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MS: NCM 112 > INTRA-POST-OPERATIVE PHASE > Flashcards

INTRA-POST-OPERATIVE PHASE Flashcards

1
Q

The Surgical Team is comprised of:

A
  • Surgeon
  • Anesthesiologist
  • Scrub Nurse
  • Circulating Nurse
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2
Q

TYPES OF ANESTHESIA

A
  • General Anesthesia
  • Regional Anesthesia
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3
Q

partial or total loss of sensation with or without loss of consciousness deliberately induced to prevent pain perception and promote relaxation during surgery

A

Anesthesia

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4
Q

Type of Anesthesia:

refers to the depression of the central nervous system by administration of drugs or inhalation agents; patients under this usually require ventilator assistance

A

General Anesthesia

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5
Q

Types of General Anesthesiaa

A
  1. Inhalation
  2. Intravenous anesthesia
  3. Rectal anesthesia
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6
Q

Type of General Anesthesia

administered through (1) open drop [anesthesia is roped directly into layers of gauze that is held on the patients’ mouth (2) mask

A

Inhalation

(halothane, ether, nitrous oxide, cyclopropane)

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7
Q

Type of General Anesthesia

commonly employed as induction agent prior to inhalation anesthesia

A

Intravenous anesthesia

(pentothal, ketalar)

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8
Q

How is General anesthesia accomplished in 4 phases:

A
  1. Pre-induction
  2. Induction
  3. Maintenance
  4. Reversal/extubation
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9
Q

Phase of General anesthesia:

Begins with the induction of anesthetic agents and ends with stabilization of the patient. Involves putting the patient safely to sleep.

A

Induction

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10
Q

Phase of General anesthesia:

Begins with closure of the wound and ends before patient transport to PACU

A

Reversal/extubation

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11
Q

suspension of sensation on affected site of the body; temporarily prevents generation and conduction of nerve impulses and may not affect motor functions

A

Regional Anesthesia

used for patients whom general anesthesia is contra indicated

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12
Q

Type of Regional Anesthesia:

injection into the surgical area making the receptor unresponsive to stimuli

A

Local

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13
Q

Type of Regional Anesthesia:

injection of an agent into the large trunk or nerve plexus

A

Peripheral Nerve Block (tetracaine)

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14
Q

Type of Regional Anesthesia:

injection of certain local anesthesia into subarachnoid space between l3 and l4 using a lumbar interspace, usually employed for almost any type of major operation below the level of diaphragm

A

Spinal anesthesia

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15
Q

Type of Regional Anesthesia:

introducing anesthetic agent into the epidural space (through the intervertebral space into the space surrounding the dura matter in the spinal column)

A

Epidural block

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16
Q

Type of Regional Anesthesia:

Insertion of long needles into acupuncture points

A

Acupuncture

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17
Q

Type of Regional Anesthesia:

Use of cold to induce anesthesia

A

Cryothermaia

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18
Q

Guedel’s Classification of the Stages of Anesthesia

A
  • Stage I (stage of analgesia)
  • Stage II (stage of delirium/ excitement)
  • Stage III (stage of surgical anesthesia)
  • Stage IV (stage of danger/ medullar stage)
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19
Q

Guedel’s Classification of the Stages of Anesthesia:

begins with the administration of anesthetic agent and ends with the loss of consciousness; patients become drowsy, dizzy; the last sense to be depressed is hearing and first to return.

A

Stage I (stage of analgesia)

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20
Q

Guedel’s Classification of the Stages of Anesthesia:

begins with the loss of consciousness and ends with the onset of regular breathing and loss of eyelid reflexes; often companied by involuntary muscle activity

A

Stage II (stage of delirium/ excitement)

the patient should no receive auditory or physical stimulation during this period

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21
Q

Guedel’s Classification of the Stages of Anesthesia:

begins with the onset of regular breathing and ends with the cessation of respirations.

A

Stage III (stage of surgical anesthesia)

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22
Q

Guedel’s Classification of the Stages of Anesthesia:

begins with the cessation of respiration and leads to death.

