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84 Cards in this Set

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When should prophylatic antibiotics be administered?

within 1 hr before surgical incision

When should prophylactic antibiotics be discontinued?

within 24 hrs after surgery (48 for cardiac surgery)

How are prophylactic antibiotics chosen?

specific to each pt and operation risks

When should catherters be romoved post-op

post-op day 1 or 2; day of surgery is day 0

When do pts on betablockers receive a beta-blocker irt surgery?

during the perioperative period

When are VTE prophylaxis given

within 24 hrs before surgery to 24 hrs after surgery

What are some common considerations for peds irt surgery?

- more suseptible to throat swelling


-- listen for strider, snoring, retractions (age dependent)


- use facial expression (not crying) to assess pain in infants


- older kids may deny pain due to fear of getting a shot, not being able to go home etc

What are some common considerations for elderly irt surgery

- elderly pts already have less efficient airway


- less likely to complain of pain


- less able to differentiate degrees of pain

hypothermia considerations irt surgery

- increases O2 demand by 300-400% (200-500% in elderly)


- fluid shift leads to edema


- increases chance for hemmorhage


- shivering in epidural spinal anesth pt may just be a side effect and not indicator of hypothermia

hyperthermia and surgery

- report if temp above 38.5 deg C (101.3 F)


- oliguria as pt warms up

peds considerations in PACU

- have parent there if possible


- greater risk for increased temp


- need very careful assessment


- caution re: overhydration


- body smaller so both good and bad effects happen quicker

Types of drains

- t-tube


- penrose


- Jackson Pratt (JP)


- Hemovac

Should JP be fully inflated

no, should be compressed

t-drain aka and used for

aka: biliary drain


used for: bile duct drainage

What to assess with drains

-location


- patency


-amount of drainage


- character of drainage

When to d/c from PACU (to unit or home)

When score reaches 7 or the score determined by facility/anesthesiologist

expalin the PACU scoring system

- A score of 0-2 pt is given for each of the following:


- Consciousness


- Respirations


- BP


- HR


- o2 sat


- Activity


While the overall goal is 7 (or so), each item also has it's own minimal score

score for LOC

at least 1

score for respirations

2 thirty minutes before discharge



score for BP

2 MAP within 20 mm/Hg of pre-op



score for HR

2 within 20 beats of pre-op

score for O2 sat

1 (or higher)

score for acvitiy

2 (or as specified by anesthesia; ie only need 2 on upperbody if given epidural anesthesia)

GI post-op interventions/considerations

- NPO


- medicate for N/V


- Assess for return of peristalsis


- oral care


- patency of NG tube


- assess abdo sounds


- abdo distention for gas or blood

post-op interventions re bladder

- monitor urin output


-- 50 mL/hr desired, 30 mL/hr acceptable


- return of post-op vioding within 6-8 hours

post-op interventions re skin integrity

- frequent turning and proper body alignment


- padding bony prominences


- clean skin and drainage


- linen changes if soiled


- reinforcing surgical dressing (do NOT remove first dressing without being told to do so by doc)

Prevention of wound infection

- frequent assessment


- admin antibiotics as ordered


- std precautions and meticulous wound care


- report signs of comlications to MD

healing by primary intention

closed by approximation, graft, flap, stiches

secondary intention

- spontaneous healing, wound left open


- used commonly in contaminated wound (like a skinned knee)

tertiary intention

delayed primary closure when wound is left open (on purpose) ; for example to let infectious material out


- once infectious material out, may be approximated within 3-4 days

common diet progression post-op

NPO, ice, clear liquids, full liquids, soft, their regular diet

Common nutritional considerations post-op

- may need more calories


- zinc


vitamin C


- protein

TPN

hypertonic solutions via central line

enteral nutrition

vai peg tubes

thrombophlebitis

an inflammatory process caused by trauma, surgery, or prolonged inactivity that results in a blood clot formation in one or more veins, usually in veins. May be either superficial or deep (DVT)

