Med Surg Exam 1 Flashcards
What is the role of the kidney’s in regulating the body’s fuid volume and and composition?
Regulates ECF volume and osmolality by excreting/retaining body fluids
Regulates electrolytes by selective retention of electrolytes or excretion of hydrogen ions
Regulates ECF by excretion or retention of hydrogen ions
Excretion of metabolic wastes or toxic substances
What is the role of the lungs in regulating the body’s fluid volume and composition?
They remove water (300mL daily)
What does the pituitary gland do to regulate the body’s fluid volume and composition?
Secrete AHD when dehydrated/during blood loss to increase reabsorption of water.
What does the adrenal cortex do to regulate the body’s fluid volume and composition?
Increases aldosterone to cause sodium and water retention, and potassium loss
Decreased aldosterone does the opposite
What do the parathyroid glands do to regulate the body’s fluid volume and composition?
Use parathyroid hormone to influence calcium and phosphate balance
What does the Renin-Angiotensin-Aldosterone system do to regulate the body’s fluid volume and composition?
Renin goes to the liver and converts a protein into angiotensin I, ACE converts that into angiotensin II, angiotensin II stimulates the the adrenal gland to produce aldosterone.
What does the hypothalamus do to regulate body fluid volume and composition?
During dehydration it secretes AHD to stimulate thirst, and for kidneys to increase water reabsorption.
What are the isotonic solutions we use?
0.9% NaCl (normal saline)
Lactated Ringer’s
5% Dextrose in Water
What is normal saline used for?
hypovolemia
shock
diabetic ketoacidosis
metabolic acidosis
hypercalcemia
What is LR used for?
hypovolemia
burns
fluid loss from diarrhea
acute blood loss
fluid loss from bile
What is D5W used for?
Hypernatremia
Fluid loss
dehydration
What are the hypotonic solutions?
0.45% NaCl (half strength saline)
What do we use half strength saline for?
hypertonic dehydration
Na+ or Cl- depletion
gastric fluid loss
What are the hypertonic solutions?
3% NaCl
5% NaCl
What are the hypertonic solutions used for?
Symptomatic hyponatremia
What lab values would you use to determine if someone is adequately hydrated?
BUN
Creatinine
Hematocrit
Urine Sodium
Urine Specific Gravity
Serum Osmolality
Urine Sodium
What does the BUN lab value show?
Measures the amount of urea in the bloodstream. Can vary with renal function, cellular breakdown, protein intake, and hydration status. Not an optimal gauge of kidney function.
What does the creatinine lab value show?
The breakdown product of muscle metabolism cleared from the bloodstream and excreted by the kidneys.
Accurate gauge of kidney function.
Does not vary with protein intake or hydration status
What does hematocrit measure?
The percentage of RBC in a volume of whole blood.
Decreased water increases the concentration of RBCs
Overhydrtion will decrease the RBC concentation
Anemia causes decreased hematocrit
What does the urine sodium lab value measure?
The level of sodium in the urine
As sodium intake increases, so does excretion
As fluid volume decreases, sodium is retained
What are risk factors for overhydration?
Age (disease)
- Too much intake
- Immobility
- Corticosteroids (puffy after taking)
- Burns (fluid shifts after burns-vascular damage)
- Heart and kidney failure
- Diet (sodium that comes mostly from packaged foods)
What are expected findings for overhydration?
Crackles lower lobes
- HTN most of time
- Polyuria (unless there is renal failure)
- Edema
- JVD, Ascites (fluid collects in the abdomen)
- SOB, Cough
- Weight gain (3 lbs in 24 hours, or 5 lbs in a week indicates fluid influence on weight)
What are lab tests for overhydration?
Decreased hematocrit and hemoglobin due to dilution
- Decreased osmolarity (amount of solutes in one volume of fluid)
- Urine sodium and specific gravity decreased
- CBC
What nursing care is performed for overhydration?
Daily weight
- Strict I&O (fluid restriction 2 L per day)
- Assess all s/s
- Restrict sodium to 2 grams per day
- Semi-Fowlers position
- Diuretics (furosemide - pulls fluid and potassium DEHYDRATION/HYPOKALEMIA CONCERN)
What are some complications of overhydration?
