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90 Cards in this Set
- Front
- Back
Conscious sedation
-IV delivery of what kind of drugs? |
-IV delivery of sedative, hypnotic, and opioid drugs
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Conscious sedation
what does this sedation do? |
reduces the level of consciousness but allows the client to maintain a patent airway and to respond to verbal commands.
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Conscious sedation
Nursing assessment of what 5 things, how often? |
of airway,
level of consciousness, oxygen saturation, electrocardiographic status, vital signs monitored every 15 to 30 minutes. |
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Conscious sedation
who administers the meds? |
Nurse administers meds but NOT propofol.
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Conscious sedation
-done for patients with what (4) |
dislocation,
cardioversion (The conversion of one cardiac rhythm or electrical pattern to another, almost always from an abnormal to a normal one) EGDs (Esophagogastroduodenoscopy, or EGD for short, is a procedure used by your doctor to gain more information about your esophagus, stomach, and small intestine. Your doctor can look at the insides of these structures by placing an endoscope (a small, bendable tube that acts like a video camera) into your throat.) , colonoscopies |
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Understand what malignant hyperthermia is :
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acute, life threatening complication of certain drugs used for general anesthesia
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The MH crisis is a biochemical chain reaction response “triggered” by
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general anesthetics and the paralyzing agent succinylcholine within the skeletal muscles of susceptible individuals.
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malignant hyperthermia is : susceptibility occurs in what people??
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inherited with an autosomal dominant inheritance pattern
This means that children and siblings of a patient with MH susceptibility usually have a 50% chance of inheriting a gene defect for MH |
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malignant hyperthermia is :
-link to which agents? -how can you see if u have the trait for MH -linked to another specific agent, such as: |
-usually linked to inhalants
-succinylcholine is a short acting paralytic and it’s usually used or induction to intubation -muscle biopsy is the only way you can find out if you have MH |
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malignant hyperthermia :
the reaction begins where: |
reaction begins in skeletal muscle exposed to specific agents, causing increased calcium levels in muscle cells and increased muscle metabolism.
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malignant hyperthermia :
serum calcium and potassium levels are increased, as is the metabolic rate, leading to (3 things) |
acidosis,
cardiac dysrhythmias, high body temperature. |
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-malignant hyperthermia :
susceptible persons have a mutation that results in the presence of |
abnormal proteins in the muscle cells of their body.
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malignant hyperthermia :
Exposed to certain anesthetic agents, it causes an abnormal release of what inside the muscle cell. |
calcium
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malignant hyperthermia :
Exposed to certain anesthetic agents, it causes an abnormal release of CA+ inside the muscle cell. •That results in |
sustained muscle contraction & the abnormal increase in energy utilization and heat production.
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Exposed to certain anesthetic agents, it causes an abnormal release of CA+ inside the muscle cell.
Results in a sustained muscle contraction & the abnormal increase in energy utilization and heat production. The muscle cells eventually run out of energy, and die. Then they release: |
Large amounts of K+ are released into the bloodstream,causing heart rhythm abnormalities.
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Results in a sustained muscle contraction & the abnormal increase in energy utilization and heat production.
The muscle cells eventually run out of energy, and die. Then they release large amounts of K+ are released into the bloodstream,causing heart rhythm abnormalities. The muscle pigment myoglobin is also released and may cause issues: |
kidney. it becomes toxic. The kidney is occluded and it can’t perform it’s function and goes into kidney failure.
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malignant hyperthermia, if left untreated can cause:
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cardiac arrest,
kidney failure, blood coagulation problems, internal hemorrhage, brain injury, liver failure, |
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malignant hyperthermia
there is a result of calcium from inside the muscle, then what happens? as the muscle fatigue, they start to die..why do they die? when the muscle cell dies, it releases K into the blood which also releases what: |
there is a stained muscle contraction, which produces the heat inside the body (fever)
they are not getting blood cuz they are contracting and they are hypoxic) myoglobin, which circulates to the kidney and sends the pt into renal failure |
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What drugs are commonly associated with MH?
