Exam 3 Flashcards
Blockage of multiple nerves around surgical site
Regional Anesthesia
- A series of injections around the operative field
- Most commonly used for chest procedures, hernia repair, dental surgery, and some plastic surgeries
Field Block
- Injection of the local anesthetic agent into or around one nerve or group of nerves in the involved area
- Most commonly used for limb surgery or to relieve chronic pain
Nerve Block
- Injection of an anesthetic agent into the cerebrospinal fluid in the subarachnoid space
- Most commonly used for lower abdominal, pelvic, hip, and knee surgery
Spinal Anesthesia
- Injection of an agent into the epidural space
- Most commonly used for anorectal, vaginal, perineal, hip, and lower extremity surgeries
Epidural Anesthesia
Metallic taste
Systemic absorption, CNS stimulation
- Reversible loss of consciousness achieved by singular or plural agents
- Analgesia and amnesia
- Retching, emesis & restlessness may occur during emergence – have suction ready
- Shivering, rigidity, and slight cyanosis may occur during recovery – warm blankets, radiate lights and oxygen
General Anesthesia
- Certified RNs admin IV sedatives, hypnotics, and opioids
- Pts can maintain airway and respond commands
- Vitals, LOC, O2 sats, ECG, capnography are taken every 15-30 minutes
- PO intake may resume 30 post sedation
- Pts can be discharged home with a Ramsay Scale score of 2=cooperative, calm, oriented
Conscious/Moderate Sedation
Increase capillary fragility
Long term steroids
Fluoroquinolones
Tendon rupture
Succinylcholine, a depolarizing blocker agent
Document general muscle twitching, it’s normal
RNs who coordinate, oversee, and are involved in the client’s nursing care in the operating room.
Circulating nurses or “circulators”
Manage the client’s care before surgery.
Holding area RNs
Set up the sterile field, drape the client, and hand sterile supplies, sterile equipment, and instruments to the surgeon and the assistant.
Scrub RNs
Sanguineous drainage is okay for how long after surgery?
5 days. Crusting is okay
Post surgical pain is usually worst when?
2nd day post op
Assess what for bandemia or left shift as sign of infection
WBC
Post op clients do IS how often?
Every 1-2 hrs
Secure the airway and IV access before starting antagonist therapy.
• Prepare to administer flumazenil (Romazicon)* in a dose of 0.2 mg to 1 mg IV.
• Repeat drug every 2 to 3 minutes up to 3 mg, as needed, depending on the patient’s response.
Benzodiazapine Overdose
Post op wound care
Transparent dressing stay in place for 3-6 days
Use Montgomery straps when indicatedClean suture lines every shift with normal saline or whatever is prescribed by the MD or policy
Offer pain meds before wound care or pulling drains.
Remove sutures or staples (day5-10 per order)
Clean
Remove every other on first day then the others the next day
Use steri strips when indicated
Dehiscence/Evisceration
Cover with a sterile moist dressing, bend knees, avoid coughing, call surgeon
Post op pain assessment
Give opioids with caution as they may mask anesthetic responses
Document pain response 5-10 min after IV injection
Around the clock pain meds are best
No knee gatch or pillows under knees
Don’t massage calves
Opioid overdose
Prepare to administer naloxone hydrochloride (Narcan)* in a dose of 1 to 2 mg IV.
• Repeat naloxone every 2 to 3 minutes up to 10 mg, as needed, depending on the patient’s response.
Post op diet to promote wound healing
High in protein, Vitamin C, zinc, and calories
Cardiac Output
amount of blood pumped from the left ventricle each minute
CO=Heart Rate X Stroke Volume
Normal CO is 4-7 liters/minute
Stroke Volume
amount of blood ejected by the left ventricle during each contraction.