Pulmonary Edema (flash PE develops quickly)
- SOB
- Decreased O2
- Hear crackles (only posterior chest- lower lobes)
What are some risk factors of dehydration?
Low intake
- Diabetes Insipidus (polyuria)
- Diuretics
- Excessive sweating/heat
- GI loss
- Medications/substance use
- Hemorrhage
- Third spacing (ICF moves into the ECF, the body doesn’t want it there so it pushes it to the area around the cells)
What are expected findings for dehydration?
Hypotension
- Tachycardia
- Dry mucous membranes
- Tented and dry skin
- Oliguria, dark urine
- Neurosymptoms
- Orthostatic hypotension
- Cool skin
What are common lab tests for dehydration?
- Elevated hematocrit and hemoglobin
- Increased osmolarity
- BUN- kidneys
- Increased BUN= kidneys overwork due to less fluid
What nursing care is performed for dehydration?
Fluids (oral first then IV)
- True Bolus- less than 30 min on straight tubing. Using isotonic fluid (normal saline). This expands the ECF.
- Monitor I&O
- Daily weights
- Fall Risk
- Change positions slowl
What are some complications of dehydration?
- Hypovolemic shock (tissues not getting what they need to survive)
What are 3 lab tests for kidney function?
BUN, Creatinine, GFR
True/False: Normal Saline is the only solution you can mix with blood products through IV
True
9% normal saline is similar to ____
plasma
Lactated Ringer Solution cannot be used in
kidney injury due to potassium which could cause hyperkalemia
5% dextrose in water should not be used solely for
fluid volume deficit because it dilutes electrolyte concentrations
In Fluid Volume Deficit, which 4 things should you assess
ADLs, Ambulation, Cognition, Gag reflex
Are electrolytes charged or uncharged?
Charged
What is the sodium range?
135-145
What is the potassium range?
3.5-5.0
What is the magnesium range?
1.3-2.1
What is the calcium range?
9.0-10.5
What is the chloride range?
98-106
What is the phosphorus range?
3.0- no max given
What does water follow?
Salt
What does sodium imbalance indicate?
water problem
Acute hyponatremia is the result of
fluid overload of a surgical patient
What are manifestations of hyponatremia
- Weakness
- Lethargy
- Confusion
- Seizures
- Headache
- Anorexia, N&V
- Muscle cramps, twitching
- Hypotension
- Tachycardia
- Weight game, edema
Seizures are a big risk because of
aspiration and self harm
Interventions for hyponatremia
- Sodium replacemnt
- Fluid restriction
- Daily weight, I&O
- Medication: conivaptan hydrochloride
Risk with hypertonic solutions
cerebral edema
What sodium labs should you check?
BMP or CMP
Do not correct sodium more then?
12 mEq every 24 hours
If you are close to overcorrecting sodium
Stop and do a neurological assessment
What are the manifestations of Hypernatremia?
Fever,
swollen dry tongue,
sticky mucous membranes, hallucinations,
lethargic,
restlessness, and irritable,
seizures,
tachycardia,
hypertension,
hyperreflexia/twitching,
pulmonary edema.
Emphasized manifestations of hypernatremia
swollen dry tongue
- hallucinations
- lethargy
- restlessness
- irritable
- seizures
- pulmonary edema
interventions for hypernatremia
daily weights
I & O
seizure precautions
iv infusion of hypotonic or isotonic fluid
diuretics
restrict sodium diet
increased oral fluids intake
Emphasized interventions for hypernatremia
daily weights
- I&O
- Sodium Restrictions
Burns impact ________
vascular impermeability
Patients with hypernatremia that are on fluid and sodium restrictions are often?
Severely Thirsty
Key thing to watch out for potassium
heart effects
What are manifestations of hypokalemia
Muscle weakness, cramping
- Fatigue
- N&V
- Irritability, confusion
- decreased bowel motility
- paresthesia
- dysrhythmias
- flat and/or inverted T waves
Interventions for hypokalemia
Monitor respiratory status
- Fall precautions
- Potassium replacement
- Monitor EKG, I&O, arterial HCO3 and pH.
