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99 Cards in this Set
- Front
- Back
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Preoperatice phase includes? |
begins, when decision for surgery is made and ends when patient is in the OR Pre-admission testing (PAT) Admission to surgical cente rIn holding area Pre-op assessment – done before surgery, usually the pt will see the anesthesiologist and a nurse. The surgeon will mark the patient prior to the surgery. |
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Intraoperative Phase includes? |
begins when the patient is transferred to the OR and ends when patient is in PACU Nurses act as scrub nurse, circulating nurse or RN first assist Maintain safety physiologic monitoring psychological support while patient is conscious |
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Postoperative phase includes? |
Begins in PACU ends with follow up evaluation Transfer patient to PACU Post op assessment in recovery area surgical nursing unit home or clinic |
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What is emergent surgery? |
needs to be done immediately to prevent serious injury or death |
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What is Urgent Surgery? |
Surgery needs to be done within 24 hours |
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What is required surgery? |
Needs to be done within a few weeks or months |
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What is elective surgery? |
Patient should have surgery, however not doing it would not be catastrophic |
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What is optional surgery? |
Decision rests with the patient |
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What is diagnostic Surgery |
exploratory to determine cause of the problem |
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What is curative surgery? |
removal of problem surgically |
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Reparative surgery? |
Fixing a wound |
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Palliative Surgery? |
relieves pain |
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Reconstructive/ Cosmetic Surgery? |
Repair External Appearance
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What is inpatient surgery? |
Patient needs to remain overnight or longer for surgery |
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Ambulatory Surgery? |
outpatient same-day surgery |
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Nutritional Risk factors for surgery? |
obesity, weight loss, malnutrition, metabolic abnormalities, supplements taken, Electrolytes. Protein to heal Allergies***shelfish - including shrimp may be allergic to iodine or contrast |
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Dentition- Surgical Risk Factors |
Dental Caries, loose teeth, partial plates are significant because they may become dislodged during intubation and occlude airway. Any infection..even in the mouth... can be a source of a post operative infection |
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ETOH surgery risk factors? |
even moderate amounts of alcohol can weaken the immune system and increase the likelihood of developing post op infections can impede effectiveness of medications and anesthesia withdrawal syndrome 2-4 days |
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Respiratory surgery risk factors? |
educate patient in breathing exercises and use of incentive spirometer educate about no smoking ALL resp related issues are significant |
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CV surgery risk factors? |
Ensure that cardio system can support O2 fluid and nutritional needs Hx of arrhythmias HTN, heart surgeries, cardio drugs taken EKG if taken beta blockers may be allowed to take with a sip of water before surgery if Dr permits |
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hepatic and renal risk factors |
liver metabolizes, kidneys excrete optimal function of the liver and urinary system ALT/AST Impairment increases mortality rate |
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Endocine surgical risk factors
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pt with diabetes is at risk for hypo and hyperglycemia stress from surgery can cause an increase in blood glucose surgical risk factors for a person with controlled diabetes is no greater than a patient without diabetes hyperglycemia increaes the risk for infection |
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what is the nurses responsibility for a consent form? |
The nurses responsibility is to be a WITNESS |
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Purpose of Opiods for Surgery? |
Pain relief, relaxation Nursing considerations: Respiratory depression, decreased LOC and BP, at risk for falls and constipation Morphine - prototype |
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Purpose of benzodiazepines for Surgery? |
Relieve Anxiety, cause Amnesia effect, east the anesthesia that is necessary Nursing Considerations: Decreased LOC and BP, at risk for falls and respiratory depression along with blurred vision midazolam (Versed) **Versed - forget what they said** |
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Purpose for antiemetics with surgery? |
prevent N/V r/t anesthesia to prevent aspiration Nursing Considerations: light sensitivity, constipation, and drowsiness prochloprazine and metoclopramide |
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Purpose for H2 Receptor Antagonists with Surgery? |
Decreases stomach acid, lacrimation, urination and defectation No special considerations climetidine |
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Purpose of Anticholinergics and Antihistamines |
