--SHALLOW BREATHING DURING SURGERY AND SUPINE POSITION ALSO ADDS TO POOLING OF FLUIDS IN LUNGS.
1) pulmonary embolism: blood clot that has moved to the lungs causing obstruction 2) atelectasis: decreased ventilation caused from the pooling of secretions in dependent areas of the bronchiole 3) Pneumonia: inflammation of lung tissue 4) Hypoxemia: lowered o2 level in blood |
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Describe 3 common cirulatory complications after surgery and anesthesia
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ANESTHETIC AGENTS DEPRESS THE METABOLIC AND HEART RATES INCREASING THE RISK OF CIRCULATORY COMPLICATIONS
1) DVT (deep vein thrombophlebitis) inflammation of a vein with the formation of a clot 2) Thrombus: a blood clot in the circulatory system 3) Embolus: a blood clot or air that moves in the circulatory system from its place of origin |
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3 reasons why turning, deep breathing, coughing, and using sprirometry helps avoid repsiratory complications
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1) promoting pulmonary circulation
2) promoting exchange of gases 3) promoting the removal of secretions |
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4 SIGNS AND SYMPTOMS OF DVT
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* REDNESS OF THE EXTREMITY
* PAIN / TENDERNESS OF CALF * SWELLING--VEINS BULGING * HOMAN'S SIGN- PAIN ON DORSIFLEXION |
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INTERVENTIONS TO PREVENT POST-OP DVT
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1) ANTI-EMBOLITIC STOCKINGS
2) PNEUMONIC PRESSURE MACHINE 3) ANTICOAGULENTS 4) BED REST 5) EARLY AMBULATION AND LEG EXERCISES (CONTINUOUS PASSIVE MOTION DEVICES) |
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What are the 3 zones of the surgical environment
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1) unrestricted-street clothes okay
2) semi-restricted: surgical attire required; up to 2 feet from sterile fields; circulating nurse 3) restricted: surgical attire--only sterile here |
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Physical signs / symptoms of anxiety
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* increased heart rate
* clammy hands * muscular tension * behavioral manifestations, such as rapid speech and irritability |
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Common IV agents used for / with general anesthesia
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1) Barbituates (esp w obstetric)
2) Benzodiazepines (diazepam, midzolam) 3) Narcotics: fentanyl 4) Neuromuscular blockers (Curare derivitives--that's the jungle dart); this one is like the one they use to paralyze respirations to put someone on a ventilator |
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Documentation in the OR
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1) procedures performed
2) positioning/draping 3) fluid balance 4) vitals 5 instrument count |
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Problems in the intraoperative phase
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1) remaining in the position needed
2) anaphylaxis (reaction to anesthesia) 3) nausea/vomiting 4) respiratory depression 5) hypothermia (OR is cold b/c gases need to be cold--patients BMR--MALIGNANT HYPOTHERMIA is a reaction to anesthesia which seems to effect mostly men ages 30-50 6) Anxiety |
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REGIONAL VS. LOCAL ANESTHESIA
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Regional blocks nerve impulse to a specific area--local disrupts the sensation at the nerve endings
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CONSCIOUS SEDATION
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* IV
* MOST COMMON: VERSED OR VALIUM * MAYBE USED WITH INHALATION (LOCAL; REGIONAL; SPINAL) * WATCH FOR RESPIRATORY DEPRESSION |
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What 8 criteria need to be met before a post op can be transferred from PACU?