- Client education
- Dietary sources (greens, milk, juices, lean meat, potato skin)
- Medications
Never give potassium IV bolus through a
straight line, must be with a pump
2 main causes of hypokalemia
GI loss and diuretic use
If there is a significant potassium issue, request an order for a
telemetry
Do not run IV potassium faster than
10 mEq/hr with a peripheral IV
If patent is not urinating (give/not give) potassium
No P, No K
IV potassium can cause a ___ sensation
burning
Manifestations of Hyperkalemia
Peaked T waves,
ventricular dysrhythmias,
muscle twitching and paresthesia (early), ascending muscle weakness (late), increased bowel motility
Key Manifestations of Hyperkalemia
Peaked T waves,
Ventricular Dysrhythmias,
Cardiac Ectopy
What is cardiac ectopy?
Extra abnormal heartbeats that begin in one of the two ventricles
Interventions for Hyperkalemia
Monitor ECG,
Monitor Bowel Sounds,
Initiate Dialysis
Dietary restrictions,
Administer medication
5 common Medications for Hyperkalemia
Kayexalate
50% glucose w/ insulin
Calcium Gluconate
Bicarbonate
Loop Diuretics
What does kayexalate do?
Removes K+ via the gut
What does 50% glucose with insulin do?
Pulls glucose into the cell, and is given via IV
What does calcium Gluconate do?
Antagonizes the hyperkalemic action on the heart, but does not lower the potassium level
What does bicarbonate do for hyperkalemia?
It lowers potassium levels when mixed with insulin.
What does loop diuretics do for hyperkalemia?
Loop diuretics like furosemide lower the potassium level through excretion
In a Acidotic state, _______ is high.
Potassium
Manifestations of hypocalcemia
Tetany, cramps
- Paresthesia
- Dysrhythmias
- Trosseau’s sign
- Chvostek’s sign
- Seizures
- Hyperreflexia
- Impaired clotting time
Interventions for hypocalcemia
Seizure precautions
- IV calcium replacement
- Daily calcium supplements
- Vitamin D therapy
- Monitor for orthostatic hypotension
-Dietary increase and education
Calcium affects your ___ system
neuromuscular
Common diseases with hypocalcemia
Kidney and parathyroid (calcium regulation) disease
Calcium has an inverse relationship with
phosphorus
Calcium IV is best replaced through a
Central line as it helps to avoid vessel damage and helps with monitoring extravasation
Hypercalcemia is tied to what disease?
Malignant disease
Manifestations of Hypercalcemia
muscular weakness
constipation
anorexia
n/v
polyuria
polydypsia
hypoactive deep tendon reflexes
lethargy
Interventions of for Hypercalcemia
Increase mobility,
isotonic IVF,
Dialysis,
Cardiac Monitoring
Manifestations for hypomagnesemia
positive Troussea and Chovstek Sign
increased tendon reflexes
neuromuscular irritability
mood changes
anorexia
vomiting
elevated BP
Interventions for hypomagnesemia
Seizure precautions
- Monitor swallowing
- Dietary measures and education
- Adminiter IV magnesium sulfate and PO magnesium salts (give PO first)
- Monitor urine output
- Monitor respirators
Magnesium acts like a
sedative
What drug works well with magnesium?
Calcium gluconate
Manfiestations for Hypermagnesemia
Hypotension
- Drowsiness
- Bradycardia
- Bradypnea
- Coma
- Cardiac arrest
- Hyporeflexia
- N&V
- Facial flushing
Interventions for hypermagnesemia
Mechanical ventilation
- IV fluids: lactated Ringer’s or NS
- Administer IV calcium gluconate or loop diuretics
- Monitor respirations and blood pressure
- Monitor deep tendon reflexes
Magnesium should not be administered to clients with
renal failure
Monitor ____ with magnesium
DTR
Hypophosphetemia is rarely seen outside of
renal failure
What is the preoperative phase?
begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the OR bed
What is the intraoperative phase?
begins when patient is transferred onto the OR beds and ends with admission to the PACU
What is the postoperative phase?
begins with the admission of the patient to the PACU and ends with a follow-up evaluation in the clinical setting or home.
