Intra-Operative & Post-Operative Panopto Flashcards
When do you give Anesthesia?
The Intra-Op Phase
Generally whenever a pt gets anesthesia, it will either be -
General Anesthesia
Regional Anesthesia
Moderate Sedation
Local Anesthesia
What type of Anesthesia used to be called Conscious Sedation?
Moderate Sedation
What does General Anesthesia cause a loss of?
Loss of Sensation, Protective Reflexes, and Consciousness
What type of anesthesia makes you enter an unconscious state to not feel pain and allow for amnesia of an event?
General Anesthesia
What route is used to give General Anesthesia?
Can be given via IV.
Can be given via Inhalation Agents (Nitrous Oxide) using a mask.
What’s the most commonly used Anesthetic Agent?
Propofol
What type of Anesthesia is Propofol used for?
General Anesthesia
What should you assess before giving Propofol?
Allergies (Allergy to Eggs + Soybean Oil are contraindicated)
When you give a pt General Anesthesia, what do you do to their airway?
Intubate them with an Endotracheal Tube
What does Regional Anesthesia cause a loss of?
Loss of sensation in a specific body area
What route can you use to give Regional Anesthesia?
Topical, Nerve Block, Local, Spinal, Epidural
Which types of Anesthesia don’t use the route of Inhalation?
Regional Anesthesia + Moderate Sedation
What is Regional Anesthesia used to prevent?
Post-Operative Pain
Regional Anesthesia is great for whenever a pt has to-
Have an Emergency Surgery whenever they haven’t been NPO
Does a pt need to be NPO before being given General Anesthesia?
Yes, to avoid Aspiration
Does a pt need to be NPO before being given Regional Anesthesia?
No (Hence why it’s good for Emergency Surgeries)
Does a pt need to be NPO before being given Moderate Sedation?
Yes
Does a pt need to be NPO before being given Local Anesthesia?
Yes
You have a pt come into the unit. They’re having a medical emergency and need prompt surgery. They have not been previously NPO.
Should you give them Regional Anesthesia or General Anesthesia?
Regional to avoid aspiration
With a Rotative Cuff surgery, what type of Anesthesia would you get?
You’ll still give General Anesthesia, but you’ll also give Regional Anesthesia to block the pain in that arm for the pt while they’re recovering Post-Operatively.
The pt should be awake when given which type of Anesthesia?
Moderate Sedation
What does Moderate Sedation cause?
A Depressed LOC
Moderate Sedation is considered to be-
Incomplete Anesthesia
What would you to the airway if someone taking Moderate Sedation?
Shouldn’t need to do anything to it
A person under Moderate Sedation can respond to Verbal Commands.
True or false?
True
What meds can you use to give Moderate Sedation?
Midazolam, Diazepam, Meperidine, or Fentanyl
Moderate Sedation is typically used when?
During an Endoscopy or a Cardiac Cath
Are RN’s ACLS Certified?
Yup
What does it mean to be ACLS Certified?
ACLS = Advanced Cardiovascular Life Support
What can RN’s administer for Moderate Sedation?
Opiates or Versed
What can RN’s not administer for Moderate Sedation?
Anesthetics or Paralyzing Agents
What are 2 Local Anesthetics that you can use for Local Anesthesia?
Procaine and Lidocaine
What is Local Anesthesia?
It’s when you give a pt a Local Anesthetic to numb a specific area
What’s the difference between Local Anesthesia and Regional Anesthesia?
They both cause Local Numbness, but you are numbing a smaller area with Local Anesthesia.
You can also take Local Anesthesia and still be actually conscious.
What is Dorsal Recumbent position?
It’s like laying supine, but your legs are bent a bit
Your Supine and Dorsal Recumbent Positions are used for-
Abdominal Surgery, Head and Neck Surgery, any Anterior Approach
What is Trendelenburg?
It’s when you elevate the foot of the bed above the head of the bead
What is Reverse Trendelenburg?
It’s when you elevate the head of the bed above the foot of the bed
If a patient is in a lateral position then they are-
On their side
What is Lithotomy Position?