A

Stage IV (stage of danger/ medullar stage)

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23
Q

Factors to consider in determining the type of anesthesia:

A
  • Age and physical condition of the patient
  • Type, location and duration of surgery
  • Degree of technical intricacy of surgery
  • Previous anesthetic history
  • Personal preference, expertise and judgment of anesthesiologist
  • Patient’s preference
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24
Q

Commonly Used Operative Positions

A
  • Supine
  • Modified Supine
  • Prone
  • Sitting/Fowler’s
  • Trendelenburg
  • Reverse Trendelenburg
  • Lithotomy
  • Kroske/Jack Knife
  • Knee-Chest
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25
Q

Commonly Used Operative Positions:

flat on bed with arms at sides or supported by arm boards (i.e. exploratory laparotomy, abdominal surgeries)

A

supine

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26
Q

Commonly Used Operative Positions:

the patient is positioned in supine position, with the neck extended (thyroid surgery) or shoulders elevated (gallbladder), dorsal recumbent (knees flexed), arm extension (arm board)

A

Modified Supine

27
Q

Commonly Used Operative Positions:

the patient lies flat on bed with the patient facing the bed (i.e. spinal operation, posterior leg)

A

Prone

28
Q

Commonly Used Operative Positions:

the patient lies on back with the body section raised 45o to 90° (i.e. thoracotomy)

A

Sitting/Fowler’s

29
Q

Commonly Used Operative Positions:

head part is lower than the foot part (surgery of lower abdomen)

A

Trendelenburg

30
Q

Commonly Used Operative Positions:

legs are flexed at right angles and placed on stirrups (to expose perineal and rectal areas) [i.e. hemorrhoidectomy, repair of vaginal laceration]

A

Lithotomy

31
Q

Commonly Used Operative Positions:

  • head part is elevated and is higher than the foot part (i.e. billiary tract surgery)
A

Reverse Trendelenburg

32
Q

Commonly Used Operative Positions:

prone position with extremities lowered and hips over center break of table (i.e. oral surgeries)

A

Kroske/Jack Knife

33
Q

Commonly Used Operative Positions:

for sigmoidoscopy, induction of spinal anesthesia

A

Knee-Chest

34
Q

Major complications of anesthesia

A
  • Respiratory arrest
  • Cardiac arrest
35
Q

Its focus is to assist the patient in returning to optimal functioning as quickly as possible

A

POST-OPERATIVE PHASE

36
Q

Ideal PACU:

each individual patient is supplied with:

A
  1. a cardiac monitor
  2. blood pressure monitoring device
  3. pulse oximeter
  4. airway management equipment
  5. suction and oxygen
  6. emergency medications and equipment
37
Q

Patient Care at the Recovery Unit

Immediate postoperative care involves the following:

A
  • Airway and Respiration
  • Vital signs
  • Bleeding
  • Consciousness
  • Drain and tubes
  • Proper Positioning
38
Q

What must be avoided When transferring the patient to the PACU

A
  • Avoid exposure
  • Avoid rough handling
  • Avoid hurried movements and rapid changes in position
39
Q

The following measures are used to determine the patient’s readiness for discharge from the PACU:

A
  • Stable vital signs
  • Orientation to person, place, events, and time
  • Uncompromised pulmonary function
  • Pulse oximetry readings indicating adequate blood oxygen saturation
  • Urine output at least 30 mL/h
  • Nausea and vomiting absent or under control
  • Minimal pain
40
Q

the length of stay in the PACU is generally how many hours

A

less than 24 hours

41
Q

How do you show Care of Postoperative Patients in the Ward

A
  • Promotion of cardiovascular function
  • Promotion or respiratory function
  • Promotion of elimination
  • Promotion of wound healing
  • Prevention of complications
  • Protection from injury and promotion of comfort
  • Promotion of fluid balance and nutrition
42
Q

occurs when blood loss is too extensive that the body is not capable of maintain adequate blood flow throughout the system