What preoperitaive assessments are performed to identifty pertinent health and surigcal risk factors?
Assess joint mobility
- Prescriptions and OTC meds
- Activity and functional levels (including aerobic exercise)
- Known allergies and sensitivities to drugs, foods, adhesives, and latex
- Assess for OSA (obstructive sleep apnea)
- Monitor for s/s of interpersonal violence, including intimate partner violence
- Autologous blood donation or patient self donation may be needed
What can latex be found in?
foods like bananas and kiwi
- hospital materials/equipment
What assessments are performed for OSA?
STOP-Bang (snoring, tired, observed, pressure, BMI, Age, Neck, Gender)
How do you perform a nutrition assessment?
Monitor for:
- Obesity
- Weight loss
- Malnutrition
- Specific nutrient deficiencies
- Metabolic abnormalities
- Effect of medications on nutrition
Nutritional deficiency should be corrected before surgery, why?
Adequate protein for tissue repair
Why do a fluid assessment?
For surgery
Confirm NPO
- This helps prevent risk of aspiration
What are the negatives of NPO before surgery?
Stress on body
- Loss of glycogen stores and lean muscle
- Dehydration that leads to fluid and electrolyte imbalances
Why do a dentition assesment?
Dental caries, dentures, and partial plates are significant to CRNA because decayed teeth or dental prostheses may become dislodged during intubation and occlude the airway.
- Mouth condition can lead to bodily post-op infections
What can alcohol consumption cause?
During surgery
Arrhythmias, infections, withdrawal
- Med effectiveness reduction.
- Malnutrition and other systemic problems or metabolic imbalances.
What happens if a person is intoxicated and requires surgery?
Postpone if needed, NG tube given
A nurse should ask a patient if they have drank alcohol in what time frame?
two drinks par day or more on a regular basis in the 2 weeks prior to surgery
When assessing respiratory status, educate them on what two things?
Breathing exercises and incentive spirometry use?
Patients who smoke are likely to experience what?
poor wound healing
- higher chance of SSI
- complications like VTE and pneumonia
Patients should be asked about ___ use in respiratory assessment
Tobaco
The ____ is an optimal visit time to advocate for smoking cessation
PAT (Pre-Assessment Test)
Patients with the highest risk of respiratory patients are what 3 kinds of patients?
Artificial implants such as grafts
- Total joint replacements
- Breast enhancement
Patients are assessed for what cardiac comorbidities?
for surgery
CHF
- SOB union movement
- Arrythmias
What 4 tests are checked in prep for cardiovascular
Chest x-ray
- EKG
- Vitals
- BP
What hepatic disease is associated with high surgical mortality
Acute liver disease
What renal issues can cause surgery contraindications?
Acute nephritis
- Acute renal insufficiency with oliguria or anuria
- Other acute renal problems
Dysfunction of the endocrine system is associated with overproduction or underproduction of?
hormones
Patients who take corticosteroids are at risk for ___ and this must be reported to the ____/_____
adrenal insufficiency; CRNA/surgeon
Patients with uncontrolled thyroid disorders are at risk for ____ or ______
Patients with uncontrolled thyroid disorders are at risk for ____ or ______
Diabetic patients are at risk for both _____ and ____ during surgery
hypoglycemia and hyperglycemia
Hypoglycemia may develop during
anesthesia or post-op from inadequate carbohydrates or excessive admin of insulin
Hyperglycemia can trigger the risk of
SSI
Hyperglycemia may result from
the stress of surgery, which can trigger increased levels of catecholamine.
- Other risks are acidosis and glucosuria.
Routine lab tests used to detect infection include
WBC and urinalysis
Dealing with immune system, it is important to identify and document?
any sensitivity to medications, solutions, adhesives, and past adverse reactions
Immunosuppresion is common with what 5 things
corticosteroid therapy, organ transplantation, radiation therapy, chemotherapy, and disorders affecting the immune system, such as acquired immunodeficiency syndrome and leukemia.