Supine, but your legs are being lifted by stirrups
When should your pt be in a Prone position?
Whenever they’re having Spine Surgery or Rectal Surgery
What is Jackknife position?
You’re lying prone on a table that bends around where your hips should be
What is Jackknife position used for?
Proctology
The branch of medicine concerned with the anus or rectum =
Proctology
When is Reverse Trendelenburg used?
For Head and Neck procedures
What is used to prevent blood from pooling in the Reverse Trendelenburg position?
Sequential Compression Devices
What is Trendelenburg used for?
Used for Pelvic Surgery.
This is a shock position for Hypovolemic Shock pt’s.
When is Lateral position used?
Whenever you need access to the Thorax, Kidney, or Hip
What is the Lithotomy used for?
Perineal Surgery, Surgery around the Genitalia, Pelvic Surgery
Sitting or Semi-Fowler’s position is used for-
Cranial Surgery
What do you have to keep in mind about the different positions for surgeries?
You should make sure to protect them with straps and appropriate padding.
Make sure you identify the purpose and pressure areas with each.
Make sure to do surgical skin preparation.
Make sure to document.
When does Post-Op begin?
Immediately after surgery. Continues through discharge from medical care.
What is the focus of Post-Op care?
Protect the pt and prevent complications
What does PACU stand for?
Post-Anesthesia Care Unit
What are the requirements to enter the PACU?
There has to be a “Hand-Off Report” from the OR to any personnel in the PACU
The hand-off report from the OR to the PACU is a part of-
The National Patient Safety Goals
For the initial PACU assessment, what do you want to do?
Gather General Information (Identifiers, Type of Surgery, Type of Anesthesia)
Perform a full body assessment (Priority = Airway, Breathing, Circulation)
For Intra-Operative management, what are you going to look at?
What Meds were given, when was last dose of Opioid / Sedative given, Total Fluid Replacement (IV, Blood) and Fluid Loss, Urine Output, any Unexpected Events (Cardiac Arrhythmias? Abnormal Vitals? What Position were they in?), most recent vitals, evaluate LOC, fall risk, any Dressings or Drains present with pt?
What are things that a PACU nurse would want to monitor and manage?
What about a nurse in a Clinical Unit?
PACU:
Airway & Breathing + Circulation + Positioning + Surgical Wound / Incision Site / Wound Dressing + I&O + Vitals + Response to Anesthesia + Mentation + Pain.
Clinical Unit:
Airway & Breathing + Positioning + Fluid Status & Oral Comfort + Pain + Kidney Functioning + Bowel Functioning + Thromboembolism + Incisions & Drain Sites + Wound Healing + Discharge Teaching.
What are some Diagnostic Procedures?
CBC
Metabolic Profile (BUN, Creatinine)
ABGs
Glucose
Prothrombin Time
INR
Prothrombin Time and INR both deal with-
Blood Clotting
What are some risk factors for Post-Operative complications?
Immobility
Anemia
Hypovolemia
Hypothermia
CV Diseases
Respiratory Diseases
Immune Disorders
Diabetes mellitus
Coagulation Defect
Malnutrition
Obesity
Age-Related
What are some Post-Operative complications that can occur?
Airway Obstruction
Hypoxia
Hypovolemic Shock
Paralytic Ileus
Wound Dehiscence or Evisceration
Deep-Vein Thrombosis (DVT)
What are some Airway concerns?
Airway could be blocked by tongue, thick secretions, laryngeal edema
What PaO2 is indicative of Hypoxemia?
Under 80 mm Hg
What SpO2 is indicative of Hypoxemia?
Under 90%
What is Hypoventilation caused by?
Shallow, Decreased Respirations
Hypoxemia (Low pO2)
Hypercapnia (High pCO2)
Airway Obstruction, Hypoxemia, and Hypoventilation are all assessed for in the-
PACU
Your pt is at a high risk for respiratory problems if they-
Have General Anesthesia
Smoke
Have Lung Disease
Have had surgery to their Lungs or Upper Body
Are Elderly or Obese
In the PACU, you always want to listen to their lung sounds to make sure that they don’t have-
Atelectasis, Pneumonia, Pulmonary Embolism, or Aspiration
A Mucous Plug can cause-
Atelectasis
How do you prevent a Mucous Plug from forming?