decreases secretions Nursing Considerations: Dry Mouth and dilated pupils glycopyrolate hydralazine |
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Elements of a safe time out |
Correct patient- 2 identifiers Correct site - marked prior to coming to the OR by patient and surgeon Allergies Antibiotics administeres Equipment and supplies available Xrays available and labeled and labs checked everyone is in agreement |
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Potential Intraoperative complications? |
Anesthesia Awareness, N/V, Anaphylaxis, Latex Allergy, Hypoxia, Hypothermia, Malignant Hyperthermia |
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Effects of General Anesthesia |
not arousable, even to painful stimuli lose the ability to maintain a patent airway CV function may be impaired as well Drugs are inhaled or given IV Larger amount are given at first to saturate tisues then less is given to maintain inhaled drugs are miced with 02 nitrous |
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Stage 1 of General Anesthesia |
beginning - breath in drugs, warmth, detachment felt, may hear ringing in ears, loss of motor control, sounds are amplified. |
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Stage 2 of General Anesthesia |
Excitement - patient struggles, sings, shouts, talks, cries, can be avoided if drugs are given quickly and smoothly. |
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Stage 3 of General Anesthesia |
surgical anesthesia: reached by continued use of vapor/gas. Pupils are small and contract in light, respirations are normal, pulse volume/rate are normal, skin is slightly flushed. With proper drug use this state can be maintained for hours at four ranges light (1) to deep (4) |
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Stage 4 -of General Anesthesia |
medullary depression: happens if too much drug given, respirations shallow, pulse weak/thready, pupils dilated with no response to light, cyanosis occurs and death can rapidly occur. Drugs must be stopped and respiratory and circulatory support is begun. |
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Regional Anesthesia |
patient awake and aware unless given a sedative. Drug injected around nerves so the area is anesthetized blocking sensory nerves more readily than motor nerves (they have thicker myelin). It is not worn off until all three systems are back to normal |
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Epidural anesthesia |
drug given in epidural space around the dura mater (L4-L5) a higher dose required than with spinal anesthesia because the it has to cross the dura mater, but has the advantage of not causing a headache (common to spinal) |
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Spinal anesthesia |
nerve block given in subarachnoid space between L4-L5 used for lower limb procedures. Patient lies on side with knees to chest. Continuous sedation can be achieved by inserting a catheter. Body elevation is changed to get the drug to flow to desired location (depending on specific gravity of drug). If patient gets too much, respiratory paralysis can occur. Headache, nausea, vomiting may occur; try to control with proper hydration/IV fluid; flat bed, quiet room. |
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Local conduction block/nerve block |
injection into a nerve plexus to achieve localized anesthesia. |
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Moderate sedation |
conscious sedation. Patient is never left alone and monitored for dysrhythmias, LOC, and vitals |
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Local anesthesia/infiltration |
injection into tissue of procedure site. Often combined with regional block. Often given with epinephrine (vasoconstriction) prolonging action. Preferred method but not used with anxiety, or if many injections would be needed |
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Primary Intention |
clean wound, edges well approximated, minimal tissue trauma, clean sutured or stapled surgical incision, granulation tissue is not visible, and a hairline scar forms, usually covered with a dry dressing or liquiband |
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Secondary Intention |
typically dirtier, edges not well approximated; larger with more tissue damage, takes longer to heal, larger scar forms, usually packed with a moist dressing, then covered with dry dressing, wounds from major trauma or burns, may leave open to heal; increased risk for infection |
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Tertiary Intention |
healing that occurs when there is a delay in wound closure; may happen when a deep wound is not sutured immediately or is purposely left open until there is no sign of infection and then closed with sutures; has increased risk for infection |
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Serous Drainage |
Clear |
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Sanguineous |
Bloody Drainage |
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Sero-Sanguineous |
Blood-tinged |
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Purulent Drainage |
White, Gray, baige, green, infected |
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S&S of infection |
New/increased slough; maceration Drainage excess or change in character Poor granulation tissue Warmth, redness, swelling, pain (inflammation) Elevated glucose Odor Increased sizeCheck COCA (color, odor, consistency, amount) |
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Desirable amount of fluid intake and ouput in adults |
1500-3500 mL's in 24 hours |
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Average Amount of fluid intake and output in adults |
