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84 Cards in this Set
- Front
- Back
When should prophylatic antibiotics be administered? |
within 1 hr before surgical incision |
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When should prophylactic antibiotics be discontinued? |
within 24 hrs after surgery (48 for cardiac surgery) |
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How are prophylactic antibiotics chosen? |
specific to each pt and operation risks |
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When should catherters be romoved post-op |
post-op day 1 or 2; day of surgery is day 0 |
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When do pts on betablockers receive a beta-blocker irt surgery? |
during the perioperative period |
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When are VTE prophylaxis given |
within 24 hrs before surgery to 24 hrs after surgery |
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What are some common considerations for peds irt surgery? |
- more suseptible to throat swelling -- listen for strider, snoring, retractions (age dependent) - use facial expression (not crying) to assess pain in infants - older kids may deny pain due to fear of getting a shot, not being able to go home etc |
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What are some common considerations for elderly irt surgery |
- elderly pts already have less efficient airway - less likely to complain of pain - less able to differentiate degrees of pain |
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hypothermia considerations irt surgery |
- increases O2 demand by 300-400% (200-500% in elderly) - fluid shift leads to edema - increases chance for hemmorhage - shivering in epidural spinal anesth pt may just be a side effect and not indicator of hypothermia |
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hyperthermia and surgery |
- report if temp above 38.5 deg C (101.3 F) - oliguria as pt warms up |
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peds considerations in PACU |
- have parent there if possible - greater risk for increased temp - need very careful assessment - caution re: overhydration - body smaller so both good and bad effects happen quicker |
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Types of drains |
- t-tube - penrose - Jackson Pratt (JP) - Hemovac |
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Should JP be fully inflated |
no, should be compressed |
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t-drain aka and used for |
aka: biliary drain used for: bile duct drainage |
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What to assess with drains |
-location - patency -amount of drainage - character of drainage |
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When to d/c from PACU (to unit or home) |
When score reaches 7 or the score determined by facility/anesthesiologist |
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expalin the PACU scoring system |
- A score of 0-2 pt is given for each of the following: - Consciousness - Respirations - BP - HR - o2 sat - Activity While the overall goal is 7 (or so), each item also has it's own minimal score |
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score for LOC |
at least 1 |
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score for respirations |
2 thirty minutes before discharge |
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score for BP |
2 MAP within 20 mm/Hg of pre-op |
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score for HR |
2 within 20 beats of pre-op |
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score for O2 sat |
1 (or higher) |
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score for acvitiy |
2 (or as specified by anesthesia; ie only need 2 on upperbody if given epidural anesthesia) |
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GI post-op interventions/considerations |
- NPO - medicate for N/V - Assess for return of peristalsis - oral care - patency of NG tube - assess abdo sounds - abdo distention for gas or blood |
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post-op interventions re bladder |
- monitor urin output -- 50 mL/hr desired, 30 mL/hr acceptable - return of post-op vioding within 6-8 hours |
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post-op interventions re skin integrity |
- frequent turning and proper body alignment - padding bony prominences - clean skin and drainage - linen changes if soiled - reinforcing surgical dressing (do NOT remove first dressing without being told to do so by doc) |
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Prevention of wound infection |
- frequent assessment - admin antibiotics as ordered - std precautions and meticulous wound care - report signs of comlications to MD |
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healing by primary intention |
closed by approximation, graft, flap, stiches |
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secondary intention |
- spontaneous healing, wound left open - used commonly in contaminated wound (like a skinned knee) |
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tertiary intention |
delayed primary closure when wound is left open (on purpose) ; for example to let infectious material out - once infectious material out, may be approximated within 3-4 days |
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common diet progression post-op |
NPO, ice, clear liquids, full liquids, soft, their regular diet |
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Common nutritional considerations post-op |
- may need more calories - zinc vitamin C - protein |
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TPN |
hypertonic solutions via central line |
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enteral nutrition |
vai peg tubes |
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thrombophlebitis |
an inflammatory process caused by trauma, surgery, or prolonged inactivity that results in a blood clot formation in one or more veins, usually in veins. May be either superficial or deep (DVT) |
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PE |
pulmonary embolism; when blood clot breaks free and travels to lung causing SOB, tachypnea, taccycardia, increased anxiety |
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treatment of PE |
amin ox establish IV route transfer to ICU |
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types of shock |
- hypovolemic - septic - anaphylactic - cardiogenic |
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cardiogenic shock |
caused by damage to heart; resulting in insufficient blood flow |
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anaphylactic shock |
systemic allergic hypersensitivy reaction |
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septic shock |
result of infection, commonly pneumonia, UTI, ruptured appendix |