Keep the jaw elevated and the head tilted back
What are the different types of Drains?
There’s a Jackson Pratt Drain (or a JP Drain), a Hemovac, and a Penrose Drain
With this type of drain, you pour the drainage into a measured cup of some sort and then you decompress it and put the plug back on =
Hemovac
This type of drain looks like a flexible straw. It goes into the wound and allows for the drainage to come out into the banadage or gauze =
Penrose Drain
67-year-old female, had colostomy with bowel resection for mass found in the intestines. She is taken to the PACU after
surgery, is extubated, and she begins to awaken from surgery.
Which nursing actions are needed to prevent respiratory complications in this patient?
Assessment?
Management/Nursing actions?
Assessment:
Assess Airway, Respiratory Rate and Quality, Chest Symmetry, Breath Sounds, Pulse Ox.
Monitor for signs and symptoms of Tachypnea, Hypoxemia, Hypercapnia, Tachypnea, Restlessness, and Confusion.
Observe Sputum Color & Thickness.
Management/ Nursing Actions:
Oxygen Therapy, Cough & Deep Breathing, Show how to Splint the incision, Incentive Spirometer, Change Position every 1-2 hrs, Ensure Adequate Hydration (Parenteral or Oral), Chest Physiotherapy (to help prevent building up secretions), Pain Management
Early Mobilization =
Less Complications
If you have an unconscious pt, you’ll want them in what kind of a position to avoid respiratory complications?
What about whenever they become conscious again?
Unconscious = Lateral Position
Conscious = Supine, HOB Up
If a pt has an airway obstruction, you may want to-
Reposition their head, or Perform Suctioning
What are some CV things that you’d want to look out for in the PACU?
Hypotension, Hypertension, Dysrhythmias
What are some CV things that you’d want to look out for in the Clinical Unit?
Post-Op Fluid & Electrolyte Imbalances
What things make you at a high risk for CV problems?
Poor Respiratory Function + History of Cardiac Disease + Elderly + Debilitated pt’s + Critically Ill pt’s
What is Hypotension characterized by?
Hypoperfusion to vital organs
What are causes of Hypotension?
Hemorrhage, Blood Loss + Fluid Loss
What’s the impact of Hypotension on the Brain?
Irritability, Disorientation, LOC
What’s the impact of Hypotension on the Heart?
Chest Pain
What’s the impact of Hypotension on the Kidneys?
Oliguria
What causes Hypertension?
SNS Stimulation (Pain, Anxiety, Distended Bladder)
Dysrhythmias
Post-Operatively on the Clinical Unit, Fluid Retention is-
A good thing
Why is fluid retention a good thing if you’re post-op and on the clinical unit?
From Stress and Response, to ADH Stimulation, this helps keep your BP and Blood Volume within limits
What are the pros and cons of Fluid Retention?
Pros: Maintains BP + Fluid Volume
Cons: Oliguria, potential for Fluid Overload
Fluid retention usually occurs when?
Post-op day 1-3
What can cause Venous Thromboembolism (VTE)?
Inactivity, Body Position, Pressure During + After Surgery
VTE is most common in-
Obese + Elderly Adults
VTE is assessed where?
In the Clinical Unit
67-year-old female, had colostomy with bowel resection for mass found in the intestines. She is taken to the PACU after
surgery, is extubated, and she begins to awaken from surgery.
Which nursing actions are needed to prevent CV in this patient?
CV Assessment?
CV Interventions?
Assessment:
Frequent vital sign monitoring (every 15 mins until stable), compare vitals every time they’re took to the baseline.
Report a systolic BP less than 90 or greater than 160, a pulse less than 60 or greater than 120.
Do continuous EKG monitoring. Report any changes in EKG.
Assess the surgical site for bleeding (Check the dressing & Under the pt).
