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81 Cards in this Set
- Front
- Back
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what is the Pre-operative phase
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*from the time the decision is made to have surgery until the pt is transported into the OR
*unique experience for everyone *all surgeries are considered major by pt |
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minor surgery
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*little risk to life
*often done with anesthesia |
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major surgery
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*may involve risk to life
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minimal invasive surgery
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*"bloodless" surgery
*done through fiberoptics *less recover time |
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reasons for surgery
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*diagnostic
*curative *restorative *palliative *cosmetic |
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diagnostic
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determines the cause of SX
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curative
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removes diseased part
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restorative
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strengthens a weakened part
ex: total knee replacement |
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palliative
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relieves the SX w/o curing disease
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cosmetic
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improves appearance
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responses to surgery
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*sympathetic NS
*hormonal *metabolic |
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responses to surgery: sympathetic NS
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*increase amt of NE secreted result in peripheral vasoconstriction
*maintains BP by maintaining fluid volume with blood loss in surgery |
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responses to surgery: hormonal
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*increase aldosterone secretion result in decreased GI activity and Na retention
*increase glucocorticoid secretion result in mobilization of stored fats and amino acids for energy (increase blood sugar) *increase ADH to maintain blood volume |
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responses to surgery: metabolic
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increase in CHO, fat, and protein metabolism
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factors that affect the pt's response to surgery
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*age
*medications *medical history *prior surgical experiences *health/family history *type of surgery planned |
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factors that affect pt's response to surgery: age
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*very old and very young likely to have more complications
*cardiovascular changes w/ aging *respiratory changes w/ aging |
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factors that affect pt's response to surgery: meidcations
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*tobacco use increase risk for pulmonary complication
*prescription drugs *illegal drugs (may react diff to anesthesia) |
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factors that affect pt's response to surgery: medical/cardiac history
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*need clearance from doc
*pulmonary *cardiovascular *renal *endocrine |
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factors that affect pt's response to surgery: prev surgery/anesthesia
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*good/bad outcomes
*allergies |
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factors that affect pt's response to surgery: family history
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*malignant hyperthermia
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factors that affect pt's response to surgery: surgical procedures
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*site of the procedure
*extent of surgery |
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pre-operative assessment
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*VS
*allergies *cardio system *resp system *renal/urinary system *neurological system *musculoskeletal system *nutritional status |
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cardiovascular asessment
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*check for hypertension
*assess HR, rhythm, sounds *look for edema *assess peripheral vascular system |
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respiratory assessment
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*assess breath sounds
*look for lung expansion *evaluate overall respiratory effort *look for clubbing of fingernail |
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renal/urinary assessment
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*look at BUN & creatinine
*monitor F&E status *I&O |
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neurologic assessment
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*overall metal status
*assess fall risk |
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muscoloskeletal assessment
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*will mobility be an issue
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nutritional assessment
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*malnutrition
*obesity |
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lab data assessment
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*blood test: CBC, electrolyte panel, established baseline usually done 24-48 hrs prior to surgery
*urinalysis *X-ray |
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Informed consent
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*signed consent implies that pt has understands the surgical procedure and its risks
*physician's duty to obtain *nurse may be witness *must be obtained before pt is sedated *may refuse surgical intervention or withdraw consent at any time |
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order in which consent is obtained if an adult pt is unable to do so
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spouse -> adult child -> parent -> sibbling
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consent for minors mus be given by?
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parents or legal guardians
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who signs consent for emancipated minors?
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minors who are married or living on their own income can sign their own consent
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what is done for emergency consent?
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*consent can be given over the phone (have two people listen)
*faxed consent |
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Questions to assess psychological readiness for surgery
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*does pt understand proposed surgery?