2500-2600 every 25 hours |
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Fluid Volume Deficit |
An abnormal decrease in the volume of blood plasma Excessive water and solutes are lost in the same porportion from the ECF Thirst; weight loss over short period; weakness; fatigue; anorexia; dry mucous membranes; poor skin and tongue turgor; sunken eyes; flat neck veins; urine output <30 mL/hr; postural hypotension; weak/rapid pulse;↑SG,↑ Hct,↑ BUN, ↑serum Na+ |
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Fluid Volume Excess |
An abnormal increase in the volume of blood plasma Weight gain over short period; peripheral edema (may be pitting); BP, shortness of breath, crackles/ wheezes in lungs; full/bounding pulse; NVD; polyuria; ascites; pleural effusion; pulmonary edema; ↓BUN, ↓Hct, ↓serum Na+, ↓SG |
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Hyponatremia |
Anorexia; nausea/vomiting; lethargy, confusion/altered mental status; muscle cramps; muscular twitching seizures, coma, SG < 1.010 |
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Hypernatremia |
Thirst; ↑ temp; tongue dry, swollen; sticky mucous membranes; severe: disorientation, hallucinations, lethargy, irritable, hyperactive, seizures, coma; SG > 1.015 |
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Hypokalemia |
Fatigue; anorexia; nausea; vomiting; muscle weakness; weakened RR (auscultate lungs) ; decreased bowel motility; cardiac arrhythmias (prolonged PR interval & wide QRS complex, peaked T waves, absent P waves); ↑sensitivity to digitalis; polyuria; nocturia; dilute urine; postural/orthostatic hypotension; ECG changes; paresthesias; tender muscles; leg cramp |
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Hyperkalemia |
Vague muscle weakness/ reduced muscle strength; cardiac arrhythmias; paresthesias of face, tongue, feet, and hands; flaccid muscle paralysis; GI distress |
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Hypocalcemia |
Trousseau’s and Chvostek’s signs; numbness & tingling of fingers & toes; mental changes; seizures; spasm of laryngeal muscles; ECG/cardiac rhythm changes: brady/tachy; cramps in muscle extremities |
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Hypercalcemia |
Muscular weakness; tiredness; lethargy; constipation; anorexia, nausea/vomiting; ↓ memory & attention span; polyuria & polydipsia; renal stones; neurotic behavior; cardiac arrest |
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Hypomagnesemia |
Neuromuscular irritability (↑reflexes, coarse tremors, seizures); tachyarrhythmias; ↑susceptibility to digoxin toxicity; disorientation, mood changes; ↑DTR; muscle cramps; numbness; tingling; resp paralysis |
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Hypermagnesemia |
Flushing; warm skin; ↓ BP; depressed respirations; drowsiness; hypoactive reflexes; muscular weakness; cardiac abnormalities;↓ DTRs |
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Hypophosphatemia |
Flushing; warm skin; ↓ BP; depressed respirations; drowsiness; hypoactive reflexes; muscular weakness; cardiac abnormalities;↓ DTRs |
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Hypophosphatemia |
Cardiomyopathy;↓ acute resp failure; seizures; tissue oxygenation; joint stiffness; slow peripheral pulses-->cardiac muscle damage |
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Hyperphosphatemia |
Short-term: tetany, tingling of fingertips, mouth, numbness, muscle spasmsLong-term: precipitation of calcium phosphate in nonosseous sites |
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Hypochloremia |
Hyperexcitability of muscles; tetany; hyperactive DTRs; weakness; muscle cramps |
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Hyperchloremia |
Tachypnea; weakness; lethargy; diminished cognitive ability; hypertension;↓ cardiac output; dysrhythmias; coma |
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Erythropoiesis |
Production of RBC in the myeloid tissue of the bone marrow Stimulated by erythropoietin (hormone produced by the kidneys)The liver detects when O2 levels are low and releases more hormones (anemia, or if you are in high elevation) Iron, Vitamin B12, and Folate deficiencies are called anemiasAverage life for a RBC is 120 days, then they are lysed in the liver, spleen, or bone marrow |
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Iron deficiency |
A decrease in RBCs due to a lack of iron available because of high demand( menstruation, GI bleeding), poor diet, or poor absorption |
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Folic acid deficiency |
A decrease in RBCs due to a lack of folic acid (folate/B vitamin). Occurs in malabsorption states, alcoholism, pregnancy, some medications |
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B12 deficiency |
A decrease in RBCs due to a lack of vitamin B12, commonly caused by the inability of the GI tract to absorb needed amounts of B12 or strict vegetarian diet |
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Pernicious anemia |
A decrease in RBCs due to a lack of intrinsic factor produced by the gastric mucosa, therefore vitamin B12 cannot be absorbed |
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Misc. anemias |
A decrease in RBCs due to low erythropoietin levels (renal failure, hemodialysis), or medications (post op pt, chemotherapy); note: sickle cell anemia was not discusse |
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Multiple Myeloma |
*MM is the second most common hematologic cancer in the US*Median 5-year survival rate for newly-diagnosed patients is 39% C- calcium (hypercalcemia)R- renal insufficiencyA- anemiaB- bone lesions |
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Non-Hodgkin Lymphoma |