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The volatile gaseous inhalation anesthetics are MH triggers:
-sevoflurane -desflurane -isoflurane -halothane -enflurane -methoxyflurane -Also, succinylcholine (Anectine), the depolarizing muscle relaxant |
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General signs and symptoms of MH??
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tachycardia b/c of the increased body metabolism,
muscle rigidity/contraction (of the jaw and upper chest) which produces the high fever that may exceed 110°F, and carbon dioxide builds up. |
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other signs and symptoms of MH??
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hypotension,
tachypenia, skin mottling, cyanosis, myoglobinuria (presence of muscle proteins in the urine) |
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MH
first sign the anesthesiologist notices is what? |
- an increase in co2 and tachycardia with unknown etiology
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MH
-Severe complications include: cardiac arrest, brain damage, internal bleeding or failure of other body systems. Thus, death, primarily due to.... |
a secondary cardiovascular collapse
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MH:
-brain damage occurs because of |
the carbon dioxide build up and high temperature (105-111) –cerebral tissue is damaged
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Malignant hyperthermia: possible treatment with
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dantrolene sodium,...WHICH IS WHAT??
a skeletal muscle relaxant. -genetically mediated problem. -It’s not known if the pt has this. -It’s a muscle link |
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-what do you do if MH occurs?
-how does flurane have to exit your body? |
-the anesthesiologist stops the “flurane” injections and they give fresh oxygen.
-The flurane has to be excreted through the lungs, and then we have to give lots of fluid and cool that body. (cooling blankets, ice, ice water in rectum, cool moist blanket |
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MH
-treatment: what does dantrolene do? |
stops the process from occurring at the muscles and stops contractions.
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MH
-how is dantrolene administered? -who gets the equipment?? |
per kilogram (90-120 lb person ways 6-8 bottles)
the circulating room nurse gets the equipment |
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Post op
-In the postop pt, what does the nurse generally include in the initial assessment when the pt returns to the floor? |
A-airway (open and accessible?)
B-breathing (look for chest rising, listen to breath sounds, RR rate, sao2, and feel for subcutaneous emphysema ---feels like rice krispies (air trapped in subq layers), lung sounds C-circulation -HR , BP, capillary refill, color, check IV sites.. Output (circulation of kidney) D-neuro (disability) -----A, V, P, U A is alert (eyes are open and they are looking at you and answering appropriately), V is verbal.. P is pain, sternal rub to get pt to respond or make a withdraw, and U is unresponsive E- exposure: lift up gown and look at skin to see if they have injuries returning from OR..looking at dressings, drains, skin interruption F-farhrenheit- what's their temp….are they warm enough? Do they need blankets? G- glucose |
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Post op
Additional assessments the nurse does when the pt gets back from the OR |
•I/O
•Hydration- do not advance diet without bowel sounds or passage of flatus •IV site/fluid •Drains •Integument –Surgical site, general body, •Pain –family can’t push button •Lab- lab work that needs to be reassessed, CBC, LFT |
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Jackson Pratt and Hemovac drains are 2 self contained drainage systems that drain wounds how?
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directly through a tube via gravity and vacuum
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Jackson Pratt and Hemovac
-both drains are sutured in place, with a suture that... what kind of technique is used to empty the reservoir? |
seals the area when the drain is removed.
use sterile technique to empty reservoir. |
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Jackson Pratt and Hemovac
how often do you drain them? what do you record? |
. during every nursing shift or more often if prescribed.
