Chapter 5 Flashcards
1
Q
Emergency-Surgical Urgency
A
Immediate to maintain life, limb organ-AAA
2
Q
Urgent-Surgical Urgency
A
Needed within 24-48 hrs
example Appendix, gall bladder,
3
Q
Planned
A
Can wait, but necessary tumor, thyroid, knee replacement
4
Q
Optional
A
Pt. Preference
5
Q
Sufex you should know
A
ectomy- excission or removal of lises- break down destruction of orophy- repair or suture of oscopy-look or view ostomy-creating a opening into otomy- what remains after cutting into ostomy-cutting into plasty-repair or reconstruction of. excission-removal of incission- cutting into
6
Q
Purposes for surgery
Diagnostic surgery
A
Biopsy for cancer, they go in and take a look at it….take something out and get in diagnosed at the lab.
7
Q
Cure
A
They are going to remove something that is troubling and then they will be cured. Like removing appendicitis then they are cured of their appendicitis.
8
Q
Palliation- Does not fix the problme
A
Comfort or pain relief,
example- Most commonly it is with tumors…they are not going to cure them….they are going to take out one tumor that is palliative because it gives them some pain relief.
+ or create a colostomy to bypass a valve problem.
9
Q
Cosmetic
A
rhinoplasty, face lift,breast jobs….Vanity, surgeries…not just for vanity…could be for cleft lip, burn victims or face transplants.
10
Q
Preventitive
A
Questionable mole, removal plaque already….if you are getting a surgery sometimes they will take out the appendix…..if someone has a strong family of breast cancer they just remove the breast.
11
Q
Exploration
A
Something going on they don’t know what it is….so they just need to go in to take a look.
12
Q
Surgical Urgency- How important is it to do this today.
EMERGENCY
A
Immediate to maintain life, limb, organ.
example AAA- Abdominal aortic Arianism-size of a garden hose bulge.
13
Q
Urgent
A
Needed within 24-48 hrs. example of this would be appendix-can rupture appendicitis, gall bladder.
14
Q
Planned or required surgery
A
Can wait but it is necessary. examples depends on what type of tumor, thyroid, knee replacement.
15
Q
Elective
A
Pt preference- most of the plastics breast are elective like lasix surgery.
16
Q
Optional
A
Patients preference-like if you have a bump in arm and it is up to you if you want to take it out.
(There is a issue and you can fix it or not…like if you are old and have cancer it might give you another three months)
17
Q
Surgery Settings
Inpatient
A
Same Day admission
example Knee-they have their surgery then they are admitted right afterwards.
Also they can be in the hospital for something else….theer. n they do lat
18
Q
Surgery Setting Ambulatory Care (minor surgery)
A
Same day
Outpatient-Have surgery recover for a couple hours and go home.
ORTHOSCOPY would be done in the ambulatory care center.
19
Q
Nursing Assessment
-Psychological status
A
What is there coping strategies
-What is there state of mind
What might affect there state- how much they know and the risk. After affects. Do they need to work, fears. Assess where they are psychologically and psycoally.
20
Q
Physiologic factors
A
Operative Risk Factors
21
Q
Baseline Data
A
For Comparison
Important- We need to know what the normal was for the first person. (MUST KNOW BASELINE) to compare the before and after affects.
22
Q
Documention
A
Surgical site and side
In preoptive what we are going to document on the patient is their left site and side. What that means is right KIDNEY, LEFT ARM…THE DOCTOR has to WRITE right on the limb…The nurse has to make sure all the documentation is sent in the order says the same THING.
23
Q
Medications
A
Prescription, OTC, herbs, ETOH, tobaccor, recreational drugs.
LOOK AT ALL BOTH PRESCRIPTION AND OVER THE COUNTER and if they have any HERBS because they interact with MEDICATIONS.
24
Q
Tobacco use affects
A
Blood Pressure and Lungs-Some doctors won’t even operate if you did not quit for six months.
25
Alcohohal and drug use
If someone is addicted to opiates and they are taking Oxycodone and we try to give them pain meds it is not going to numb them up because they built up a tolerance.
