Chapter 4 Flashcards
special populations
definition of geriatric patient
over the age of 65
what does the surgical team need to watch out for when dealing with geriatrics
chronic debilitation
how can you ensure a proper outcome with geriatric cases
preoperative assessment and planning
which type of procedure has the higher mortality rates for geriatric PT
emergent
how many geriatric patients have one or more conditions
80%
what are the most common disabilities geriatric patients come into the OR with
hearing and/or visual impairment
what do you do if a geriatric patient has hearing or visual impairment
discuss it previously
how can you ensure physiological security with geriatric patients
return things such as glasses and dentures as soon as you can post op
what do you do to accommodate geriatric fragile skin and bones
delicate transportation + positioning
what are the most delicate parts of a geriatric patient
skin and bones
what can you do to accommodate geriatric patients in the OR
provide them with a blanket
why do you provide geriatric patients in the OR with a blanket
they are easily prone to hypothermia
what do you do to prevent problems with hypotension and low circulation for geriatric PT
anti embolism stockings + sequential compression device
critical factors for the surgical team to remember for the best outcomes:
(7)
careful surgical technique
optimization of function level
appropriate anesthesia
prevention of alterations in BP + heart rate
avoide changes to fluid, electrolyte + acid based status
minimize stresses of postop
hyperthermia, hypoxemia, and pain
careful periop precautions
surgical needs of a pregnant patiently births a year
4.31 million
how many births need surgery (other than C-s)
1-2%
when do we do pregnancy surgeries
delay first trimester- increase chance of abortion
abd procedures best done in second trimester
third trimester surgeries:
- 40% increase in premature labor
- organs become displaced
altered vital signs with pregnancy
increase pulse
low arterial BP
signs not immediately displayed
- lose 30% of blood before signs of shock
- fetus may be hypoxic before you notice
anesthesia 3 main worries
- premature
fetal death
low birth weight *
anesthesia medications for pregnancy
bupivacain
lidocaine
what to do to carry out best pregnancy surgeries
be fast!
raise OR temp to avoid maternal hypothermia
- be ready for C section*
patient positioning with pregnancy
slight trendelenburg 30 degrees
- to help with venous return
hearing impairments combats
interpreter ASL
speaking with writing
nonverbal communication goes long way
preop visit patient w/ hearing aids
visual impairment
most important sense
fear
contacts not allows in surgery
how can you help with visual impairment
describe words they can’t see
examples of physical challenges
arthritis
loss of limb
deformaties
paralysis
stiffness
tremors
hoe to deal with paralysis
careful positioning + transporting
cognitive impairment def.
condition that limits an individuals ability to learn and reason
challenges with cognitive impairment
hard cooperation
requires team effort
Down syndrome patients characteristics
lower cognitive ability
risk of heart defects
GERD
ear infections
sleep apnea
lose joints
muscle hypotonia
other names for PTSD
shell shock
combat fatigue
history of PTSD
first though physical condition
then temporary medical condition
military leaders doubted its existence
PTSD problems in the OR
difficulty trusting healthcares professionals
triggered by sharps + new environment
may have irrational fear of surgery
emotions of PTSD pt in OR
dissasocitated, unresponsive, poor concentration
how a CST should treat PTSD pt
avoid loud noises
keep sharps out of view
keep environment calm quite + peaceful
what separates kids from adults
different vital ranges
how to accommodate kids
let them bring toys into OR
meet surgical staff
explain everything + walk through
temperature for pediatrics
neonate can not shiver
- incubators and overhead heaters
-warm blankets
-keep extremities covered
monitoring pediatric urine output
1-2 ml/kg/hr for neonates
monitoring cardiac function for pediatrics
ill peds w/ constant ECG
infants children: radial artery
neonate: umbilical artery
non ill peds:
older kids: internal jug vein
neonate: external jugular
monitoring oxygenation fro peds
measuring arterial blood gases
shock in peds
septic shocks
- negative bacteria
hypovolemic shocks
- bradycardia, from dehydration
- battle with fluid replacement
fluid and electrolytes for peds