A medication history is obtained because of
the possible interactions with medications that might be given during surgery and the effects of any of these medications on the patient’s perioperative course
Aspirin, clopidogrel, and other medications that inhibit platelet aggregation should be prudently discontinued
7 to 10 days before surgery
Additional herbal medications may include
echinacea and licorice extract (Glycyrrhizic acid)
If the patient has doubts and has not had the opportunity to investigate alternative treatments…
a second opinion may be requested. No patient should be urged or coerced to give informed consent.
Refusing to undergo a surgical procedure is a person’s
legal right and privilege
You must have consent for
sterilization, therapeutic abortion, disposal of severed body parts, organ donation, and blood product administration
Discussion with patients and their family members may be supplemented with
audiovisual materials
Asking patients to describe in their own words the surgery they are about to have promotes
nurses’ understanding of patients’ comprehension.
A completed, updated and signed _____ and _____ must be present prior to the patient entering the OR.
History and Physical
Not more than ___ days before the date of the scheduled surgery, each patient must have a comprehensive medical history and physical assessment.
30
The _____ _____ is required to update the form within ___ hours of scheduled surgery on all non-inpatient clients
primary provider; 24
The History and Physical consists of
the history of present illness; surgical, medical, social, and family histories; allergies; current medications; and plan of care
It is the ____ ______ responsibility to make sure the presence of these forms and all other supporting documentation (medication reconciliation, Power of Attorney form, etc.) are current and accurate in the preoperative area.
surgical team’s
Preoperative education is initiated when and where?
as soon as possible beginning in the physician’s office, in the clinic, or at the time of PAT when diagnostic tests are performed
Frequently, education sessions are combined with various preparation procedures to allow for an easy and timely flow of information. The ____ should guide the patient through the experience and allow ample time for questions
nurse
Overly detailed descriptions may increase ____ in some patients; therefore, the nurse should be sensitive to this, by watching and listening, and provide less detail based on the individual patient’s needs.
anxiety
One goal of preoperative nursing care is to educate the patient how to promote _____ and _____ after anesthesia.
optimal lung expansion and resulting blood oxygenation
Teaching deep breathing, coughing, incentive spirometry
- Sitting positions
- Slow deep breath
- Exhale slowly
- Short breath
- Cough deeply
If a thoracic or abdominal incision is anticipated, the nurse demonstrates how to
splint the incision to minimize pressure and control pain. The patient should put the palms of both hands together, interlacing the fingers snugly. Splinting or placing the hands across the incision site acts as an effective support when coughing.
The goal in promoting coughing is to
mobilize secretions so that they can be removed
If the patient does not cough effectively
atelectasis (collapse of the alveoli), pneumonia, or other lung complications may occur.
The goals of promoting mobility postoperatively
are to improve circulation, prevent venous stasis, and promote optimal respiratory function
Exercise of the extremities includes _____ and ______ (similar to bicycle riding while lying on the side) unless contraindicated by type of surgical procedure (e.g., hip replacement).
extension and flexion of the knee and hip joints
Performing extremity exercises
The great toe is pointed and rotated as though tracing a large circle (see Chart 14-5). The elbow and shoulder are also put through their range of motion. At first, the patient is assisted and reminded to perform these exercises. Later, the patient is encouraged to do them independently
A pain assessment should include differentiation between
acute and chronic pain
A ____ _____ ____ should be introduced and explained to the patient to promote more effective postoperative pain management.
pain intensity scale
Postoperatively, _____ are given to relieve pain and maintain comfort without suppressing respiratory function.
medications
The patient is instructed to take the medication _____ during the initial postoperative period for pain relief.
as frequently as prescribed
Types of pain meds given
patient-controlled analgesia (PCA), epidural catheter bolus or infusion, or patient-controlled epidural analgesia
_____, ______, _____, and _____ have been reported postoperatively in patients with increased preoperative anxiety
Tachycardia, arrhythmias, hypertension, and increased levels of pain
Examples of general cognitive coping strategies include:
Guided imagery
- Distraction
- Optimistic Self-Recitation
- Music Therapy
- Aromatherapy
-Reiki
Preop education for ambulatory care consists of the same education previously mentioned, but adds what 2 things
Collaborative planning with patient and family for discharge
- Follow-up home care
During the preoperative assessment of psychological factors and spiritual and cultural beliefs, the nurse assists the patient to identif
coping strategies that he or she has previously used to decrease fear
The nurse assesses for any patient specific needs that may affect the _____, ______, _____, ______experience. In some cultures, for example, people are stoic in regard to pain, whereas in others they are more expressive.
spiritual, emotional, or physical surgical
adults may be advised to fast for ___ hours after eating fatty food and ____ hours after ingesting milk products.