26
NURSING ASSESSMENT we want to look at their labs and diagnostic tests.
Depending on the need for the surgery they are going to have labs done. There may be something in the chart or it may be drawn.
27
Most important electrolyte for surgery
Potassium because of heart arrythmias.
28
Cultural ethnic factors that may effect religious experience.
Jehova witness is a big one. They won't take blood or blood products that they may or maynot take plasma protein or abumin but whole blood no....Cultural things females don't want males near them they won't take off their bra....or if they get in the OR everything comes off. Wear it until they go to sleep.
29
Consent sign
Make sure they have had adequate information from the doctor and that the consent has been signed. By both Patient and Surgean....It is the Surgeans responsiblity to answer all questions about the surgery and explain any questions that the patient may have. But the NURSE still needs to follow up and to ask them questions to make sure they are OK and KNOW what they are going to have what is going on today.
-Do you feel comfortable with that.....and if not have the doctor have them talk to them again.
30
Allergies
We are going to assess for allergies both food and nondrugs.
31
If SOMEONE DOES NOT know they have a LATEX allergy what do we ask them what they are allergic too?
PITTED FRUITS, STONE FRUITS-PEACHES, AVOCADO, NECTORIN, BANANA
32
Allergic to SHELLFISH
IODINE
33
CLICKER
| What type of surgery is a total KNEE REPLACEMENT
ANSWER PLANED
34
PSYCHOLOGICAL ASPECTS
| How much time have they had to adjust to this procedure
-Have they had time to adjust and plan or is it sudden.
35
Common Fears
Unknown, How much pain are they going to be in afterwards.
- Death and disfigurement. Anesthesia.
- PROFORAL
- Financial ramifications- if they can't work or if they don't have insurance.
36
Pain SCALE 0
IS UNREASNABLE- YOU HAVE TO POINT OUT THAT THEY JUST HAD MAJOR SERGERY
37
Hope may be the patients strongest mechanism for HOPING
YOU WANT TO FOSTER THAT HOPE, DON'T MAKE ANY PROMISES-TELL THEM WE ARE GOING TO TAKE REALLY GOOD CARE OF YOU....
38
To help PROMOTE PYCHOLGICAL READYNESS we do a lot of active listening.
ASK A LOT OF OPEN ENDED QUESTIONS. Ask FOLLOW UP QUESTIONS AS THEY ARE TELLING YOU.
39
PREOP TEACHING
KEEP IT IN THE SHORT TERM- TEACH THEM what they need to KNOW IMMEDIATLY, what they are going to experience in the OR and a little afterwards.
TELL THEM WHAT THEY ARE GOING TO SEE AND WHY?
40
ALWAYS EDUCATE on the IS
INCENTIVE SPIRAMATOR after each SURGERY
41
You want to talk to the patient about
PAIN CONTROL- EXPLAIN we will do our very best to keep you out of pain and tell them what you know about what is happening.
42
Pre OP teaching
Give them a run down on what they are going to feel. example so you are going to get a tube placed down your mouth when it is removed you are going to have a little bit of a sore throat. (QUICK RUN DOWN) on what ever it is going to be.
43
Family TEACHING
Tell them where they can wait and that the doctor will come out to them and explain to them after he is done. (Surgery 90 minutes then they will be out on the PACU for two hours then you can see them around three oclock....This is how it normally goes but the doctor will come out and give you a heads up.
44
QUADS ISOMETRIC EXERCISES
HELPS TO RETURN BLOOD TO HEART and GLUTEAL SETS ARE THE SAME THINGS.
45
Teach them to do ANKLE PUMPS...
SAY THINGS THEY UNDERSTAND AND CAN RELATE TOO.
46
Why do you have to chart pain immediately after PAIN MEDICATION IS GIVEN.
To see if it was successful....we have to quantify it.
47
Promoting Psych Readiness- Pre-Op about to go it
Orient them only about their immediate future.
FOCUS ON THE IMMEDIATE FUTURE ONLY- They are freaking out.