*what previous experience has the pt had with surgery? *does pt have any specific concerns? *what support system does pt have available? |
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objective data R/T preparedness for surgery
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*speech patterns-repetition of themes, change of topics, avoidance of topics
*degree of interaction w/ others *physical assessment- increased HR & RR, increased hand movement, perspiration and voiding |
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physiological preparation for surger: medical interventions
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*diet: NPO
*bowel cleansing: laxatives/enemas, decrease sz of bowel *skin prep: hair, disinfect skin |
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pt teaching pre-op goal
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to decrease anxiety
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pt teaching pre-op should include
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*what to expect during surgical experience pt and family
*explain & reason for pre-op test and pre-op routines (NPO, enema, prep) *amt of info depends on pt's background, interest, stress level, age *anticipated post op interventions |
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Teaching pre-op information for family
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*where they should wait
*where surgeon will talk to them *how long it will be |
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day of surgery
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*promote rest and sleep
*antiembolic stockings prior to surgery *patient belongings given to family or locked up according to facility policy |
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day of surgery: final assessment
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*VS
*ID band *blood band *labs *tests *nail polish off *gown on *bladder emptied |
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day of surgery: purpose of pre-op medications
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may be given prior to surgery to:
*decrease anxiety *provide sedation *induce amnesia *decrease saliva |
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Possible pre-op meds
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*narcotics
*barbiturates *benzodiazepines *neuroleptanalgesic |
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Narcotics
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*reduce anxiety & promote sleep
*depress resp, circulation & GI *ex: demerol, morphine |
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barbutrates
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*reduce anxiety, promote relaxation & sleep
*cause excitement or confusion in elderly *ex: nembutal, seconal |
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benzodiazepines
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*reduce anxiety & promote relaxation
*cause dizziness & headache *ex: valium, librium |
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neuroleptanalgesic
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*promote state of indifference
*decrease motor activity *analgesia *antiemetic *causes resp depression & hypotension *ex: fentanyl |
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Transporting to OR
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*pt ID prior
*pt ID upon arrival *orthopedic surgery-correct part is noted |
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intra-operative phase
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begins when pt is transferred to the operating table and ends with the transfer to the RR
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holding area
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*used as area where pt waits for OR to be ready
*nurse double checks chart *procedures are done *visit by the anesthesiologist |
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surgical team members
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*scrub nurse/tech
*circulating nurse *anesthesiologist or CRNA *surgeon *second surgeon |
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responsibilities of scrub nurse/tech
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*prepares sterile supplies & equipment
*assist surgeon *accounts for equipment |
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responsibilities of circulating nurse
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*oversees entire OR
*creates & maintain safe environment *makes sure sterile technique is followed *accounts for equipment *assist other team members as necessary *maintains communication |
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upon arrival of pt to OR, circulating nurse should
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*ask pt to state their name
*check pt's name and number w/ ID band *check consent *review chart *check for jewelry, glasses, dentures, etc... |
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responsibilities of Anesth/CRNA
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*administration of anesthetic agents
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effects of anesthesia
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*amnesia
*analgesia *hypnosis *relaxation |
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general anesthesia
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*given IV or inhalation
*blocks awareness centers in the brain *producing unconsciousness, body relaxation and loss of sensation |
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regional anesthesia
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*analgesia occurs over a specific body area
*given via spinal, Bier block, epidural *pt is conscious |
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local anesthesia
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*analgesia given over limited tissue area
*pt conscious |
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Stages of anesthsia
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stage 1- begins w induction and ends w loss of consciousness
stage 2- ends w relaxation, loss of eyelid reflex stage 3- ends w loss of reflexes and depression of vital functions stage 4- ends w resp failure, cardiac arrest, death |
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important considerations for spinal anesthesia
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*type of regional anesthesia
*usually done on lower extremities *pt remains awake during procedure *H/A common post anesthesia problem- keep pt supine, force fluids if allowed |
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conscious sedation
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*IV delivery of sedative, hypnotic, and opioid drugs to reduce LOC
*but maintain patent airway & to respond to verbal commands *very short acting *nurse must monitor airway, O2 sats, EKG, VS |
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what is malignant hyperthermia?
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*life threatening complication triggered by anesthetic agent
*only occurs in pt w inherited defect in membrane of skeletal muscle *pt's clacium level rises and emtabolic rate increases dramatically |
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if malignant hyperthermia is allowed to continue
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pt may develop:
*renal failure *DIC (clotting problem) *neurological damage *heart failure |
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clinical manifestations of malignant hyperthermia
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*tachycardia (occurs first)
*unstable BP *tachypnea *muscle rigidity *skin mottling *rapidly rising body temp |
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treatment of malignant hyperthermia
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*stop administration of causative agent
*ice *chilled IV fluids *diuretics *steroids *dantrium (to stabilize calcium) |
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termination of surgery
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*dressings applied
*documentation done by circulating nurse or anesthesiologist *moved from OR to PACU w circulating nurse and anesthesiologist |
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post-operative phase arriving at PACU
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*circulating nurse will give report to PACU nurse
*PACU will do quick assessment: airway, VS, LOC, EKG |
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report from circulating nurse to PACU
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*diagnosis
*surgical procedure *type of anesthetic agent used *any meds administered *any problems/complications *amt fluid lost/given (EBL) *drains/lines/tubes *surgical site *dressing *review medical orders |
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maintaining a patent airway
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*goal is to prevent hypoxemia and hypercapnia - most common cause of this is airway obstruction and hypoventilation
*pt will have a pulse oximeter on and oxygen |
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causes of airway obstruction
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*relaxation of the tongue as a result of anesthesia
*secretions |
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what is noisy breathing a sign of?
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obstruction but don't have to have noise to have an obstruction
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pharyngeal airway
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*most common
*keeps the airway open and the tongue forward until the gag reflex returns *removed when the pt is awake and has gag and swallowing reflex back *isn't tolerated in a conscious patient-may stimulate vomiting or laryngospasm |
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endotracheal
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*keeps the airway open by insertion of a tube into the pt's trachea
*may or may not be removed prior to leaving the OR *pt may complain of sore throat *may be left in post operatively in ICU |
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positions to promote ventilation
depends on |
*type of surgery, pt's size, type of anesthesia used
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initial position to promote ventilation
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*initially pt is supine w head hyperextended and w suction equipment ready
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recovery position to promote ventilation
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*side lying when stable
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why is O2 given to post op pt?
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*O2 almost alway given to post op pt due to decreased pulmonary expansion and areas of atelectasis
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when can oxygen be discontinued post op?
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O2 should be given until pt is conscious, can take deep breaths on their own or as determined by blood gases or O2 sats (keep between 92-98%)
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administration of oxygen
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*can be given by cannula, mask, ventilator
*deep breathing exercises are important and should start now |