8;6
Healthy patients are allowed clear liquids up to ___ hours before an elective procedure.
2
Enemas are not commonly prescribed preoperatively unless the patient is undergoing _____ or ____ surgery
abdominal or pelvic
The goal for enemas is what two things
allow satisfactory visualization of the surgical site and to prevent trauma to intestine or contamination by fecal matter
The goal of preoperative skin preparation is to
decrease bacteria without injuring the skin.
At a minimum, preoperative bathing should consist of
a full-body wash using antimicrobial soap the night before the planned surger
Additional body cleansing with chlorhexidine wipes may occur in the preoperative area via the
nurse or patient under supervision of nurse
To ensure the correct site, the surgical site is typically marked by the _____ and ____ prior to the procedure.
patient and surgeon
Day of Preparation for patient
Confirm ID
- Don’t alter bracelets
- Allergies, fall risk, extremely precautions
- Code status
- Denture or plate removal
- Jewelry removal or warning of risks if not removed
- Voiding
Urinary catheterization is performed in the
OR only as necessary
The use of preanesthetic medication may be used to help
patients remain calm and comfortable
Abx are given pre-op to reduce
SSI
Abx is prescribed
prior to patient arriving
Preoperative checklists contain critical elements that must be checked and verified
before the procedure. Must be easily accessed and verified by surgical team
Preoperative patient warming for a period of at least ___ minutes can be beneficial to prevent hypothermia development after anesthesia induction.
30
What is diffusion?
Process by which solutes move from an area of high concentration to lower concentration. Doesn’t require energy
What is osmosis?
When fluid moves across a semipermeable membrane from an area of low solute, to an area of high solute.
(Water will move to the area that has more particle)
What is active transport?
uses energy to move electrolytes from one region to another
What are the effects of aging on fluid and electrolyte imbalance?
Decreased muscle mass reduces serum creatinine
Decreased renal function can cause slightly elevated serum creatinine
Dehydration is more common because of decreased kidney mass.
What causes hyponatremia?
An imbalance of water rather than sodium
What causes hypernatremia?
fluid deprivation
heatstroke
nonfatal drowning in seawater
What causes hypocalcemia?
primary hypoparathyroidism
surgical hypoparathyroidism
Pancreatitis
Acute kidney injury
What causes hypercalcemia?
Malignancies
hyperparahyroidism
What causes hypomagnesemia?
Nasogastric suction
diarrhea
fistulas
chronic alcohol abuse
proton pump inhibitors
What causes hypermagnesemia?
Kidney injury
untreated DKA
Excessive use of antacids or laxatives
What causes hypophosphetemia?
Chronic diarrhea
Crohn’s disease
celiac disease
high intake of antacids
What are manifestations of hypophosphetemia?
Muscle weakness
bone pain and tenderness
confusion
chest pain
respiratory failure
paresthesias
What are symptoms of hyperphosphatemia?
Tetany
tachycardia
anorexia
nausea
vomiting
hyper reflexes
What causes hyperphosphatemia?
kidney injury
excessive vitamin D intake
DKA
high phosphate intake
How is hyperphosphatemia treated?
laxatives and enemas
reduced phosphate intake
What causes hypochloremia?
Addison’s disease
reduced chloride intake
untreated DKA
excessive sweating/vomiting
diarrhea
gastric suctioning/surgery
What are s/s of chloride deficit?
agitation
irritability
tremors
cramps
arrhythmias
shallow respiraitons
seizures
How do you treat chloremia deficit?
