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79 Cards in this Set
- Front
- Back
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What does anesthesia include?
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analgesia, muscle relaxation and amnesia
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How are surgeries classified?
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seriousness
urgency purpose |
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What are the two types of seriousness?
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major
minor |
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What is considered major surgery?
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involves extensive reconstruction or alteration in body parts; poses greater risks to well being
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Give an example of major surgery
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CAB, colon resection, removal of larynx, resection of lung lobe
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What is considered minor surgery?
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involves minimal alteration in body parts; often designed to correct deformities; involves minimal risks compared with major procedures
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Give an example of minor surgery.
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cataract extraction, facial plastic surgery, tooth extraction
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What are the types of urgency categories for surgery?
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elective
urgent emergency |
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What is elective surgery?
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performed on basis of client choice, not essential and may not be necessary for health
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What is urgent surgery?
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necessary for client's health
may prevent additional problems from developing not necessarily an emergency |
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What is emergency surgery?
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must be done now to save life or preserve function of a body part
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Removal of cancerous tumor
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urgent surgery
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Control of hemorrahaging
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emergency surgery
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hernia repair
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elective surgery
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removal of gallbladder for stones
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urgent surgery
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Perforated appendix repair
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emergency surgery
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What are the types of surgery according to purpose?
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diagnostic
ablative palliative reconstructive/restorative procurement for transplant constructive cosmetic |
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Give example and definition of constructive surgery
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Restores function lost or reduced as result of CONGENTIAL ANOMALIES
*creating for the first time something example: repair cleft palate, make a bladder |
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Give example and defintion of ablative surgery.
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Ablative - excision or removal of diseased body part
example: amputation, appendectomy, cholecystectomy |
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Give example and defintion of palliative surgery.
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Palliative - relieves or reduces intensity of disease symptoms; wil not produce cure
example: colostomy, debridement of nectrotic tissue, resection of nerve roots, removing cancer lump from nerves *decreases intensity of symptoms without curing |
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What is reconstructive surgery vs. constructive surgery?
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reconstructive is restoring function or appearance to traumatized or malfunctioning tissues
constructive - restoring function lost or reduced as a result of congential anomalies |
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What is a key that it is elective surgery?
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scheduled ahead of time
client's choice |
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What is key that is its urgent vs. emergency surgery?
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urgent - client's health
emergency - life saving |
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What type of surgery for a client who is in hospice but just wants better life for the moment?
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palliative
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What is the goal of assessment in the preoperative stage?
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establish client's normal preoperative function
assist RN in preventing and recognizing possible postoperative complications |
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What are the 7 physiological risk factors for the nurse to assess during the preoperative phase?
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1. Age
2. Nutrition 3. Respiratory 4. cardiovascular 5. Elimination 6. Use of medications 7. Pre-existing conditions |
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What are some pre-existing conditions that can increase risk of surgery?
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**these can influence choice of anesthetic agent used, as well as the client's ability to tolerate surgery and recover
bleeding disorders diabetes heart problems sleep apnea respiratory infections liver problems fever respiratory problems immunological disorders use of street drugs chronic pain |
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Anesthesia causes
cardiac output respiratory function vasoconstrict or vasodiolate heat gain or heat loss |
decreased CO
decreased respiratory vasodiolate heat loss |
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What are infant problems during surgery?
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inability to regulate body temp
difficulty maintain circulatory blood volume |
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What does the older client have that is a problem with surgery?
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reduced cardiac reserve
reduced vital capacity |
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What is the ND for anxiety and the surgical client?
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Moderate anxiety R/T situation crisis secondary to impending surgery
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What is intervention for ND of moderate anxiety r/t situation crisis secondary to impending surgery?
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assess client's Level of Anxiety and physical responses to anxiety at 8-4-12 and prn
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What is goal statement for ND?
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Client will have decreased level of anxiety AEB decreased heart rate, slowered rate of speech
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What are purposes (4) of informed consent?
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provides MD with legal permission
limits activities of MD and anesthesia to those listed provides pt opportunity to learn risks and benefits protects MD and hospital |
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What types of things do you have to have informed consent?
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any surgical procedure
any dx invasive procedure admin of anesthesia |
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Who does most of the nursing stuff in the OR?
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circulating nurse
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What is the goal of a nurse during the intraoperative phase?
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prevent injury and complications related to anesthesia, surgery, positioning and equipment used
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What are the four types of anesthesia?
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general
regional local conscious sedation |
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What are a client's safety needs during intraop?
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electrical equipment grounded (no burns from cautery grounding pad)
proper positioning of client (strap with belt) correct sponge and instrument count asepsis maintained |
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What are the physiologic needs of a client during the intraop phase?
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fluid balance
thermoregulation cardiac function respiratory function |
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What is client's temp at time of surgery up to 12 hours?