Determined by the amount of RESISTANCE the ventricles must overcome to eject blood through the semilunar valves into the peripheral blood vessels
Afterload
Determined by the VOLUME of blood returning from the venous and pulmonary systems
Preload
Is the FORCE of cardiac contraction independent of preload
Myocardial contractility
cardiac output X peripheral vascular resistance
Blood Pressure
RETURNS the blood to the right side of the heart
Veins
Deliver oxygen and nutrients
Arteries
Pumps blood out of heart
Left Ventricle
More cardio deaths
American Indians, Alaska Natives
Triglycerides desired range
<150
HDL desired range
> 40
LDL desired range
<100 in moderate risk pts
Cardiac Cath Surgery
Performed in “Cath Lab”
Local Anesthesia
Instruct patient to report chest pain or pressure
Catheter inserted through:
Femoral VEIN to superior vena cava (Right heart only)
Basilic VEIN to superior vena cava (Right heart only)
Femoral or brachial ARTERY up the aorta into left heart
Echocardiography
Non-invasive Risk free Use of ultrasound waves to assess cardiac structure and mobility Cardiomyopathy Valvular disorders Pericardial effusion LV function Ventricular aneurysms
Transesophageal echo
Ultrasound transducer placed immediately behind the heart in the esophagus or stomach
Allows for a good look at the posterior cardiac structures
Splinter hemorrhages
Infective endocarditis
Often transmitted as a single-gene autosomal dominant trait
Hypertrophic cardiomyopathy
Usually from rheumatic carditis (developing countries) or is often congenital in industrialized countries causing valve thickening by fibrosis and calcification
Mitral Stenosis
Etiology varies-Marfan, family tendency, other congenital cardiac defects
Valve leaflets enlarge and prolapse into LA during systole
Usually benign but may progress to mitral regurgitation
Mitral Valve Prolapse
Most common in US and in all countries with aging populations
Disease of “wear and tear”, congenital, rheumatic disease, atherosclerosis
Aortic orifice narrows
Obstructs LV outflow during systole
Resistance leads to LV hypertrophy
Cannot meet demands of body during exertion
LV fails
Blood back up into LA-lungs-RHF
When valve surface 1cm or less EMERGENCY SURGERY!
Aortic Stenosis
Collect family history
Ask about rheumatic fever or endocarditis-obtain date of disease and whether or not patient used antibiotics
IV drug abuse?
Clue to infective endocarditis
Activity level
Vital signs, auscultation, palpation
-avoid MRIs, wear medicine alert bracelet
Valvular Heart Dz
Accomplished with cardiac bypass during open heart surgery
Surgeon visualizes valve
Removes thrombi from atria
Incises fused leaflets
Debrides calcium from the leaflets, widening the orifice
Direct Open Commissurotomy
Mitral regurgitation
Surgeon to make annulus (valve ring) smaller
May repair leaflets
Valve can close completely
Regurgitation eliminated or markedly reduced
Mitral Valve Annuloplasty (reconstruction)
Sensitivity Response
Develops after upper respiratory tract infection with group A beta-hemolytic streptococci
-pleural friction rub
Rheumatic Carditis
Replacement of myocardial tissue with fibrous and fatty tissue
1/3 of patients also have left ventricular disease
Familial association
Some have symptoms, others do not
Arrhythmogenic Right Ventricular Cardiomyopathy (dysplasia)
Restrictive filling during diastole
Restrictive Cardiomyopathy
Heart Transplant Requirements
Life expectancy less than 1 year < 65 years of age Normal or slightly increased PVR Absence of infection Stable psychosocial status No evidence of current drug or alcohol abuse
Monitor the patency of the graft by checking the extremity every 15 minutes for the first hour and then hourly for changes in color, temperature, and pulse intensity.
Compare the operative leg with the unaffected one. If the operative leg feels cold; becomes pale, ashen, or cyanotic; or has a decreased or absent pulse, contact the surgeon immediately!
May require emergency thrombectomy
Graft Occlusion
Initiate treatment promptly
Heparin therapy
Angiography
Surgical thrombectomy or embolectomy
Acute Peripheral Arterial Occlusion