record the amount and color of drainage after emptying and compressing the reservoir to restore suction, secure the drain to pts gown to prevent pulling and stress on the surgical wound. |
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Jackson Pratt and Hemovac
used in open or closed wounds? drainage collects where? |
-used in closed wound drainage systems
- in a collecting vessel by means of compression and re-expansion of the system. |
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JP (Jackson- Pratt tube) :
are like big eggs and they have a flip tip. In order to produce suction you have to squeeze egg and close top…when you open the top what happens: |
it release negative pressure and you can pour the liquid out
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- Hemovac seen on (small or large) joints
-done with negative pressure -The compression of these drains does what to the fluid? |
large
pulls the fluid out of the space) |
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Hemovac
-used for what 2 kinds or surgery |
hips or knee surgery
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Hemovac
--complications can occur from: |
seroma-serious tumor
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What does dehiscence mean?
what is it sometimes referred to? |
the partial or total separation of wound layers. A client who is at risk for poor wound healing
splitting open of a wound |
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dehiscence
-what kind of people are at risk? 3 |
poor nutritional status,
infection, obesity |
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dehisence
uses what kind of dressing? what do you instrut the pt to do? (2) |
a sterile nonadherent or saline dressing.
instruct the pt to bend the knees and avoid coughing. a wound becomes infected dehiscences by itself or it may be opened by a surgeon through an incision and drainage procedure. |
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if a wound dehiscences , do you leave it open or resuture it up?
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the wound is left open
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dehiscence and evisceration
-usually occurs when? |
- between the 5-10 day post op ,
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dehiscence
what 5 people are at risk for these: |
usually with:
obese pts diabetes, immune deficiency people using steroids malnutrition |
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-what may follow forceful coughing, vomiting, or straining when not splitting the surgical site
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dehiscence
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_________often occurs with abdominal surgical wounds after a sudden strain, such as coughing, vomiting, or sitting up in bed
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Dehiscence
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Dehiscence
-what do patients often report feeling when this happens? |
the feeling as though something has popped.
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When there is an increase in serosanguineous drainage from a wound, the nurse should be alert for the potential for __________
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dehiscence
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To prevent dehiscence, what should the nurse do?
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place a folded thin blanket or pillow over an abdominal wound when the client is coughing. This provides a splint to the area, supporting the healing tissue when coughing increases the intra-abdominal pressure.
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What does evisceration mean?
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a wound opening with protrusion of internal organs.
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With total separation of wound layers, _______(protrusion of visceral organs through a wound opening) may occur.
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evisceration
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dehiscence or evisceration
The condition is an emergency that requires surgical repair. |
evisceration
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When evisceration occurs, the nurse does what:
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places sterile towels soaked in sterile saline over the extruding tissues.
-The client should be allowed nothing by mouth (NPO), observed for signs and symptoms of shock, and prepared for emergency surgery. |
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fyi: A fistula is an abnormal passage between two organs or between an organ and the outside of the body.
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fyi: A fistula is an abnormal passage between two organs or between an organ and the outside of the body.
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Resp complications post –op
what 2 things should you assess for? |
- patent airway and adequate gas exchange
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Resp complications post –op
-monitor pulse oximetry, what should it be? -when should you call the rapid response team? |
-greater than 95%
-drop of 10% or more |
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Resp complications post –op
-respirations (what should you all assess to determine the adequacy of air exchange) |
rate,
pattern, depth of breathing to determine adequacy of air exchange |
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Resp complications post –op
-respirations (assess rate, pattern, and depth of breathing to determine adequacy of air exchange) -less than 10 breaths per minute indicate |
anesthetic or opioid analgesic induced depression
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Resp complications post –op
-respirations (assess rate, pattern, and depth of breathing to determine adequacy of air exchange) -rapid, shallow respirations may signal (4 things) |
shock,
cardiac problems, increased metabolic rate pain |
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-listen for lung sounds, symmetry of breath and chest movements
-absent sounds may indicate: |
decreased lung expansion
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-atelectasis:
is what what do you hear while assessing? |
collapse of alveoli. (p 573),
crackles, decrease breath sounds |
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-what results from excess fluid in lungs resulting from inflammatory process, interstitial spaces??
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pneumonia-
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-pulmonary embolism
what is it?? |
- blood clot that is obstructing the pulmonary blood flow-leading to decrease oxygen, hypoxia-possible death
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-laryngeal edema- swelling in the laryngeal, doing what?
