Class 2 TLO 2.6 Safety/Perioperative Flashcards
Surgical risk/considerations factors
Smoking Age Nutrition Obesity Obstructive sleep apnea fluid/electrolyte imbalance Postoperative N/V Venous thromboembolism Low socioeconomic status ETOH/substance abuse Diabetes Immunosuppression Nicotine use Renal/liver disorders Respiratory disorders Medications/OTC Thromboembolism Hypothermia Surgical site Infection
Response to surgical stress
GAS vasoconstriction increased pulse, BP, cardiac output Na and H20 retention increased gastric acidity broncho dilation protein catabolism increased blood glucose increased cortisol, inflammatory response increased metabolic
Components of medical history
past illnesses/surgeries primary reason why seeking medical care medical conditions surgical medical risks family history (anesthetic complications medications/OTC
Four types of anesthesia
General anesthesia
Regional Anesthesia
Conscious sedation
Monitored anesthesia care (MAC)
General anesthesia
Advantages vs Disadvantages
Advantages:
Rapid excretion = prompt reversal
All ages
All types of surgery
Disadvantages: Circulatory Respiratory Hepatic/renal side effects Malignant hyperthermia
What is Malignant hyperthermia
Rare genetic disorder
Can develop during/after surgery
Manifestations of Malignant Hyperthermia
Unexplained rise in ETCO2 Rapid temp rise as high as 109.4 Tachycardia Tachypnea Muscle stiffness Cardiac dysrhythmias If left untreated: hyperkalemia myoglobinuria DIC (Disseminated intravascular coagulation) CHF bowel ischemia
Malignant Hyperthermia NI
Oxygen admin IV access Dantrolene admin (muscle relaxant) Measures to decrease body temp Urinary cath I/O
What is regional anesthesia
Produces analgesia
Reflex loss/muscle relaxation in area of body
No loss of consciousness
Regional anesthesia
4 types
Local nerve infiltration- numbing local nerves
Nerve block- numbing at nerve trunk, larger areas
Epidural block- injected into epidural space with cath, can be left in place
Spinal anesthesia- similar to epidural but is single shot
Conscious sedation
Altered LOC Maintain own airway Responds to stimuli Reversal agents handy Initiate rescue intervention if needed
Monitored Anesthesia Care (MAC)
Safe admin of max depth of sedation in excess of that provided during conscious sedation
Ability to adjust from full consciousness to general anesthesia
Preop Consideration
PATIENT RISKS
Medication interactions Thromboembolism Hypothermia Surgical site infection Pressure injuries/positioning Cardiac event
Common lab test for surgery
CBC Hemoglobin A1C PTT/PT/INR UA CMP Liver function test Hematocrit
Common diagnostic for surgery
Chest X ray
ECG
Post surgical complications
ATELECTASIS
Incomplete expansion of lung tissue Inadequate ventilation/retention of secretions S/S elevated RR fever SOB/restlessness/anxiety dimished Ls/crackles productive cough NI cough and deep breathing ambulate inspirex
Post surgical complications
PNEUMONIA
Inflammation of lung tissue caused by infection, retained secretions, foreign substance S/S chills/fever tachycardia, tachypnea productive cough dyspnea, SOB, chest pain crackles/wheezes NI V/S, O2 sat, O2 as ordered elevate HOB inspirex hydration
Post surgical complications
DVT
Formation of blood clot in association with inflammation deep veins S/S cramping in calf/thigh localized tenderness redness/edema slightly increased temp dull aching pain when ambulating NI early ambulation anticoags IPC's/TED hose elevate FOB avoid crossing legs tight clothing
Post surgical complications
PULMONARY EMBOLUS
Dislodged blood clot or other substance that lodges in pulmonary artery S/S dyspnea sudden chest pain anxiety/restlessness rapid respiration tachycardia drop in BP cyanosis NI notify doctor STAT O2 saturation HOB up
Post surgical complications
HEMORRHAGE
Excess loss of blood S/S depends on amount restlessness/anxiety weak/rapid pulse cool/clammy skin rapid breathing decreased urine output NI pressure on bleeding notify doctor IV fluids
Post surgical complications
HYPOVOLEMIC SHOCK
Lack of blood flow to vital organs S/S altered LOC/confusion restlessness tachycardia tachypnea weak thready pulse hypotension low urine output cool/clammy pale skin NI IVF V/S O2 notify provider
Post surgical complications
GASTROINTESTINAL
N/V, constipation, abdominal distention, paralytic ileus (non mechanical bowel obstruction with no bowel sounds) S/S hypoactive/absent BS no flatus enlarged abdomen pain NI medicate ambulate insert NG if ordered NPO until return of bowel sounds
Post surgical complications
URINARY RETENTION
URINARY TRACT INFECTION
Retention: S/S inability to void/empty restlessness bladder distention UTI: S/S dysuria itching cloudy/foul smelling urine possible fever NI monitor I/O encourage fluids provide privacy to urinate assess distention bladder scan cath if ordered
Post surgical complications
WOUND INFECTION
Inflammation /drain from wound r/t microorganisms S/S swelling/redness/heat pain fever >100.4 (low grade temp= <100.1) foul smelling drainage/change in color ****usually appears 3-6 days after surgery IN notify provider aseptic/sterile with dressing change antibiotics as ordered teach s/s of infection