-Make sure they know what they are having done to them. (then you may want to refer them back to the surgeon to get some more information)
-Get a brief history-ASK THEM THE SAME QUESTION. -SECOND TIME WE ASKED THEM>....DOUBLE AND TRIPLE CHECKS FOR THEIR SAFETY.
+ TELL THEM WHAT IS GOING TO HAPPEN IN THE NEXT FEW MINUTES dealing with the surgery. TELL THEM WHAT THEY CAN EXPECT IN THE OR.
-+TELL ALL THE STUFF TO THE PATIENT....EDUCATE ABOUT IS EVERY DAY FOR THE REST OF YOUR LIFE.
48
PRE OP TEACHING
expalin
- OR IS COLD
- LOTS OF BRIGHT LIGHTS
- ASPECTIC SMELL
- LOTS OF NOISE
49
PRE OP TEACHING PROCESS
- TRANSFER TO THE HOLDING AREA
- VISIT BY NURSE, ANESTHESIA CARE PROVIDER
- VISIT BY SURGEON-HE WILL MARK THE SITE AND SIDE
- ASKED to move on narrow bed with strap over thighs.
- Walking up in the PACU (Family can come visit now.
50
Cardiovascular system
- Vitals recorded pre opertively for baseline-HEAD TO TOE BEFORE THEY GO IN.
- Bleeding/clotting times
- Laboratory reports
- Possible prophylactic antibiotics
- Your patient has Hx of Cardiac disease what might you see ordered for thi9s patient (to assess for cardiac rhythm. Do all patients have this order. .
51
We will do a head to toe...
-We want to know if they have any HEART ISSUES or if they HAVE A PASTE MAKER.
-ARTIFICIAL VALVE or do they have any stents.
-ANY HEART ATTACKS....IF THEY ANSWER YES THEN WE WILL NEED AN EKG PRE GOING IN.
SHOULD ALREADY BE IN THE CHART AND IF NOT FIND OUT WHY. EVERYONE DOES NOT GET AN EKG ONLY IF THEIR IS A RISK.
52
ALSO, want to know if there was any blood thinners or BP MEDS and if SO
WHEN WAS THE LAST TIME THEY TOOK THEM.
-IF ELECTIVE SURGERY THEY WANT THEM OFF THE THINNER FOR 5 DAYS.
BP MEDS - THEY WILL HAVE THEM TAKE THEM THAT DAY.
WE DON'T WANT THEM TO EVEN TAKE BABY ASPIRIN PRIOR TO THE SURGERY.
53
RESPIRATORY SYSTEM WE TO KNOW
IF THEY HAD ANY COUGH-
IMOSTICES, any cough or anything thing comming up with that cough....do you have COPD or ASTHMA or do they SMOKE.
+PROCEDURE could be cancelled because of increasse risk of larygo/bronospacm or decrease SaO2.
+Chronic illness.
HOW LONG HAVE THEY SMOKED....GREATER PACK YEARS.....GREAT RISK....CAN'T SMOKE FOR SIX WEEKS.
(CONSTRICTS BLOOD VESSELS, LONGER TO HEAL.
54
IF YOU HAVE A PRODUCTIVE COUGH with GREEN SPUTUM who should you notify?
THE SURGEON.
| WHAT MIGHT THEY ORDER: SPUTUM CULTURE or MAY WANT TO ORDER A CHEST X RAY JUST TO SEE HOW THE SPUTUM GOES.
55
Nervous system you want to check
CHECK VISION or HEARING or understaind so if their is any deficits we can correct it....If they are having trouble with glasses get them or if they need a hear aid we need to get it. BEFORE GIVING THEM THE INFORMATION-IMPORTANT to commuicate with these patients.
56
Assess for any cognitive IMPARIMENTS
If patient is not congnitive make sure we have their care givers or power of attorney with them. Make sure we have it documented POWER of ATTORNEY.
57
Make sure they can concentrate or RESPOND
We need to tell them what we are doing before we do it. Or do it as we are doing it before they go to sleep.
58
Who can sign for a PATIENT
POWER OF AN ATTORNEY.
59
RENAL SYSTEM THEY MAY DO RENAL FUNCTION TEST
+CREATINE to make sure the kidneys are functioning so they can process the medications they will be getting.