PE

pulmonary embolism; when blood clot breaks free and travels to lung causing SOB, tachypnea, taccycardia, increased anxiety

treatment of PE

amin ox


establish IV route


transfer to ICU

types of shock

- hypovolemic


- septic


- anaphylactic


- cardiogenic

cardiogenic shock

caused by damage to heart; resulting in insufficient blood flow

anaphylactic shock

systemic allergic hypersensitivy reaction

septic shock

result of infection, commonly pneumonia, UTI, ruptured appendix

hypovolemic shock

- r/t sever blood loss



s/s of hypovolemic shock

- obvious bleeding


- signs of internal bleeding


- cold, moist, pale skin


- tacchycardia


- oliguria


- hypotension

malignant hyperthermia

- severe reaction to anesthesia given in OR


- extremely high temp


- increased acid levels in blood


- rapid HR


- muscle fibers break down


- muscle rigidity


- some ppl with some muscular disorders are more likely to have this reaction

common urinary complications

- retention


- infection

s/s of urinary retention

- unable to void


- lower abdo pain


- restless


- confusion


- sweating


- increased BP

interventions re retention

- monitor I&O


palpate bladder if no foley

s/s of urinary infection

- frequency


- urgency


- burning

urinary infection interventions

- collect urine for C&S


- antibiotics as prescribed


- pain relief


- fluids

GI complications

- N/V


- hiccoughs


- abdo distention


- paralytic ileus

tx of post-op hiccoughs

time


breat CO in paper bag


NG tube


throazine to relax phrenic nerve

paralytic ileus

Obstruction of the intestine due to paralysis of the intestinal muscle

s/s of paralytic ileus

- slight abdo distention


- absent bowel sounds

interventions of paralytic ileus

- NPO


- NG tube


- accurate I &O

Penicillins effective against

streptococci and staphylococci

penicillins for surgery can be given what routes

- IV in units per mL


- IM

penicllin contraindications and precautions

contraind: ppl with hypersensitivy


- caution: - renal disease


- GI disease


- lactating


-pregnancy





Penicllin nsg considerations

- assess 30 min after admin


- dilute for Im and rotate sites


- IVPB diluted

Cephalosporins start with

cef- or ceph-

cephalosporins work by

-gram neg bacteria and anaerobic microorgs


- interfere with cell wall synthesis


- bacterialcidal

cephalosprins used to tx

- respiratory infections


urinary infections


ear infections


skin infections


abdo pelvic inflammatory disease


septicemia


meningitis


prophy: GI, GU, bone or skin surgery







nsg considerations for cephalosporin admin

- assess for penicllin allergies


- s/e: hypersentivity,


N/V


diarrhea


rash


possible superinfections


monitor: IM/IV site, usually given over 60 min; monitor renal and hepatic studies


- encourage fluids

Macrolides end in

~mycin

action of macrlides

- bacteriostatic and


- bacteriacidal

macrolides used to tx

- upper and lower respiratory infections


- skin infections


- soft tissue infections

macrolide nsg considerations

- interfere with other drugs that are highly protein-bound or hepatically metabolised


- assess fro drug allergies


- impaired liver functions do not give

aminoglycosides contraind and cautions

- Do NOT give with other antibiotics and some other meds

S/e of aminoglycosides

- ototoxcity


- nephrotoxicity

aminoglycosides

- antimicrobial


- used only for severe infections of :


- GI


- respiratory


- urinary


- CNS


- Bone


- Skin


- soft tissue

contraind and cautions re aminoglycosides

contraind:


- hypersensitivity


- toxicity


caution:


- renal impaired


- hx of 8 CN defects


- neonates


- pregnant, can cause fetal damage

common s/e of aminoglycosides

tremors


uticaria


oliguria





common assessments re aminoglycosides

- I &O


- peak and trough


- renal fx via BUn and creatnine


- sensory problems r/t 8th CN ; hearing

tetracycline action




ends in

- bacteriostatic against gram pos and neg, spirocehtal and some protozoa




~cycline

tetracylcines topically used for

- acne


- intestinal infection


sinusitis


tetnus

tetracycline contraind and cautions

- hypersensentive


caution:


renal and hepatic pts


peds


pregnant women


- stains developing teeth




photosensitivity


take on empty stomach


do not use with milk, antacids



tetracycline common S/e

- photsensitivity


GI upset N/V diarrhea

Antifungal

- dsirputs structre and fx of fungal cells

common antifungal meds

metronidazole


flagyl

Tricylic Glycopeptide common one -

vancomycin (Vancocin)

Fluoroquinolones/Quinolones typically end in

~floxin

common fluroquinolone/quinolones

- ciprofloxacin (Cipro)


- levofloxacin (Levoquin)


- moxifloxacin (Avelox)

nsg considerations re tricyclic glycopeptides (vancomycin)

- 8th CN damage


- superinfection


- contrain in hypersensiticity


- caution in renal and hearing impaired, intestinal obstruction or inflammation


- watch for: pseuomebranous colitis by assess bowel sounds

contra and cautions for fluroquinones

contra: hypersenstivity, mysanethia gravis, use with tizanidine


- caution: known CNS disorder, renal impair, concurrent corticosteroid use, lactating, kidny, lung and heart transplant pts

nsg implications for fluroquinoines

- monitor bowel sounds