Chapter 16 personal flash cards part 2
Why is it important to ask the patient about a history of cardiac disease?
Cardiac problems can increase surgical risks. They impair the patient’s ability to withstand hemodynamic changes and alter the response to anesthesia.
What type of drugs would be used for a patient who is about to have MI surgery and has a history of cardiac disease?
Beta-blocking drugs
What complications can occur with smoking?
Increased chest rigidity and loss of lung elasticity. This reduces anesthetic excretion. Action of cilia decreases and leads to retained secretions and predisposes patient to infection. It also collapses alveoli.
What is atelectasis?
The collapsing of alveoli. Can be caused by smoking.
When can patients give an autologous donation?
Up to 5 weeks before surgery, infection free, hemoglobin greater than 11. THE LAST DONATION CANNOT BE MADE WITHIN 72 HOURS OF SURGERY.
A blood donation from a family member or friend is called:
Directed blood donation.
Patients with religious or medical restrictions to blood transfusions might benefit from:
“bloodless surgery” or minimally invasive surgery.
What things might you give to a patient to stimulate his own production of blood?
epoetin alpha (procrit, epogen), supplemental iron, folic acid, B12 and vitamin C
Key Point
All PATIENTS ARE REQUIRED TO HAVE DISCHARGE PLANNING, NO MATTER WHAT.
The number of serious problems during surgery is called:
Morbidity
The number of deaths during surgeries is called:
Mortality
Why is it important to assess kidney function?
Kidney function affects the excretion of drugs and waste products, including anesthetic and analgesic agents. Any problems urinating can indicate reduced kidney function.
What can indicate a poor fluid status?
- Brittle Nails
- Dry, flaky skin, decreased skin turgor, hair changes
- Orthostatic Hypotension
- Decreased serum protein levels and abnormal serum electrolytes
What drugs can alter lab values?
Warfarin (Coumadin), Aspirin, duretics
Key Point
Report any electrolyte imbalance to the anesthesia team and surgeon before surgery.
Hypokalemia can cause what problem for a patient going into surgery?
It increases the risk for toxicity if the patient is taking digoxin, slows recovery from anesthesia and increases cardiac irritability
What problems can Hyperkalemia cause for a patient going into surgery?
It increases the risk for dysrhythmias especially with the use of anesthesia.
Key Point
ANY POTASSIUM IMBALANCE SHOULD BE CORRECTED BEFORE THE SURGERY.
What are the normal lab values for Potassium?
3.5 - 5.0
Key Point
If you believe that the patient has not been adequately informed, contact the surgeon and request that he or she see the patient for further clarification. Document this action.
Key Point
At a minimum, the patient’s identity, correct side and site, correct position and agreement on the proposed procedure must be verified by all members of the team.
Key Point
Emphasize the importance of adherence to the prescribed NPO restriction. Failure to adhere can result in cancellation of surgery or increase the risk for aspiration during or after the surgery.
What factors that can predispose a wound to contamination or surgical site infection?
- Bacteria found in hair follicles
- Disruption of the normal protective mechanisms of skin
- nicks in the skin
How do you remove hair from a patient?
Electrical clippers or depilatory creams.
What kind of catheter is usually used for an IV in the arm?
Large Bore, Short Catheter (i.e. 18 gauge, 1 inch catheter)
Who is at the greatest risk for dehydration?
Older adults.
A patient feels a dull ache in the calf that gets worse with ambulation. What do they have?
Venous Thromboembolism (VTE) which can lead to a pulmonary embolism.
These drugs are sedatives:
Hydroxyzine (Atarax, Vistaril)
What is an example of a hypnotic drug?
Lorazepam (Ativan)
What is an example of an anxiolytic?
Midazolam (versed)
What is an example of opioid analgesics?
Morphine, hydromorphone
What is an example of an anticholinergic agent?
Atropine