60
Urinary system we want to ask?
If they had any trouble voiding. Let the TEAM KNOW if they do....We want to know if they have a UTI or a history of glomular nephritis. Problems if they have a strep infections.
61
We want to do a PREGNANCY TEST
Of anyone who is of child bearing age. Because Anestitia can harm the FETUS. So unless they can say absolutly prove they are not pregnant they SHOULD HAVE A TEST.
62
We are going to look at their FLUID and ELECTROLYTE BALANCES.
So we will CHECK SOIDIUM and POTASIUM......FOR HEART....MAJOR DYTHRIMTHMIAS.
63
BIG THING WITH THE KIDNEYS IS WE WANT TO MAKE SURE THEY CAN -METABOLIZE THE DRUGS we are giving them.
OK
64
Skin Integmentary SYSTEM
We are just looking at it to make sure we do not have any breakdown, we will not the color.
65
Remember that during surgery we are going to be in one situation for a long time so we want to look at the skin before hand to make sure that when we look at it afterwards their is no difference.
-Want to make sure everything is well padded. So there should be NO CHANGE IN THE SKIN....MAKE SURE WE GIVE A GOOD THROUGH SKIN ASSESSMENT because HOSPITALS don't get PAID NOW if a PROBLEM HAPPENS WITH THE SKIN.
66
MUSCULAR SKELETAL SYSTEM
Want to be aware that they can walk or can transfer themselves. IDENTIFY any JOINTS THAT ARE AFFECTED WITH ARTHRITIS.
67
MOBILITY RESTRICTION MAY AFFECT POSITION in THE OR.
So if they have a CONTRACTURER.....THEN WE NEED TO WORK AROUND it when we are working.
68
Someone may have some hardware and they don't have full range of motion so we don't want to take that arm and put it anywhere we want.
SO WE NEED TO ASSESS FOR ALL OF THAT.
69
ALL THE DIFFERENT SYSTEMS WE ARE ASSESSING WE WANT TO ASK THEM IF THERE ARE ANY METALS IN THEIR BODY ANYWHERE.
So do you have any after market parts.
70
We don't want to put the electrical carbo pad near any metal....
So if we know where metal is we keep it away from it.
71
So what if we have problems in the neck or lumbar spine as far as movement who do we report it to.....
ANETHESIOLOGIST in PARTICULAR......
72
Circulating NURSE is the ONLY ONE that is concerned about the WHOLE PATIENT.
The ANETHIASIOLOGIST is concerned with the HEAD and the air way...
+SURGION is concerned with the Knee they are working on.
SURGICAL TECH IS WITH THE DOCTOR and HE IS CONCERNED ONLY WHAT THE DOCTOR IS WORKING ON.
73
AFFECTING THE NECK will mean that the ANESTHISIOGIST will have some TROUBLE
Intubating or possissioning the head around so they need to know that if they have any hardware in their.
74
ENDOCRINE SYSTEM- THE BIG THING WE ARE WORRIED ABOUT IS.
DIEBETES- and IF THEY HAVE IT DID THEY TAKE THEIR INSULIN THIS MORNING OR NOT.
75
Anethisiogilist care provider will determine if they need their PREOP INSULIN
And it will be monitored and treated throughout the surgery.
76
NPO since MIDNIGHT....WHY WOULD THEIR SUGAR BE UP...
STRESS as a response to SURGERY. Patients will always be asking.....and they will ask why their sugar is so high....YOU NEED TO COMMUICATE that STRESS of the HOSPITAL and the SURGERY raises the GLUCLOSE LEVEL.
77
With DIEBETES we are concerned with WOUND HEALING and INFECTION
Those are two big complications with DIEBETICS.
78
We also want to give their baseline GLUCLOSE PRIOR TO SURGERY.
OK
79
SLIDING SCALE FOR INSULIN
ALL SLIDING SCALES ARE DIFFERENT FOR EACH PATIENT...THEY ARE INDIVIDUAL.
