INTRA-POST-OPERATIVE PHASE Flashcards
The Surgical Team is comprised of:
- Surgeon
- Anesthesiologist
- Scrub Nurse
- Circulating Nurse
TYPES OF ANESTHESIA
- General Anesthesia
- Regional Anesthesia
partial or total loss of sensation with or without loss of consciousness deliberately induced to prevent pain perception and promote relaxation during surgery
Anesthesia
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
General Anesthesia
Types of General Anesthesiaa
- Inhalation
- Intravenous anesthesia
- Rectal anesthesia
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
Inhalation
(halothane, ether, nitrous oxide, cyclopropane)
Type of General Anesthesia
commonly employed as induction agent prior to inhalation anesthesia
Intravenous anesthesia
(pentothal, ketalar)
How is General anesthesia accomplished in 4 phases:
- Pre-induction
- Induction
- Maintenance
- Reversal/extubation
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.
Induction
Phase of General anesthesia:
Begins with closure of the wound and ends before patient transport to PACU
Reversal/extubation
suspension of sensation on affected site of the body; temporarily prevents generation and conduction of nerve impulses and may not affect motor functions
Regional Anesthesia
used for patients whom general anesthesia is contra indicated
Type of Regional Anesthesia:
injection into the surgical area making the receptor unresponsive to stimuli
Local
Type of Regional Anesthesia:
injection of an agent into the large trunk or nerve plexus
Peripheral Nerve Block (tetracaine)
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
Spinal anesthesia
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)
Epidural block
Type of Regional Anesthesia:
Insertion of long needles into acupuncture points
Acupuncture
Type of Regional Anesthesia:
Use of cold to induce anesthesia
Cryothermaia
Guedel’s Classification of the Stages of Anesthesia
- Stage I (stage of analgesia)
- Stage II (stage of delirium/ excitement)
- Stage III (stage of surgical anesthesia)
- Stage IV (stage of danger/ medullar stage)
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.
Stage I (stage of analgesia)
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
Stage II (stage of delirium/ excitement)
the patient should no receive auditory or physical stimulation during this period
Guedel’s Classification of the Stages of Anesthesia:
begins with the onset of regular breathing and ends with the cessation of respirations.
Stage III (stage of surgical anesthesia)
Guedel’s Classification of the Stages of Anesthesia:
begins with the cessation of respiration and leads to death.
Stage IV (stage of danger/ medullar stage)
Factors to consider in determining the type of anesthesia:
- 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
Commonly Used Operative Positions
- Supine
- Modified Supine
- Prone
- Sitting/Fowler’s
- Trendelenburg
- Reverse Trendelenburg
- Lithotomy
- Kroske/Jack Knife
- Knee-Chest
Commonly Used Operative Positions:
flat on bed with arms at sides or supported by arm boards (i.e. exploratory laparotomy, abdominal surgeries)
supine
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)
Modified Supine
Commonly Used Operative Positions:
the patient lies flat on bed with the patient facing the bed (i.e. spinal operation, posterior leg)
Prone
Commonly Used Operative Positions:
the patient lies on back with the body section raised 45o to 90° (i.e. thoracotomy)
Sitting/Fowler’s
Commonly Used Operative Positions:
head part is lower than the foot part (surgery of lower abdomen)
Trendelenburg
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]
Lithotomy
Commonly Used Operative Positions:
- head part is elevated and is higher than the foot part (i.e. billiary tract surgery)
Reverse Trendelenburg
Commonly Used Operative Positions:
prone position with extremities lowered and hips over center break of table (i.e. oral surgeries)
Kroske/Jack Knife
Commonly Used Operative Positions:
for sigmoidoscopy, induction of spinal anesthesia
Knee-Chest
Major complications of anesthesia
- Respiratory arrest
- Cardiac arrest
Its focus is to assist the patient in returning to optimal functioning as quickly as possible
POST-OPERATIVE PHASE
Ideal PACU:
each individual patient is supplied with:
- a cardiac monitor
- blood pressure monitoring device
- pulse oximeter
- airway management equipment
- suction and oxygen
- emergency medications and equipment
Patient Care at the Recovery Unit
Immediate postoperative care involves the following:
- Airway and Respiration
- Vital signs
- Bleeding
- Consciousness
- Drain and tubes
- Proper Positioning
What must be avoided When transferring the patient to the PACU
- Avoid exposure
- Avoid rough handling
- Avoid hurried movements and rapid changes in position
The following measures are used to determine the patient’s readiness for discharge from the PACU:
- 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
the length of stay in the PACU is generally how many hours
less than 24 hours
How do you show Care of Postoperative Patients in the Ward
- 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
occurs when blood loss is too extensive that the body is not capable of maintain adequate blood flow throughout the system
Shock
Refers to the inflammation of a vein secondary to blood clot
Thrombophlebitis
Treatmenet for Hemorrhage and Shock
Ligation of blood vessels
Secondary to failure of cardiac muscles to contract, may be due to effects of anesthesia
Management: CPR, cardiac stimulants
Cardiac Arrest
An inflammatory condition of lung (alveoli) characterized by consolidation of the lungs
Pneumonia
The most common cause is microaspiration of bacteria the colonize the oropharynx upper
it is the Partial or complete collapse of the lungs
Atelectasis
Examples of Urinary Complications
- Urinary retention
- UTI
- Renal Failure
Examples of Wound Complications
- Infection
- Dehiscence
- Evisceration
secondary to decreased mobility, decreased circulation
Decubitus ulcer
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
Dehiscence
Management: Resuturing, application of adhesive to pull edges
Wound Complications:
There is a separation of all the tissue layers in an abdominal wound and prostrusion of the abdominal content
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
GI Complications:
Paralysis of the intestinal peristalsis
Paralytic ileus
Manifestation:
* Absent bowel sounds
* No flatus
Management:
* Ambulation
* Gastric decompression
* IVFluid
GI Complications:
Secondary to decreased activity, decreased peristalsis
Constipation
Management:
* Ambulation
* Increase oral fluid intake
* Laxatives or stool softeners as ordered
GI Complications:
Characterized by frequent vomiting of small amounts without effort which may impose strain or diaphragm causing dyspnea
Abdominal distention
Management:
* Insertion of NGT
* Lavage
* IVFluid replacement of electrolytes
poor oral hygiene, management: mouth wash with diluted hydrogen peroxide
Acute parotitis
An effect of anesthesia which interfers with vowel sensation and ability to void
Urinary retention
Management: catheterization
May be attributed to cathetetization or urinary retention
UTI
Management: Administration of antibiotics as prescribed, increase fluid intake
May be attributed to grief of lost body part, body image disturbance, standing emotional problem, exhaustion
Post-opersative psychosis
Manifestation:
* Insomnia, restlessness, anorexia, irritability/suicidal tendency
Management:
* Verbalization, 24 hour responsible watcher
Examples of GI Complications
- Abdominal distention
- Constipation
- Paralytic ileus
may be an evidence of post-operative complications
Fever
Types of Regional Anesthesia
▪ Topical Surface
▪ Local
▪ Peripheral Nerve Block (tetracaine)
▪ Spinal anesthesia
▪ Epidural block
▪ Acupuncture
▪ Cryothermaia
Factors affecting wound infection:
▪ Obesity
▪ Debilitation
▪ Old age
▪ Lengthy complicated operation
▪ Drugs
▪ Presence of other diseases
▪ Poor operative technique
Nursing Problems Related to Post- operative Period:
• 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