Monitor I&O + Lab Results (Especially Potassium and Hemoglobin).
CV Interventions:
Oxygen Therapy, Early Ambulation + Leg Exercises, Treatment of Hypertension (by meds), IV Fluid replacement, May give Heparin or Enoxaparin for VTE, Monitor for Orthostatic BP, Monitor increases in mobility, Have pt’s change positions slowly
What is the single most important preventative for CV problems post-operatively?
Early Ambulation + Leg Exercises
Hypothermia is when your core temp reaches below-
96.8 Degrees
Hypothermia can be caused by-
The pt’s skin exposure combined with a low room temp in the O.R.
The use of cold irrigants.
Long Surgical Procedures + Anesthesia.
What can you expect in terms of fever during the first 48 hours Post-op?
A mild or moderate elevation of temp (Greater than or equal to 100.4 F), due to the inflammatory response.
A moderate elevation can cause Congestion + FVD
What can you expect in terms of fever during the third day Post-op?
It should be less than 100 F, if it’s higher then there’s likely to be an infection
When you have a rapid increase in temp to 105 or greater and severe muscle contractions that are caused by Anesthesia =
Malignant Hyperthermia
Malignant Hyperthermia is an adverse effect that usually occurs how long after the pt receives Anesthesia?
What is the latest it can occur?
As they are receiving it.
Can occur at the latest, 1 hr post-op.
Socks, blankets, reducing skin exposure are all examples of-
Passive Warming
External Air (like Forced Warm Air, Heated Water Mattress, Warmed IV Fluids) are all examples of-
Active Warming
How often should you measure the temp of a pt with Malignant Hyperthermia?
4 hours for the first day, then less if indicated
For a pt with Malignant Hyperthermia, you should promote-
Airway Clearance + Meticulous Asepsis
What things might you have to do for a pt with a fever?
Chest X Ray.
Administer Antipyretic Meds.
May have to Obtain Cultures (From blood, sputum, urine, or wound).
Give IV Antibiotics if they have a bacterial infection.
A temp over 103 = Need body cooling measures.
What are some common Post-Op GI problems?
Nausea & Vomiting, Postoperative Ileus
What causes a postoperative pt’s high risk for GI Complications?
It’s due to the actions of anesthetics or opioids and the duration of the surgery
Postoperative Nausea and Vomiting is due to the -
Or it can be because-
Handling of the intestine (bowel) with abdominal surgery.
Oral fluids were given too soon after surgery.
What are reasons for postoperative Constipations?
Opioids, Anesthesia, Immobility, Alterations in diet and fluid intake
Postoperative Ileus can also be called-
Paralytic Ileus
What can cause Paralytic Ileus?
Handling of the intestine w/abdominal surgery
Limited dietary intake pre- and post-op
Effects of general anesthesia
Opioid analgesia medication
When peristalsis stops (Peristalsis is the muscle contractions of the intestines to push food forward) =
Paralytic Ileus
A measure of physiologic recovery after anesthesia and includes gauging consciousness, activity, respiration, and blood pressure =
Aldrete Scoring System
What is the scoring like for the Aldrete Scoring System?
Can be given a 2, 1, or a 0. 2 is ideal, 0 is the least ideal
What are some expected urinary findings for a post-operative pt? Why?
Oliguria for the first day postoperative.
What is post-operative Oliguria caused by?
Stress response and ADH
NPO or combination of fluid restriction & fluid losses
Effects of anesthesia or opioids– depresses urge to void
Your urinary output when given a Foley catheter, should be at least-
0.5 mL per kg per hr
It’s typical that a pt will urinate how long after surgery?
You may need to use an-
6-8 Hours
In and out catheter. It is one time use, and should be removed within a day.
Should you scan with a bladder scan after surgery?
Yes
What will scanning with a bladder scan tell you?
How much residual urine is there in the bladder
What things should you take on a DAT Diet? (Diet As Tolerated)
Start out with a clear liquid diet and you work your way up slowly but surely
For GI surgeries, never consume-
Red Colored Liquids or Gelatin
What Aldrete score do u need to be discharged?
7-10