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hypovolemic shock |
- r/t sever blood loss |
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s/s of hypovolemic shock |
- obvious bleeding - signs of internal bleeding - cold, moist, pale skin - tacchycardia - oliguria - hypotension |
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malignant hyperthermia |
- severe reaction to anesthesia given in OR - extremely high temp - increased acid levels in blood - rapid HR - muscle fibers break down - muscle rigidity - some ppl with some muscular disorders are more likely to have this reaction |
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common urinary complications |
- retention - infection |
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s/s of urinary retention |
- unable to void - lower abdo pain - restless - confusion - sweating - increased BP |
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interventions re retention |
- monitor I&O palpate bladder if no foley |
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s/s of urinary infection |
- frequency - urgency - burning |
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urinary infection interventions |
- collect urine for C&S - antibiotics as prescribed - pain relief - fluids |
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GI complications |
- N/V - hiccoughs - abdo distention - paralytic ileus |
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tx of post-op hiccoughs |
time breat CO in paper bag NG tube throazine to relax phrenic nerve |
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paralytic ileus |
Obstruction of the intestine due to paralysis of the intestinal muscle |
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s/s of paralytic ileus |
- slight abdo distention - absent bowel sounds |
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interventions of paralytic ileus |
- NPO - NG tube - accurate I &O |
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Penicillins effective against |
streptococci and staphylococci |
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penicillins for surgery can be given what routes |
- IV in units per mL - IM |
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penicllin contraindications and precautions |
contraind: ppl with hypersensitivy - caution: - renal disease - GI disease - lactating -pregnancy |
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Penicllin nsg considerations |
- assess 30 min after admin - dilute for Im and rotate sites - IVPB diluted |
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Cephalosporins start with |
cef- or ceph- |
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cephalosporins work by |
-gram neg bacteria and anaerobic microorgs - interfere with cell wall synthesis - bacterialcidal |
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cephalosprins used to tx |
- respiratory infections urinary infections ear infections skin infections abdo pelvic inflammatory disease septicemia meningitis prophy: GI, GU, bone or skin surgery |
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nsg considerations for cephalosporin admin |
- assess for penicllin allergies - s/e: hypersentivity, N/V diarrhea rash possible superinfections monitor: IM/IV site, usually given over 60 min; monitor renal and hepatic studies - encourage fluids |
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Macrolides end in |
~mycin |
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action of macrlides |
- bacteriostatic and - bacteriacidal |
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macrolides used to tx |
- upper and lower respiratory infections - skin infections - soft tissue infections |
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macrolide nsg considerations |
- interfere with other drugs that are highly protein-bound or hepatically metabolised - assess fro drug allergies - impaired liver functions do not give |
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aminoglycosides contraind and cautions |
- Do NOT give with other antibiotics and some other meds |
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S/e of aminoglycosides |
- ototoxcity - nephrotoxicity |
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aminoglycosides |
- antimicrobial - used only for severe infections of : - GI - respiratory - urinary - CNS - Bone - Skin - soft tissue |
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contraind and cautions re aminoglycosides |
contraind: - hypersensitivity - toxicity caution: - renal impaired - hx of 8 CN defects - neonates - pregnant, can cause fetal damage |
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common s/e of aminoglycosides |
tremors uticaria oliguria |
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common assessments re aminoglycosides |
- I &O - peak and trough - renal fx via BUn and creatnine - sensory problems r/t 8th CN ; hearing |
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tetracycline action ends in |
- bacteriostatic against gram pos and neg, spirocehtal and some protozoa ~cycline |
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tetracylcines topically used for |
- acne - intestinal infection sinusitis tetnus |
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tetracycline contraind and cautions |
- hypersensentive caution: renal and hepatic pts peds pregnant women - stains developing teeth photosensitivity take on empty stomach do not use with milk, antacids |
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tetracycline common S/e |
- photsensitivity GI upset N/V diarrhea |
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Antifungal |
- dsirputs structre and fx of fungal cells |
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common antifungal meds |
metronidazole flagyl |
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Tricylic Glycopeptide common one - |
vancomycin (Vancocin) |
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Fluoroquinolones/Quinolones typically end in |
~floxin |
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common fluroquinolone/quinolones |
- ciprofloxacin (Cipro) - levofloxacin (Levoquin) - moxifloxacin (Avelox) |
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nsg considerations re tricyclic glycopeptides (vancomycin) |
- 8th CN damage - superinfection - contrain in hypersensiticity - caution in renal and hearing impaired, intestinal obstruction or inflammation - watch for: pseuomebranous colitis by assess bowel sounds |
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contra and cautions for fluroquinones |
contra: hypersenstivity, mysanethia gravis, use with tizanidine - caution: known CNS disorder, renal impair, concurrent corticosteroid use, lactating, kidny, lung and heart transplant pts |
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nsg implications for fluroquinoines |
- monitor bowel sounds |