*NHL is the 7th most common type of cancer diagnosed in the US*Incidence rates have almost doubled in the past 35 yrs*The incidence increases with each decade of life*The average age at diagnosis is 65 yrs*Many lymphomas can be cured |
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Acute Myeloid Leukemia |
*AML is the most common nonlymphocytic leukemia*Any age group can be affected, usually occurs after 55 yrs; average age is 67 yrs*The prognosis is highly variable; patients who are younger may survive for 5 years or more after the diagnosis—less for older people |
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Chronic Lymphoid Leukemia |
*CLL is the most common malignancy in older adults; average age 72 yrs*Most common form of leukemia in the US & Europe*Vietnam vets who have been exposed to Agent Orange may be at risk*Most patients survive more than 20 yrs |
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Acute Coronary Syndrome |
An umbrella classification encompassing clinical presentations ranging from unstable angina through myocardial infarctions. |
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Hypertensive Emergency |
CrisisBP is severely elevatedand there is evidence of actual or probable target organ damagepotential target organ damageleft ventricular hypertrophymyocardial infarctionheart failuretransient ischemic attack (TIA)cerebrovascular accident (CVA, stroke, brain attack)renal insufficiency and failureretinal hemorrhage |
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Hypertensive Urgency |
CrisisBP is severely elevatedbut there is no evidence of immediate or progressive target organ damageTreatmentpatient requires close monitoring of blood pressure and CV statusassess for potential evidence of target organ damageMedications:Fast acting oral agents:BB - labetalolACEI - captoprilAlpha₂-agonist - clonidine |
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Coronary Atherosclerosis |
Atherosclerosis is the abnormal accumulation of lipid deposits and fibrous tissues within arterial walls and lumenBlockages and narrowing of the coronary vessels reduce blood flow to the myocardium.leading cause of death in the US |
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CK-MB |
the concentration of the enzyme creatine phosphokinase in the myocardium, increases during MI |
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Myoglobin |
an oxygen-binding protein found in skeletal and cardiac muscle cells, released into circulation after an injury |
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Troponin T and I |
biochemical markers for cardiac diseases, increases during MI |
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Brain Natriuretic Peptide |
a neurohormone secretion primarily in the cardiac ventricles and increases in response to volume expansion and pressure overload |
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CRP |
C-reactive protein is produced in the liver in response to tissue injury and inflammation |
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Homocysteine |
naturally occurring amino acids found in blood plasma in response to inflammation |
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lipid profile |
cholesterol <200HDL female >60 male>50LDL <100 HD <70Triglycerides <150 |
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ECG |
12 leadContinuous monitoring, hardwire, telemetryCardiac stress testing - exercise (treadmill)Pharmacologic stress testing (nuclear stress test, isotope given to take a picture that makes the heart stand out) |
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CAD Prevention |
Control cholesterolDietary measuresPhysical activityMedicationCessation of tobacco useManage HTNControl diabetes |
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CAD Treatment: |
seeks to decrease myocardial oxygen demand and increase oxygen supplymedicationsoxygenreduced control risk factorsrefusion therapy may also be done |
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Right Sided Heart Failure |
Viscera and peripheral congestion JVD Dependent Edema Hepatomegaly Ascites Weight Gain |
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Left Sided HF (Lungs) |
Pulmonary Congestion, crackles S3 or Ventricular Gallop Dyspnea on exertion Orthopnea Dry, nonproductive cough initially Oliguria PND/paroxysmal nocturnal dysrhythmia |
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ACEI |
*vasodilation*diuresis*decreases afterload*monitor for: hypotension, hyperkalemia, altered renal function*cough |
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ARBS |
prescribed as an alternative to ACEI, but works similarly |
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Hydralazine and Isorbide Dinitrate |
prescribed as an alternative to ACEI |
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Beta-Blockers |
prescribed in addition to ACE inhibitors*may be several weeks before effects seen*use with caution in patients with asthma |
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Diuretics |
Decrease fluid volume monitor serum electrolytes |
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Digitalis |
*improves heart contractility*monitor for digitalis toxicity especially if patient is hypokalemic*check digitalis and potassium levels |
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Prevention and Management of VTE |
Elastic hose Pneumatic compression devices Subcutaneous heparin or LMWH, warfarin for extended therapy Positioning: periodic elevation of lower extremities Exercises: active and passive limb exercises; deep breathing exercises Early ambulation Avoid sitting or standing for prolonged periods; walk 10 minutes every 1 to 2 hours. |
