Final Flashcards
Preoperative checklist
-Client teaching completed
-Consent form signed
-NPO (at least 8 hours/ordered time)
-In gown
-Allergy & ID bands on
-No jewelry, bands taped
-Voiding prior to transfer
-Pre op meds
-Side rails up after pre op
-Contact lens out
-Dentures/Bridges out
-Nail polish removed
-Vitals within 4 hrs of surgery or 30 min after pre op
-Pre op lab values
-Skin prep
-Hx of aspirin (antidepressant, steroids, NSAIDs)
Meds that can be take Preoperatively
-Insulin (1/2 of normal dose if CBG is >150)
-GERD meds
-Thyroid meds
-Respiratory Inhaler
-Heart meds
-BP meds
-Anticonvulsants
Preoperative Labs
-WBC: 5,000-12,000
-H&H
-RBC
-Platelets: 150,000-450,000
-CBG
-Potassium
-HCG (female 12-55)
Preoperative contraindications
-Not NPO
-Potassium less than 3.2
-Platelets less than 50,000
Time out
-Right person
-Right site
-Right procedure
-Sign, date, time
Informed consent
- Must be informed
-Adequate disclosure of diagnosis
-Nature and response
-Risks and consequences, prob. of success - Must be competent
-Not competent if unconscious, insane, can’t read, write, or heat, under the influence - Decision is voluntary
Nurses responsibility is to assess competency and understanding.
Local anesthesia effects
-Local doesn’t reduce consciousness but blunt sensation only in a limited area.
-Generally use local ester (Procaine) or aime (Lidocaine, Xylocaine)
-Sequence in which perception or sensation is lost : pain, cold, warmth, touch, then deep pressure
-
Regional anesthesia (Epidural)
-AE: hypotension, N/V, penetrate dura, prolong labor=potential bradycardia and CNS depression in neonate, delay ambulation
Regional anesthesia (Spinal)
-AE: hypotension, N/V, spinal fluid leak = HA, muscle paralysis, duramorph-respiratory depression
-Keep patient in recumbent position to decrease HA, migration of spinal agent (resp. depr)
-Can give fluids, caffeine for HA
Pain/Sedation medication and assessment
-General assessment = OLDCART
-Adjuvant analgesic are corticosteroids, anti-inflammatory(ibuprofen/ketorlac), acetaminophen, neuropathic (Gabapentin)
-Need RR to be 10+
-Need systolic >100 mmHg
Priority actions in PACU
Cardiopulmonary Assessment:
-A AIRWAY PATENCY
-B BREATHING
-C CIRCULATION
-D DOING
Phase 1 : Recovery 1 hr
-Extubation/Airway (ABCD)
-Pulse ox, continuous
-Cardiorespiratory monitor
-Document P,RR(10 or higher),BP, q5-15 min
-Manage SE/AE, pain, n/v, temp (want 35.5)
Postop teaching
-Don’t drive for 48 hrs
-Meds to not give
-Coughing and breathing
-
What to report to surgeon?
-Temp >38C, 100.4F
-RR<10, O2 sat <93, respiratory distress
-Change LOC
-HR <60, >120
-New arrhythmia
-Hypotension <90
-Hypertension 20-30% above baseline
-Chest pain
-Pain uncontrolled
-Abdominal distension, uncontrolled vomiting
-UO <30/hr or 0.5ml/kg/hr
-Excessive bleeding, drainage, redness, purulent
-Absence of pulses, swelling, redness calf
-S&S malignant hyperthermia
Malignant hyperthermia
-Triggered from inhaled anesthesia or succs
-Muscle are rigid, spasm, hypercalcemic muscles, and hypermetabolic state which leads to hypercarbia and metabolic acidosis
-Antidote = Dantrolene sodium IV
Postop interventions
Initial nursing assessment when receive patient:
-VS q30min x2, then 1hr x2
-Head to toe
-Focused site
-Re-positioning
Ongoing interventions:
-I&O q8-12 hr shift/24 hr
-Hydration/IV
-NPO/Ice chips/Advance diet as ordered/tolerated
-Restart routine/home meds–timing
-Elderly alterations
-Shift, then focused assessment
-Assess incision/wound 4hr
-Dressing change/drains daily
-Progressive ambulation/activity
-Up by 8hr usu unless restricted
-Up in chair for meals
Purpose of Preoprative Interview and Assessment
To obtain baseline data, identify potential problems, validate patients understaning of the procedure and anesthesia, and assess the patients emotinal state and readiness.
Nursing Preoperative Interview
Past Medical History:
-BMI > 44 anesthesia must see
-Pre-existing disease
-Sleep apnea hx or sx
-Allergies
Previous Surgery:
-Type, complications
-Anesthesia history
-Malignant hyperthermia (Succinylcholine and volatile inhaled anesthetics)
Address Medications:
-Antibiotics
-Anticoagulants
-Anticonvulsants- can have a reaction with anasthesia
-Antidysrhythmics
-Antihypertensives
-Corticosteroids- suppress immune system
-Diuretics
-Herbal / CAM
-Vitamins
-Hypoglycemic
-NSAIDS
Preoperative Medications that need to be stopped
-All containdicated meds need to be stopped 2-7 days prior
-CAM/Herbal supplements need to be stopped 2-3 weeks before surgery
-High dose asprin (anticoagulant) needs to be stopped at least 48 hours prior
-Vitamins and mineral supplements should be taken until the day before
Preoperative Assessments
Systems:
-Cardiovascular
-Respiratory
-Neurologic
-Gastrointestinal
—Hepatic
-Genitourinary
-Musculoskeletal
-Immune
Nutritional:
-Balanced / adequate
-Increased Protein/Albumin > 3.0
–Protein supplemented
—Meat, seafood, whole grains, nuts, seeds
–Vitamins A, C, & B complex
-Stop Vit E and fish oil supplements 5 days before surgery
Tobaco Use:
-Do they smoke?
-How much do the smoke?
-Do they live with or work with smokers?
-Are you expose to respiratory irritants in your workplace
-Are there other pollutants in your workplace
-Do you want to quit?
–Any clients who want to quit must be given smoking cessation kit and referrals
Alcohol Assessment:
-How often do you have a drink containing alcohol? (or use recreational drugs of any kind)? When did you last use?
-Have you felt you ought to cut down on your drinking (or drug use)?
-Have people annoyed you by criticizing your drinking (or drug use)?
-Have you felt bad or guilty about your drinking (or drug use)?
-Have you ever had a drink (or used drugs) first thing in the morning to steady your nerves or get rid of a hangover (get the day started)?