80
FLUID AND ELECTROLYTE- VOMITING AND DIAREA......CAN CAUSE IMBALANCE, also SOME DRUGS THAT ALTHER ELECTROLYTES LIKE DIURETICS.
DIERETICS MAKE YOU LOSE SODIUM AND POTASSIUM>
81
Some DRUGS ELEVATE ELECTROLYTES.
CHART ON 111 and 206 deal with how different medications and HERBS AFFECT DIFFERENT BODY SYSTEMS.
82
Bowl PREPS.
Something else that can affect electrolytes.....similar to DIAREAHA and that makes you lose electrolytes.
83
EVIDENCE BASED PRACTICE shows that clear FLUIDS up till 2 HOURS BEFORE THE OPERATION is OK but that is not always the PRACTICE.
There are things always constantly changing and that is why you need to read the journals.
84
If someone is NPO fluid restriction they are at RISK FOR
DEHYDRATION or FLUID VOLUME DEFICIT.
85
POOR NUTIRICIAN AND DEHYDRATION will BOTH AFFECT WOUND HEALING.
Want to make sure they are adequetly fed and hydrated as possible.
86
OLD LADY IN A NURSING HOME IS MALNURISHED AND DEHYDRATED BREAKS HER HIP WHAT ARE WE GOING TO DO...
Get her better NUTRICIAN and HYDRATE HER BEFORE WE do HER SURGERY.
87
CARDIVASCUALY- THEY are going to have a LOW CARDIAC OUTPUT WHAT IS THE FORMULA FOR CARDIAC OUTPUT.
Cardiac Output= STROKE VOLUME x HEART RATE
88
CARDIVASCULAR-ELDERLY
DROP in cardiac output and increase in BP
Decrease in Peripheral ciruculation, arrthimias
Related to loss of ELASTICITY IN BLOOD VESSELS OR THEY MAY BE PARTIALLY CLOGGED.
89
Repiratory-ELDERLY
Decrease in VITAL CAPACITY the amount of air they can move.
90
RENAL-ELDERLY
LOWER GFR, and RENAL BLOOD FLOW.
91
Muscular Skeletal-ELDERLY
LEAN BODY MASS, OSTEOPOROSIS, OA
92
THINGS IN SURGERY are Very different for the Very old and very young
Keep in mind this because they have these deficitis
93
Legal Consent who's responsibility
The Surgeon-Need to educate patient about it and answer questions.
94
CONSENT has to have on it
Diagnosis and Nature and purpose of the TREATMENT
95
Three KEY WORDS for EVERY CONSENT
RISK, PURPOSE and ALTERNATIVES
96
RISK- YOU CAN DIE
PURPOSE- YOU CAN GET BETTER
ALTERNATIVES- We can wait and see what things happen.
OK
97
Probability of SUCCESS
Doctors say one thing and patients here another. In my experience about 80% have improved....Patient will hear that there is an 80 percent they will be fine...patients want to hold the doctor to it.
98
Sufficient Comprehension
Patient has to demonstrate a clear understanding on what is going to happen. That is why we ask them everywhere and what they are having done and make sure they understand that they know what they are having done...and they are there on a voluntary basis and have not been cohersed by anyone like a family memeber or doctor.
99
If they do not speak English get an interpreter Or concent should be in spanish.
Make sure form is in Spanish if they speak spanish or maybe Arabic now that there are so many middle easterners.
100
Who should interpretor not be...
Family members.
101
Make sure conscent is signed by both SURGEON and PATIENT.
Sometimes a NURSE may be asked to sign as a witness and that means that YES that is the PATIENT SIGNATURE. ONLY...
102
So legal PREPERATION make sure ALL THESE INFORMED CONSCENT ARE IN THE CHART.
That means they are INFORMED ABOUT IT.
103
Maybe a second conscent for BLOOD TRANSFUSION- ADVANCE DIRECTIVES always ask for patient if they have an advance directive. IF they don't have ONE WE CAN GIVE THEM A FORM...
On the SPOT.....
104
may be a legal representive for a child or a mentally incompetent patient.
Permission maybe withdrawn at any time.