0.9% saline
0.45% saline
discontinue diuretic
What causes chloride excess?
excessive administration of chloride relative to sdoium
What are s/s of chloride excess?
tachypnea
weakness
lethargy
deep, rapid respirations
diminished cognitive ability
hypertension
How do you treat chloride excess?
administer hypotonic solutions
Diuretics
What is the preoperative assessment?
Provides info regarding underlying conditions that may affect the patient’s response to surgery techniques and anesthesia.
What are preoperative considerations for older patients?
Assess condition of skin
provide cotton blanket for warmth (decreased subcutaneous fat)
blood tests, BP, and EKG (poor circulation)
nuero assessment (memory and cognition)
respiratory asessment
renal assessment
What are some preoperative considerations for bariatric pateints?
Delayed wound healing at incision site
Difficult IV access
hypoventilation risk
shallow respirations when supine
What are some special considerations for paitents with disability?
need for assistive devices
modification to preoperative education
additional assistance with positioning or transferring
Hearing impaired entitled by law to a sign interpreter
Patient’s needs must be identified in advance
What are some preoperative interventions that prevent infection and other complications?
Preoperative bathing using antimicrobial soap
hair removal at surgical site
cleansing enema or laxative (in event of abominal/pelvic surgery)
avoid food and fluid to prevent aspiraiton
What happens during immediate preoperative preperation?
patient is ID’d
client removes clothes and valuables
antibiotics and pre anesthetic are administered
nurse checks preoperative checklist
warm patient via blankets, forced air, or IV fluid
tend to family needs
What does the circulating nurse do?
Manages the OR
protects patient’s safety and health
Verifies consent
initiates time-out
continually assess patient
What does the scrub nurse do?
set up sterile equipment
hands surgeon tools
count all instruments after incision is closed
What does the surgeon do?
Perform the surgical procedure
What does the registered nurse frist assistant do?
practice under direct supervision of surgeon
handle tissue
suturing
maintain hemostasis
provide exposure
What does the anesthesiologist/CRNA do?
selects anesthesia
administers it
intubates patient
deals with the anesthesia
What is general anesthesia?
Patient no arousable
lose ability to maintain ventilatory function
consists of 4 stages
What is multimodla anesthesia?
Combination of nonopioid anaglesic agents and regional anesthesia techniques
What is regional anesthesia?
Anesthestic agent is injected around nerves to that region is anesthetized
The patient is conscious
What is moderate sedation?
Reduces patient anxiwty and control pain during diagnostic procedures.
What is local anesthesia?
injection of a solution agent into the tissue at the planned incision site
What is included in a preoperative assessment?
current meds
allergies
health history
surgical history
activity and functional level
What are some adverse effects of surgery and anesthesia?
agitation/disorientation
allergic reation
bleeding
cardiac arrhythmia
hypotension
oversedation
undersedation
malignant hyperthermia
thrombosis
(more on page 419)
What are the principles of surgical asepsis?
any people, tools, and the patient’s own skin, are sterilized to free the area of ALL microorganisms
Who is responsible for obtaining informed consent?
the surgeon (because they explain the benefits/risks of surgery)
the nurse witnesses
What are some major responsibilities of the nurse in the post anesthesia care unit?
Assess the patient
maintain the airway
monitor/return vitals to baseline
relieve pain and anxiety
control nausea/vomiting
What are some common postanesthesia problems?
hypertension
pain
n/v
What are some gerontologic considerations for PACU?
transferring and moving patient will be slower
may recover from anesthesia slower
more attention to keep warm
maintain safe environemtn (fall risk)
possible delirium and confusion (try to orient)
Compare PACU care of an ambulatory surgery patient and a hospitalized surgery patient
Ambulatory
Same day surgery
go home same day
What factors effect wound healing?
Age
hemorrhage
hypovolemia
dressing too small/tight
foreign bodies
O2 deficit
drainage build up
hypothermia
edema
nutritional deficit
immunosuppresed
How do the lungs help maintain acid-base balance?
The lungs can either decrease or increase respirations to control the CO2 in the body
What do the kidneys do to maintain acid-base balance
They excrete/retain hydrogen ions or bicarbonate ions (inverse relationship) to maintain balance
How do the body’s chemichal buffers maintain acid-base balance?
by removing or release hydrogen ions