A

Shock

43
Q

Refers to the inflammation of a vein secondary to blood clot

A

Thrombophlebitis

44
Q

Treatmenet for Hemorrhage and Shock

A

Ligation of blood vessels

45
Q

Secondary to failure of cardiac muscles to contract, may be due to effects of anesthesia

Management: CPR, cardiac stimulants

A

Cardiac Arrest

46
Q

An inflammatory condition of lung (alveoli) characterized by consolidation of the lungs

A

Pneumonia

The most common cause is microaspiration of bacteria the colonize the oropharynx upper

47
Q

it is the Partial or complete collapse of the lungs

A

Atelectasis

48
Q

Examples of Urinary Complications

A
  • Urinary retention
  • UTI
  • Renal Failure
49
Q

Examples of Wound Complications

A
  • Infection
  • Dehiscence
  • Evisceration
50
Q

secondary to decreased mobility, decreased circulation

A

Decubitus ulcer

51
Q

Wound Complications:

  • Refers to partial or complete separation of the wound edges
  • Usually occurs on the 6th-7th post-operative day when sutures heal
  • Caused by excessive strain, severe coughing, malnutrition
A

Dehiscence

Management: Resuturing, application of adhesive to pull edges

52
Q

Wound Complications:

There is a separation of all the tissue layers in an abdominal wound and prostrusion of the abdominal content

A

Evisceration

Management:
* Position patient flat or low fowlers position
* Cover the protruding organ with sterile moist dressing
* Instruct patient not to cough
* NPO
* Notify the surgeon STAT
* Prepared the patient for surgery for immediate closure of wound

53
Q

GI Complications:

Paralysis of the intestinal peristalsis

A

Paralytic ileus

Manifestation:
* Absent bowel sounds
* No flatus

Management:
* Ambulation
* Gastric decompression
* IVFluid

54
Q

GI Complications:

Secondary to decreased activity, decreased peristalsis

A

Constipation

Management:
* Ambulation
* Increase oral fluid intake
* Laxatives or stool softeners as ordered

55
Q

GI Complications:

Characterized by frequent vomiting of small amounts without effort which may impose strain or diaphragm causing dyspnea

A

Abdominal distention

Management:
* Insertion of NGT
* Lavage
* IVFluid replacement of electrolytes

56
Q

poor oral hygiene, management: mouth wash with diluted hydrogen peroxide

A

Acute parotitis

57
Q

An effect of anesthesia which interfers with vowel sensation and ability to void

A

Urinary retention

Management: catheterization

58
Q

May be attributed to cathetetization or urinary retention

A

UTI

Management: Administration of antibiotics as prescribed, increase fluid intake

59
Q

May be attributed to grief of lost body part, body image disturbance, standing emotional problem, exhaustion

A

Post-opersative psychosis

Manifestation:
* Insomnia, restlessness, anorexia, irritability/suicidal tendency

Management:
* Verbalization, 24 hour responsible watcher

60
Q

Examples of GI Complications

A
  • Abdominal distention
  • Constipation
  • Paralytic ileus
61
Q

may be an evidence of post-operative complications

A

Fever

62
Q

Types of Regional Anesthesia

A

▪ Topical Surface
▪ Local
▪ Peripheral Nerve Block (tetracaine)
▪ Spinal anesthesia
▪ Epidural block
▪ Acupuncture
▪ Cryothermaia

63
Q

Factors affecting wound infection:

A

▪ Obesity
▪ Debilitation
▪ Old age
▪ Lengthy complicated operation
▪ Drugs
▪ Presence of other diseases
▪ Poor operative technique

64
Q

Nursing Problems Related to Post- operative Period:

A

• Ineffective airway clearance
• Ineffective breathing pattern
• Potential for injury
• Potential for infection
• Knowledge deficit on wound care and resumption of activities
• Pain
• Fluid volume deficit
• Self-care deficit
• Urinary retention

MS: NCM 112 (14 decks)

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