105
What if there is a MEDICAL EMERGENCY
LIFE OR DEATH SURGION can document that and DO IT.
106
Urinalysis- ASSESS
assess renal status, hydration, urinary track infection and disease.
107
Chest X ray-ASSESS
Pulmonary disorders Cardiac enlargement
108
BLOOD STUDIES, RBC, HB, HCT, WBC, differential
Anmeia, immune status, infection
109
ABGs Oximetry
Pulmonary and metabolic functions
110
Pt, PTT, INR, Platelet count
Bleeding tendencies
111
ABG's oximetry
Pulmonary and metablic functions
112
Blood Gluclose
Metabolic Status, diabetes melitus
113
Creatine
Renal Functions
114
Blood urea nitrogen
Renal Functions
115
Serum Albumin
Nutritional Status
116
Electrocardigram
Cardiac disease electrolyte abnormalitis
117
Pulmonary functions studies
Pulmonary status
118
Liver function tests
Liver functions
119
Type and cross match
Blood available for replacement (elective surgery patients may have own blood availalble)
120
hCG
Pregnancy.
121
All required forms are signed and in the Chart
- Informed consent
- Blood transfusions
- Advance directive
- Power of attorney
122
Surgeon responsible for obtaining conscent
Nurse may obtain and witness signature.
- Verify patient has understanding
- Permission may be withdrawn at anytime
123
HAIR REMOVAL IN THE OR
| SKIN PREPS
CLIPPERS with GUARD or NOTHING ONLY
REALLY HAIRY CLIPPER OR JUST DO NOTHING
124
SKIN CLEANSING
THEY MAY HAVE THE CNN DO AN ANTIBACTERIA WASH
125
BIG THING WITH PREP HAND WASHING
IS THE MOTION OR FRICTION...YES CHEMICALS INVOLVED BUT ALSO THE FRICTION
126
ANTIMICROBIAL PAINT
NORMALLY IODINE BASE, SPONGES ON A STICK AND YOU JUST PAINT IT ON....USUALLY USE FOR GU PROCECURES......PERINEAL AREA
127
CHLORAPREP
HAS A LOT PUSH DOWN ON IT AND SCRUB FROM INSIDE OUT....CHLORHEXADINE- ALCHOHAL base so you don't want to use it around MUCOUS MEMBRAINES. or CHOLOPREP
128
CHLOROHEXADINE IS ALCHOHAL BASE...MAKE SURE IT IS DRY---ELECTORCARDIA SPARKS, wait for PREPS TO DRY
CAN CAUSE A FIRE
129
DIRTY TO CLEAN- CIRCLE OUT
That is how we PREP, push down so some of the juices go into the belly button.
130
Bowl PREPS
+It is all needed to be very clear and clean.
131
Cathatics
+TASTE BAD and MAKES YOU GO TO THE RESTROOM- THEY NEED TO DO AN 8 oz glass an hour and it helps if it is cold.
132
Rest and Sleep
We want them well rested....we want to allow them to rest...when they are out on the table it is not really restful.
133
Pharmacodynamics
What drug does to the body
134
Pharmoacokinetics
What the body does to the drug.
135
Benzoidiazines
Versed, Vallium and Atrivan
136
Properties of Benzoidzepines
-Relieves anxiety
-Induce sleep
-Produces amnesia
-Does not have analgesic properties
-Metabolized by the liver
-Rapidly absorbed
-Make you drowsy and ATAXIA
_INCREASE EFFECTS OF OTHER DRUGS
137
Versed gives YOU ADMESIA- CAN RESPOND AND TURN AND MOVE but will not remember any of it.
