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97 Cards in this Set
- Front
- Back
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-Increased respiratory rate
-Crackles over lung area -Elevated temp -Productive cough -Chest pain |
Atelectasis or Pneumonia
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-Restlessness
-Dyspnea -Hypertension -Tachy -Diaphoretic -Cyanosis |
Hypoxia
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-Dyspnea
-Sudden sharp chest or upper abd. pain -Cyanosis -Tachy -A drop in blood pressure |
Pulmonary Embolism
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-Restlessness
-Weak and rapid pulse -Hypotension -Tachypnea -Cool clammy skin -Reduced urine output |
Hemorrhage or Shock
(If shock, elevate the legs) |
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-Vein inflammation
-Aching or cramping pain -Vein feels hard and cordlike -Elevated temp |
Thrombophlebitis
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-Nausea and vomiting immediately post op
-Abdominal distension -Absence of bowel sounds or flatus |
Paralytic Ileus
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The post op period lasts from when to when?
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From the OR to the last follow up with the surgeon
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A primary consideration of the immediate post op pt. is to maintain ______ and _______
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ventilation and oxygenation
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Keep the head of the post op pt. elevated ____ to _____ degrees unless contraindicated
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15 to 30
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List the classifications of hemorrhage and the time frame for each
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Primary- at surgery
Intermediary- 1st few hours when rise of normal blood pressure dislodges a clot Secondary- Some time after when suture slips |
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Replacement of blood is indicated if the blood loss exceeds ______
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500 mL
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List the 3 mechanisms of wound healing
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first, second and third intention.
1st- In OR, sterile, edges well approximated 2nd- Infection, abscess, edges not approximated 3rd- Deep wounds, not sutured, wound vac possible |
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List the criteria for discharge from the PACU unit
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Uncompromised pulmonary function
Stable vitals Oriented X4 Good pulse ox Urine 30 mL Minimal pain and nausea |
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How often are vital signs done on the immediate post op pt?
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Every 15 minutes
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Evidence of post op wound infection is not usually evident before the ______day
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5th
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Name a scoring system commonly used to determine a pt's readiness for discharge out of PACU
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Aldrete score
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Classic signs of hypovolemic shock
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Pallor
Cool, moist skin Rapid resp. Cyanosis Rapid, weak thready pulse Decreasing pulse pressure Lowering blood pressure Concentrated urine |
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What is pulse pressure?
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Systolic minus Diastolic
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What criteria is used to determine those at high risk for PONV
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Female
Nonsmoker History of motion sickness Surgery longer than 2 hours |
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What is the difference between medical and surgical asepsis?
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Medical
-Reduces pathogens -"Clean technique" -Used w/ meds, enemas, tube feedings, and daily hygiene Surgical -Eliminates pathogens -"Sterile technique" -Used in dressing changes, cath, and surgical procedures |
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What drugs are off limits preop?
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Aspirin
Antidepressant Steroid NSAID's |
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When does perioperative period begin and end?
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Transfer to OR table and ends with admission to PACU
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Why do the elderly need lower doses of meds?
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Decrease organ function
Inefficient liver enzymes |
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Who is responsible for setting up the sterile field?
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The scrub nurse
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What is the circulating nurse responsible for?
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Pt. advocate
Counts w/ scrub nurse Prepares legal document r/t surgical procedure |
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Who is the RNFA responsible to?
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The surgeon
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Tracrium
Nimbex Zemuron Norcuron |
Neuro blockers- Intermediate muscle relaxants. Commonly used for intubation
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Sublimaze (Fentanyl) *Most common
Morphine Sulfate Ultiva Sufenta |
Opiod Analgesics- Surgical analgesia
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Versed (Midazolam)
Valium (Diazepam) Diprivan (Propofol) Pentothal (Thiopental Sodium) |
IV Anesthetics- Induction and maintenance of anesthesia
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Which anesthetic is used for induction?
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Diprivan
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What is Phenergan used for?
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Prevents nausea
Used w/ pain meds post op Mild sedation |
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What drug reverses neuromuscular blockers?
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Neostigmine
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Fluothane
Ethrane Forane Ultrane |
Inhalation volatile liquids- General anesthesia
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Char. of stage 1 anesthesia
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Still conscious
Ringing or Buzzing in ears Feeling that limbs cant be moved Warm Detachment |
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Char. of stage 2 anesthesia
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Excitement
Pupils dilated (Can be contracted w/light) Struggling can occur Rapid pulse Abnormal resp. Stage can be avoided if administered smoothly and quickly |
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Char. of stage 3 anesthesia
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Surgical Anesthesia
Unconscious Pupils dilated but reactive Normal resp. and pulse Ranges from light to deep |
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Char. of stage 4 anesthesia
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Medullary depression
*Too much anesthesia Shallow resp. Pulse is weak and thready Pupils widely dilated and unreactive |
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How does the anesthetist gauge level of anesthesia?
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Pupils
BP Resp. Cardiac rates |
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What is the most critical phase of anesthesia?