water is lost through skin and lungs during surgery
cover neonates limbs + humidify gases
infection for neonates
GI + skin underdeveloped
sign: fever, treat with antibiotics
pediatric treatment exceptions
sulfonamides
cholarmphenicol
tetracycline
metabolic + nutritional responses for peds
surgery increases caloric responses
feeding tubes
trauma with peds
accidents leading cause of death ages 1- 15
best method is preventing
emergency treatment for peds
more likely to hyperventilate
insert nasogastric tube
iv in great sapphenous
most common birth trauma
fractured clavicle
2 main difficulties with substance abuse people
behavior + communication of pt
most substance abuse pt are
trauma
comorbid psychiatric disorder
causes substance abuse
30-80% of pt form
coexisting psychiatric illness
who provides assistance to team ant PT with substance abuse pt
counselor/ social worker
what does the counselor communicate to the surgical team about substance abuse pt
mood of pt
know how to properly react
organs of immune system
has none of its own but uses from other strictures
factors that effect immunocompetence
old/ young
drugs (immunosuppressants)
chemotherapy
what should the CST be aware of with immunocompromised
be very diligent with sterility
HIV
retro virus
may remain dormant
disrupts t lymphocytes
can be passed through birth
AIDS
most severe HIV
associated with opportunistic infections
- kaposi
- PCP
- fungal and parasitic infections
complications with AIDS pt
experience pain from multiple complications
- lesions
type 1 diabetes
pancreas produces little to no insulin
IDDM
type 2
non dependent NDDM
pancreases requires different amounts of insulin
what must be prevented during surgery
ketonuria
acetonuria
keto acidosis
hyperglycemia (shock)
what is performed prep for diabetes pt
EKG
fasting
CBC
blood urea nitrogen
complications with diabetes PT
type 1 more at risk because no insulin
effects caloric intake
how to prevent ulcers for diabetes pt
lots of padding because they have poor circulation
preop Strats for diabetes PT
blood test for blood sugar level
insulin dose lowered
prevent throwing up- hypoglycemia
intra op diabetes PT care
anesthesia monitors insulin+ electrolytes
prevent metabolic crisis
glucometer measure blood glucose
anti embolic stockings
post op diabetes PT care
provided with proper nutrients after for control of glucose
sequential compression device for DVT
anti hyperglycemic meds
definition of bariatrics
body weight 100 lbs greater than ideal body weight
barriers bariatrics have in OR
lifting them/ getting them to OR
Hoyer
what to do if peripheral veins not available in bariatrics
venous cutdown to put IV in place
intubation difficult due to lots of fat
anesthesia has multiple a airway carts
why does an obese pt take longer to wake up
adipose tissue absorbs anesthetic gasses
what to do when positioning obese pt
avoid skin wrinkles and tears on lots of skin
what position do you use for obese patients
reverse trendelenburg
three most common obese surgeries complications
abd catastrophes, internal hernia, and acute gastric distention
gallstones with obese
be prepared to remove gallbladder
most common with every obese patient
degenerative osteoarthritis with obese
one of the most popular complications with weighing so much on joints
golden hour in trauma
difference between life and death
level 1 trauma center
operating room 24/7
trauma surgeon available 24/7
expensive for hospital
-U + IMC
level 2 trauma center
seriously injured, but system doesn’t have everything level 1 does
- ogden regional
level 3 trauma center
community or rural hospitals
- Riverton, Jordan valley
level 4 trauma center
just a little more than urgent care
kinematics/ MOI 3 factors
1- flexibility of tissue
2- shape of injuring force
3- velocity of injuring force
blunt trauma
compression, shearing, hitting
MVA
spleen most common injured (seatbelt)
3 causes of blunt trauma MVA
- car into another car
- person collides with object in car
- internal body structure collide with rigid bone - seatbelt + airbag
penetrating trauma
foreign object passes through tissue
velocity, distance, location
m-16 bullet
what is it called when bullet goes all the way through
through and through
revised trauma score (RTS)
decides severity of trauma
Glasgow coma score
considerations for Surg Tech in trauma
- keep spine alignment!!!*
- often need multiple procedures performed (same time)
- deal with life threatening first
—- head> chest> abdomen> limbs - challenging to prepare