FROM TIME IT HITS YOU.
| -GIVEN FOR CHOLENSCOPY or ANDOSCOPY
138
BENZOIDAZEPINES COMBINED WITH OPIOTES, AGENTS INCREASE the effect of the other drug increaseing risk of resp depression (Versed, Vallum, Atrium)
ok
139
Benzoidiazephines side effects
- CNS DEPRESSION
- REPRIRATORY DEPRESSION
- HYPOTENSION
- Bradycardia
- Drowiness and ataxia
- fatigue and confusion
- Weakness and dizziness
140
What is the Reversal Agent for Bezoidiazephine
FLUMAZENIL (Romazicon)
141
Adjuncts to General Anethsia
| OPIOIDS
Opiods (Morphine, Dmeral, Fentanyl)
- Properties
- Analygesics and sedation
142
OPIODS SIDE EFFECTS
- RESPIRATORY DEPRESSION
- Nasea and vomiting
- Drowsiness
- Hypostension, orthstaic hypotension
- Bronschospasm in athmatics
- Metabolized by the liver
- Excreted in Kidneys
- Reversal agent: Naloxone (Narcon)
143
Histamines (H2) receptor agtangonists (Tagamet, Pepcid, Zantac, Prilosec, Prevacid)
Properties inhibit gastric acid secretion
| -abaialbe in oral and parteral (IM, IV) Preperations
144
Side effect of Histamines (H2)
- Skin rash (hyperseensitivity
| - Decrease RBC's and WBC's Platelet synthesis
145
Nursing Care of Histamines (h2)
- Do not administer at same as antacids
| - Give ORAL preperation with meals.
146
OPIODS is the main pain killer
Sometimes they give them in combination like Versed and Fetnaly.....
147
OPIODS REVERSAL AGENT
NARCAN- Naloxone- WAKES THEM UP but it reverses the pain relief effects as well. CANCEL IT OUT....BE READY TO RESTRAIN because they may wake up flaling and yelling.
148
Antiemtics (reglan, Droperidrol, Zofran, Phenergan
Properties
- Alleviate nausea and vomiting
- Available in oral, parentaeral (IM, IV). rectal and transdermal.
149
Side effects of ANtimetics
- Drowsiness (CNS depression)
- Hypotension
- Dry Mouth
- Blurred vision (dilation from antircholingeric)
- In coordination
150
Antichollernergic (Atropine, Glycopyrolate, Scopoline)
- Decrease salivation
- Prevents badycardia
- Inhibi smooth muscle contraction in the GI tract.
- Avaialble in oral and parentaer (IM, IV) preperation
151
Anticholinergics (Atropine, Glycopyrolate, Scopolamine) Side EFFECTS
- Related to decrease paraympatheric stimulation.
- Decrease persiialsis
- Urinary retention
- CNS disturbances
152
Which class of drugs has a side effect of respiratory depression?
Opiods (morphine, Demerol, Fentayl)
153
Pr-Op Check list
-Physical Exam on Chart
-Signed consent on Chart
-Pre op tests, labs on chart
-Preps done (skin, bowel
--Pt voided
Pre-op meds given
-Side rails up
-Charting completed
154
Pre-Check list 2
- Baseline vitals
- Consultation records
- Nurse's notes
- History and physically
155
Day of surgery Preperation
- Patients should not wear cosmetics
- Observation of skin color is important
- Remove nail polish for pulse oximeter
156
Day of Surgery Preperation
- Valuable returned to family member or locked up.
- Dentures, contact, protheses are removed
- Identification and allergy bands on wrist
157
Voids before surgery
- Preveents involuntary eleimation under anethsia or early postoperative recovery.
- Before medication is adminstration
158
You have medicated your patient with an opiod and now they are requesting to go to the restroom, what should you do...?
Use a bedpan.
159
Delegation
The transfer of responsibility for the performance of an activity to another individual while retaing accountability for the outcome.
160
Five Rights of Delegation
Right task
- One that can be delegated
- Right person
- One that is qualified to do the job
- Right communication
- Clearly state objective, expectations
- Right feedback
- evaluation during/after task completed
- Right time
161
Before Delegating
Pt. Condition
- Complexity of activity
- Potential for harm
- Degree of problem solving + innovation necessary
- Level of interaction required with pt.
- Capabilities of delegate
- Availability of other nurses to do task
162
Client Abuse
- Therapeutic Nurse-Client relationship
| - California responsibilities to abused clients.
163
Ciruclatory Nurse
-Responsible for the TIME OUTS
-Make sure all bony prominence are covered
-Checks on urinary output
-Doing all the charting
-