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1. uncompromised breathing (breathing on their own except for cardiac); client can clear the airway and cough effectively
2. adequate o2 sat (95-100) 3. stable vital signs within baseline ranges for 30 minutes 4. conscious, oriented "times 3", can move all extremities, full return of reflexes 5. urinary output 30mL/hr--intake adequate 6. nausea, vomiting, pain all under control 7. dressings dry with minimal drainage 8. client afebrile or febrile condition has been treated |
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5 Post Operative Interventions: preventing circulatory complications
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* leg exercises q1hr
* check peripheral pulses, capillary refill, temperature, color of extremities * encourage early ambulation * medications such as lovenox, heparin, coumadin * position |
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5 Post Operative Interventions:
preventing respiratory complications |
* deep breathing and cough q2h with splinting
* turn/change position q 1-2h *early ambulation *incentive spirometer *positioning : usually semi-fowlers--depends on type of surgery |
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5 Post Operative Interventions:
monitoring stability |
* monitor vital signs, fluid i&o, maintain body temp (shivering can be from body shock, meds or fluid loss)
*promote rest/comfort with adequate pain management (epidural, pca pump) * assess level of consciousness * assess neuro function (lower extremity movement and sensations-especially after regional anesthesia) * inflammatory response sometimes elevates temp slightly--monitor for dysrythmias as temp goes up) |
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3 Post Operative Interventions:
Safety |
* side rails/bed in low position
* control and educate about orthostatic hypotension * assess neuro function and level of consciousness |
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5 Post Operative Interventions: Nutrition
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* listen for the reappearance of bowel sounds--elimination in 2 -3 days
* progressive diet: clears, then full liquids (milk/yogurt), then soft food, then regular diet * stool softeners (colace) * early ambulation for gas * monitor i & o |
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3 Post Operative Interventions: Wound Healing
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* Monitor and assess wound for discharge and healing
* Use asceptic technique for changing dressings * Educate patient in proper positioning,"splinting" and avoiding restrictive clothing to avoid stress on suture line |
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Wound Healing Complications:
Describe Dehiscence and Eviseration |
**at risk are the obese and elderly
DEHISCENCE: opening of suture line--keep moist with normal saline and call doctor EVISCERATION: opening of suture line with viscera or other tissue coming out--normal saline and call doctor |
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Wound Healing Complications: signs and symptoms of infection
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* increased temperature and pulse
* increased white blood cell count * wound swelling 3 days or more after surger * tender, pain, reddness, purulent and foul smelling discharge |
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Who is at risk for post-op infection?
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elderly, abdominal surgery, diabetics, immunosuppressed, very young
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3 Interventions for post-op infection
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1) culture the wound
2) antibiotics 3) incision and drainage |
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4 Post Operative Interventions: Urinary elimination
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*assist with position (males)
* monitor for urge * monitor for bladder distention in 8 hours * normal 30 mL/h |
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2 Post Operative Interventions: Self Concept
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* body image disturbance (amputations, mastectomy)
* promote involvement in care (ex: dressing change) |
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3 Post Operative Interventions: Home Care
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* assess support system (family member/visiting nurse)
* assess limitations (stairs, ADLs, nutritional, meds) * patient teaching: med admin, wound care, s/s of concern, o/t |
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Complications of Surgery: Shock (CAUSE, S/S, Prevention)
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* Caused by blood/fluid loss, stress from surgery
* S/S: pallor, cool/moist skin, cyanosis, rapid breathing and rapid weak/thready pulse, decreased b/p, decreased pulse pressure, decreased temperature * prevention adequate fluids before, during and after surgery, cardiac stimulants, keep warm, continuous monitoring, blood replacement |
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Pre-op preparation
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* hygiene (scrub/shave)
* mark the area (JCAHO) * side rails * empty bladder * possible medications: antacids, valium, insulin, atropine (dries up secretions), vistaril (anxiety/itching), morphine (decreases respirations, allows for less anesthesia, relax) * IV, cath |
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PACU (post anesthesia care unit) assessments
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* all pre-op orders cancelled (like a brand new patient)
*airway in place until gag reflex returns * assess respiration once extubated * assess cirulation, possible hypotension (from fluid loss, stress, shock, meds), hemorrhage, dyrhythmias * assess pain, hypertension (bp increases with pain), wound status, neuro status, fluid balance (i&o, bladder distention) * try to get patient more alert/conscious |