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hypothermia to 94
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General anesthesia is usually administered via ____________. It has three phases called
1. 2. 3. |
iv and inhalation
induction maintenance emergency |
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What type of surgery requires general anesthesia?
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extensive tissue manipulation
when you want pain relief, muscle relation, immobility and control of autonomic nervous system (amnesia) |
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What does not happen with regional anesthesia?
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loss of consciousness does not happen, but client may be sedated
given by infulatration and local application nerve blocks epidurals **look fo traveling up spine and causing respiratory problems |
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What is route for local anesthesia?
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rubbed on or injected
done for minor surgery and also shot into surgery area for major surgery to stop pain for awhile post surgical |
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What is conscious sedation?
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client is at depressed LOC
independently retains patent airway and airway reflexes and be able to respond appropriately to physical and verbal stimuli colonoscopy |
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What is main priority for PACU nurse?
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client's airway
assessment of client's respiratory , circulatory and neruological status pain control |
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In first 24-48 hours what can you expect of a temperature?
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elevation to 100.4 is normal
above 100.4 means what? |
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What about fever on third and subsequent days?
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Above 100 means:
wound infection UTI Respiratory infection Phlebitis |
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What is the purpose of preop drugs?
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facilitate admin of anesthesia
decrease risks calm client |
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What are the three sedatives?
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versed
valium vistaril/atarax phenergan |
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What are the other terms used for sedatives?
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hypnotics
tranquilizers |
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Sedatives/hypnotics/tranquilizers al do what?
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produce drowsiness/sedation
decrease anxiety potentiate the effects of narcotis facilitate anesthesia induction |
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What drug is a sedative, but also produces amnesia?
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versed
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What would be a situation that you would use versed?
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conscious sedation
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Why would a doctor administer valium over vistaril?
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vistaril has to be given IM ztrack
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When are the sedatives/hypnotics given?
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pre op to decrease anxiety, produce sedation and faciliate anesthesia induction
post op to potentiate the effects of narcotics |
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What is the function of natcotic analgesics?
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decrease perception of pain
induce euphoria faciliate anesthesia induction decrease requirements for anesthesia |
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What are the two narcotic analgesics that we need to know?
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morphine sulfate
Demerol |
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What are the actions of the narcotic analgesics?
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decrease pain
induce sedation reduce anxiety |
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What are the anticholinergic drugs?
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Robinul
Atropine sulfate |
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Why do we give anticholinergics?
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given preop to educe salivary bronchial and gastric secretions
keep respiratory passages clear faciliate intubation prevent reflex bradycardia (surgical maniuplation can stimulate vagus nerve) |
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What is the action of antiemetics?
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stimulates motility of the upper GI tract and accelerates gastric emptying
=in decreased n/v and decreased gastric status |
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What is the other name for antiemetics?
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gi stimulants (which seems weird because they decrease n/v but they also decrease gastric STATIS, so OK)
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Insensibility to pain and trauma with or without loss of consciousness
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Anesthesia
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State of profound CNS depression during which there is _______ loss of
1. sensation 2. consciousness 3. pain perception 4. memory |
general anesthesia
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A person who administers an anesthetic, chiefly concerned with maintaining
1. 2. |
Anesthetist
(could be MD or CRNA) airway circulation |
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Anesthesiologist
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MD who specializes in anesthesiology
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CRNA
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an RN who specializes in administering anesthesia
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Client is awake, becoming drowsy and losing consciousness
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stage 1 anesthesia
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What happens in stage 2 of anesthesia?
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muscle tone, swallowing and vomiting reflexes begin to disappear
breathing may be irregular you have to STFU so patient can pass to stage 3 |
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What happens in stage 3?
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This is the stage of surgical anesthesia....onset of regular, rhythmic breathing, vital functions and reflexes are depressed or temprarily lost and surgeon begins to CHOP
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What is happening in stage 4?
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Someone totally fucked up. Complete respiratory depression, circulatory collapse and death can follow
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What are the commonly used drugs for conscious sedation?
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iv sedation during dx and surgical procedure that alters patient LOC thereby alleviating fear and anxiety.
morphine demerol valium fentanyl versed |
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When administering local anesthesia, what did ms. tyler say is the big thing to watch for?
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neuro piece....assess for sensation, movement, numbness (spinal anesthesia)
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What are three ways to administer local anesthesia?
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topical (...caine)
simple local infiltration regional (injection of the agent at some point along the conductive nerve pathway to and from region selected to be anesthetized |
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What are three ways that a regional injection is used?
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nerve block (injection of specific nerve)
spinal (subarachnoid space below LD2..quicker than epideral and more bigger) |
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What must you do for spinal local regional anesthesia?
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keep flat 6-12 hrs
do not place in trendelenburg no heat or cold to extremities keep in pacu until sensation returns check voiding carefully |
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What is advantage of epidural anesthetic over spinal anesthetic?
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no headache
given in epidural space not subarachnoid space |