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Induction
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Order of anesthetization in the brain (For General)
"Could Hamper My Speaking Mechanism" |
Cerebral cortex
Hypothalamus Midbrain Spinal Cord Medulla |
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With regional anesthesia, which fibers are affected first?
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Sympathetic (smallest fibers)
Next is sensory, followed by Motor (thickest myelin sheath) |
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Occurs with injection of a local into or around a nerve or group of nerves
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Nerve block
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Where is a spinal injected into?
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Subarachnoid space
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Which anesthesia is not dependent on the pt's position for level of anesthesia?
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Epidural
Higher doses are used and slower onset |
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With spinal anesthesia, what is the order of loss of sensation?
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Feet and perineum first
Then legs and abdomen Sympathetic (Autonomic) Sensory (Pain) and then Motor **Comes back in reverse |
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Order of return of Motor and Sensory Functioning After Regional Anesthesia
"The Pain Will Come Momentarily" |
Touch
Pain Warm Cold Move |
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How many units of packed cells do you give for every 1 unit of plasma?
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4
Packed cells don't have clotting factors |
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Advantage of general anesthesia
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You can control the airway
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Disadvantage of general anesthesia
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You don't know how they will metabolize
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What is the preferred method of anesthesia for the elderly?
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Regional
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What is Ketamine?
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PCP
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Which route of administration is most easily controlled?
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Inhalation
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Common Local conduction blocks
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Brachial Plexus
Paravertebral Transsacral (Caudal) |
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Another term for Conscious Sedation
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Moderate Sedation or "Mod Sed"
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When is conscious sedation used?
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Endoscopy
Cardiac cath Closed fractures Angiography |
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Char. of Malignant Hyperthermia
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Hereditary
May occur 24 hours after surgery Temp can go up a degree per minute Increased Ca leads to increased muscle contractions |
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What is used to treat Malignant Hyperthermia?
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Dantrium
?Dantrolene |
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What is the reversal drug for Versed and Valium?
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Romazicon
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Why is local anesthesia commonly combined with local/regional block?
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The anesthesia causes the sedation and the block causes muscle paralysis
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What are the main differences between Mod Sed and Monitored Anesthesia Care (MAC)?
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Airway intervention may be required and ventilation may be inadequate
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What is it that nerve blocks do not do?
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Cause sedation or relieve pain
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What is a common nerve block agent and it's reversal drug?
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Curare
Reversal- Neostigmine |
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What is DIC?
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Disseminated Intravascular Coagulation
Life threatening Thrombus formation Unknown cause May occur with major surgery or shock Affects coagulation proteins causing hemorrhage |
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What is the first indicator of Malignant Hyperthermia?
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Tachycardia
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No Epi where?
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Fingers nose and toes
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Blood loss causes Alk or Aci?
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Acidosis
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Who has last say on meds?
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Anesthesia
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What are key indicators of complications in the elderly?
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Pre op condition and level of function
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Beginning and end of pre op
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Decision to have surgery and transfer onto the OR table
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Beginning and end of intra op
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Pt transferred to OR table and admission to PACU
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Beginning and end of post op
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Admission to PACU and follow up evaluation
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Carpal Tunnel is what kind of surgery?
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Elective
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When is the antibiotic administered?
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1 hr. prior to incision
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What drugs are commonly used for conscious sedation?
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Versed or Fentanyl
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What does Atropine do?
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Speeds up the heart
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What distance is surgical asepsis?
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Within 2 ft.
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How is an epidural like topical?
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They both coat the nerves
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Why do we use a stool softener after surgery instead of a laxative?
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Laxative will affect electrolytes
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What is the last sense to go with anesthesia?
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Hearing
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What is the minimum percentage of O2 needed?
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21%
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If BP is down, what can a nurse give to raise pressure?
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IV fluids
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Why do we add Epi with local?
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Causes vasoconstriction and keeps it local
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What may be a side effect of being in surgery for 3 to 4 hours?
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Decreased gaseous exchange from CNS depression
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What does an oral airway do?
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Keeps tongue pulled forward and away from trachea
**Not the same as Endotracheal Tube |
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What is the shock position?
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Flat on back, feet elevated 20 degrees, knees straight
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What is compartment syndrome?
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Fluid buildup between fascia and muscle
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Rate of absorption by route?
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IV
IM SQ PO |
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Five sites for IM injections
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Deltoid
Rectus Femoris Vastus lateralis Ventrogluteal Dorsogluteal |
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How much air for an air lock?
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0.2 mL
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What are the four components of pharmacokinetics?
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Absorption
Distribution Metabolism Excretion |
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What is physiologic reserve?
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the ability of an organ to return to normal function
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What are the three surgical zones?
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Unrestricted-street clothes
Semirestricted-scrubs and caps Restricted-Sterile |
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How many air exchanges per hour in OR?
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15 positive pressure
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Where is local anesthesia injected?
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Into the tissues
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Usual surgery position
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Dorsal recumbent
*(Lower Abdomen - Trendelenberg) *Sims for renal *Lithotomy for perineal |
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Safe distance suction tip?
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6-8 inches
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For spirometer, how many deep breaths per hour?
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10
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