Exam 1 Flashcards
preoperative phase
when the decision is made to do surgery till operation
intraoperative phase
in the operating room
postoperative phase
when the patient is admitted to PACU until the patient is released by the doctor from care
purposes for surgery
diagnostic, explorative, reconstruction, curative, transplant, or palliative (just to better quality of life)
urgency of surgery
emergent (right now), urgent (waiting 24- 48 hours), required (needs done within weeks/ months), elective (nothing is going to happen if you wait)
ectomy
removal
ostomy
creating an opening
plasty
repair or reconstruction
orraphy
suture or repair
scopy
looking into
nurse is responsible for ________ pre-op
knowing about the surgery, patients response to the stress, assess diagnostic testing, and provide a baseline to identify risks and complications
DNR may be _____ for surgery
suspended
pre-op diagnostic testing
CBC= RBC WBC platelets, EKG or ECG, glucose test, types and screen for blood replacement
sensory information
what the patient will feel hear smell and see
process information
the general flow
procedural information
exactly what’s going on with specific details
ways to prepare pt for surgery with teaching
walk through the surgical events, pain managment, deep breathing leg exercises, turing in bed
preop medications are used to
aid anesthetic, minimize respiratory tract and gastric secretions, relax pt, and reduce risk of infection
preop medications are the _____ thing you do
last
preop check list includes
documentation of diagonistic tests complete, preop medications given, VS complete, safety data (ID band, jewelry removed, last void, detures removed, informed consent, allergies, mark site)
most important goal preop
establish baseline data
nurses role in the informed consent is
to get the pt signiture and be a witness
3 zones of surgical suit
unrestircted area (street clothes), semi restricted area (scrubs and caps), restricted area (full gear)
holding area nurse
reviews chart, preop procedures (IV lines), cares for pt while in this area
circulating nurse
should be an RN, coordinates and oversees clients care while in OR, sets up the OR, does documentation, positions pt, preps site
scrub nurse
is sterile, preps instrament table, gowns rest of team, monitors aseptic technique
patient skin prep
makes skin as free as possible from microorganisms, starts with scrubing at the surgical site and is extended outward in a circular fashion
surgical time out
to verify the right pt procedure and site, ask the pt
the most comon potential threat to pt safety related to electrical devices are
electric shock and burns
when are instrument counts done?
before the procedure, before closure of a body cavitivy, before wound closure, at skin closure, and with staff change by both scrub and circulating nurse
classifications of anesthesia
general (sleep), regional (epidural), local (at site, lidicain for IV), monitored anesthesia care MAC (colonoscopy)
catastrophic events in OR
anaphylactic reactions, malignant hyperthermia
anaphylactic reactions
severe allergic reaction, causes hypotension tachycardia and bronchospasms
malignant hyperthermia
genetic, hyperthermia and rigidity of muscles hypotension heart arrhythmias
occurs when given certain anesthetic agents
treatment of MH
stop inhalation agents, 100% O2, give dantrolene sodium IV, cooling techniques, monitor closely
initial assessments in PACU
respitory and cardiovascular status, level of consciousness, pain managment, gastrointestinal, genitrourinary, skin integrity/ incision, temperature, activity, IV, drains and tubes
assessment from PACU to unit
stable VS, orientation, uncompromised pulmonary function, urine output, N/V, minimal pain
hypoxemia (decreased O2)
restlessness, dyspnea, diaphoresis, trachycardia, hypertension, cyanosis
atelectasis
collapse of alveoli and the surrounding airways, crackles and cough
pneumonia
inflammation of lung parenchma caused by virus bacteria or other organism
potential problems post op
hemorrhage, shock, thrombophlebitis, pulmonary embolism, fluid retention, syncope
cardiac problems on the clinical unit
fluid retention from stress response, fluid overload when IV is too rapid, fluid deficit from inadequate fluid replacement
hemorrhage
restlessness, weak rapid pulse, hypotension, tachycardia, cool clammy skin, reduced urine output
interventions for hemorrhage
apply pressure to site that is bleeding, notify MD, administer O2, administer IV fluids and blood replacement, prep for return to surgery if needed
interventions for shock
elevate legs, notify MD, determine and treat cause, monitor VS and intake/output, administer IV fluids Blood replacement and colloid solutions as prescribed
deep vein thrombosis
Virchow’s triad- venous stasis, hypercoagubility, injury to vessel.
clinical manifestations of DVT
most asymptomatic, pain/swelling on calf or thigh, slight fever with chills and perspiration, circulation distal to the DVT may be compromised
pulmonary embolism
sudden dyspnea, sudden sharp chest or upper abdomen pain, cyanosis, tachycardia, decreased BP
interventions for PE
notify MD, monitor VS, administer O2 and medication
maximal post op pain occurs between ___ and ___ hours after surgery
12, 36
wound dehiscence
partial to complete separation of wound edges
wound evisceration
protrusion of internal organ through incision and onto the skin
Hemoglobin
vehicle for oxygen and c02 transport (gas carrying capacity of RBC), increased levels can be from smoking
hemoglobin normal levels
male 14-18 g/dl, female 12-16 g/dl
hematocrit
percent of RBC compared to total blood volume, normally 3times the hemoglobin value
normal levels hematocrit
male 40%-54%, female 38%- 47%
Red blood cell count normal levels
male 4.5-6, female 4-5
MCV
mean corpuscular volume
MCH
mean corpuscular hemoglobin
MCHC
mean corpuscular hemoglobin concentration
RDW
red blood cell distribution width
MVC MCH MCHC RDW are used to
classify anemia and understand the cause
White blood cell count
number of leukocytes in 1 cubic mm of blood, the body’s main line of defense
WCB normal levels
5000- 10,000 mm3
white blood cell count differential
measures % of each type of leukocyte
lymphocytes are ____ to ___ % of WBC
20, 40 (t cells and b cells from fighting chronic infection or acute viral infection)
neutrophils
50-70% (acute infection or trauma), are the first responder, immature (blasts) juvenile (bands) mature (polys)
order (by amount) of WBC
Neutrophils, Lymphocytes, Monocytes, Eosinophil, and Basophils (Never Let Momma Eat Beans)
platelet count
needed for blood clotting, adult level 150,000-400,000 mm3
C-reactive protein
helps diagnose inflammatory diseases infection and widespread malignancy
Prothrombin Time (PT)
assessment of extrinsic coagulation by measurement of factors I II V VII and X, measures amount of time for clot formation
Warfarin (Coumoadin)
decreases clotting, oral, PT INR
Heparin
decrease clotting, given sub q or IV, antidote is protamine sulfate
Prothromdin time normal value
11-12.5 seconds (with full anticoagulation therapy 1.5-2 times control)
International Normalized Ratio
standard system of reporting PT, therapeutic INR is 2-3.5
Active Partial Thromboplastin Time
asses the intrinsic system for clotting, normal values 30-40 seconds
Blood Urea Nitrogen
primarily used to determine renal function, normal levels 10-20 mg/dl
creatinine
tells if renal disease/ out side factors don’t effect, male levels 0.6-1.2 mg/dl, female levels 0.5-1.1 mg/dl
if BUN is elevated with normal Creatinine
sign of dehydration
if bun and creatinine are elevated
kidney failure
to infuse blood you need at least a ____ gauge needle
18
blood should be transfused at no more than
2ml/min
whole blood infusion should be done in
3-4 hrs
RBC infusion should be done in
2-4 hrs
fresh frozen plasma should be given
as quickly as possible
hemolytic reaction
given the wrong blood, starts with lower back pain