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cutting air supply off
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-ventilator dependence- risk for infection increases, why?
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because the body doesn’t filter the air as it would normally
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-pulmonary edema-
what is it? what does it cause? |
an abnormal build up of fluid in the air sacs of the lungs,
leads to SOB |
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Resp complications post –op
s/s |
-anxiety
-cough -difficult breathing -excessive sweating -feeling of ‘air hunger’ or ‘drowning’ (if this occurs suddenly, awakening you from sleep and causing you to sit up and catch your breath, its called ‘paroxysmal nocturnal dyspnea) -grunting or gurgling sounds with breathing -pale skin -restlessness -sob (also when lying down ---orthopnea—you may need to sleep with head proper up or use extra pillows -wheezing -pleruitic pain |
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GI problems
-most common reactions after surgery |
-n/v
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GI
n/v -what is a preventative drug? |
ondansetron ( Zofran ), a serotonin antagonist
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GI
n/v -common in a pt with a history of: -why is it common in an obese person? |
motion sickness
-because anesthetics are retained by fat cells |
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GI
n/v what non-pharm thing can you help the pt do to reduce this feeling? |
-having the pt in a side lying position before raising the head slowly
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GI
-Paralytic ileus what is it? |
Obstruction of the intestine due to paralysis of the intestinal muscles.
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GI
-Paralytic ileus 5 s/s include |
absent or few bowel sounds,
distended abdomen, abdominal discomfort, vomiting, no passage of flatus or stool |
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GI
-Paralytic ileus -intestinal peristalsis, may be delayed because of long anesthesia time. pts with abdominal surgery may have decreased or no peristalsis for how long |
24 hrs
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GI
-Paralytic ileus what happens to the abdominal wall? WHAT OCCURS? |
-decreased peristalsis occurs in pts who have a paralytic ileus.
the abdominal wall is distended and there is no movement of intestinal wall, few bowel sounds, discomfort, vomiting, no passage of stool |
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what drugs may reduce peristalsis
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-opioid analgesics
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How does the nurse know when to advance a patients diet if the MD writes advance as tolerated.
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-usually need to hear movement throughout intestinal tract before advancing to higher consistency diets
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used post op if pt is scheduled for diagnostic test, no more than 24 hours. limit caffeine
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-clear liquid
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pts who are lactose intolerant don’t do well on this diet, problem for dysphagia who can’t swallow thin liquids
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-full liquid:
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those pts with chewing or swallowing difficulty
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-mechanical soft
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usually pts with mild GI issues
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-soft diet:
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eggs, tender meats, milk, white breath, rice , strained juices, cooked veggies, cooked or canned fruits
– no nuts, seeds, or skins |
-low-fiber/residue
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high fiber: more than ______ day
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20g
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-low fat: restricts to less than ___ day
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50 g
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-low sodium: restricts for less than ______day
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2000 mg
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-low protein: restricts to less than ______ day
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60 g
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Listen for bowel sounds and ask if they are passing flatus or stool. After NPO, The patient is usually started on what kind of diet??
then advances to 2) 3) |
clear liquid diet and then advanced to full liquid diet and then a full solid diet.
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KNOW WHAT CATEGORIES ARE ON THE FOOD PYRAMID
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grains:
vegetables: fruits: milk: meats: oils- |
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FOOD PYRAMID
grains: vegetables: fruits: milk: meats: oils- |
grains: 6 oz
vegetables: 2 ½ cups fruits: 2 cups milk: 3 cups meats: 5 ½ oz oils- not a food group but you need some in your diet |
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Interventions related to relieve distention and promote peristalsis
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-suction fluids
-increase physical movement when safe to surgery site -increase oral intake when safe -increase fiber intake -mild use of laxatives if not contraindicated -enema may be needed -If necessary a NG tube is put in place during surgery to decompress and drain the stomach, promite GI rest, and allow the lower GI tract to heal |