Mod 6 - Perioperative focus for Midterm Flashcards
What are the factors increasing surgical risk
- Pre-existing medical conditions and medications such as cardiac, COPD, renal disease, diabetes, liver disease
- Age – very young and very old
- Nutrition/Malnurition
- Obesity – reducing respiratory and cardiac functions
- Immunocompetence - pt with aviation or chemo therapy or after organ transplantation have increased risk of infection
- Fluid and electrolyte imbalance
- Pregnancy – major systems are affected during pregnancy
How Nutrition/Malnurition increase surgical risk? Pt is prone to poor tolerance of..
Normal tissue repair and resistance to infection depend on adequate nutrients; surgery intensifies this need
- pt is prone to poor tolerance of anaesthesia, negative nitrogen balance, delayed blood clotting mechanisms, infection, poor wound healing, and the potential for multiple organ failure
Bleeding disorders increase risk of
hemorrhaging during and after surgery
How does diabetes mellitus increase risk of surgery
increase chance of infection and impaired wound healing
- (due to altered glucose metabolism and associated circulatory impairment, Stress of surgery may cause increase in blood glucose)
How does Heart disease (recent myocardial infarction, dysrhythmias, heart failure) and peripheral vascular disease increase risk of surgery
o Stress of surgery causes increased demands on myocardium to maintain cardiac output.
o General aesthetic agents depress cardiac function
how does obstructive sleep apnea increase risk of surgery
Administration of opioids increases risk of airway obstruction postoperatively.
o Patients will desaturate as revealed by drop in oxygen saturation
How do Upper respiratory infection increase risk of surgery
increase risk of respiratory complications during anaesthesia (e.g. pneumonia and spasm of laryngeal muscles)
how does Liver disease increase risk of surgery
- alters metabolism and elimination of drugs administered during surgery
- impairs wound healing and clotting time because of alterations in protein metabolism
what medical condition/symptom Predisposes patient to fluid and electrolyte imbalances and may indicate underlying infection?
Fever
How does Chronic respiratory disease (emphysema, bronchitis, asthma) increase risk of surgery
o Reduces patients means to compensate for acid-base alterations
o Anaesthetic agents reduce respiratory function, increasing risk for severe hypoventilation
how do • Immunological disorders (leukemia, HIV, bone marrow depression, and use of chemotherapeutic drugs or immunosuppressive agents) increase risk of surgery
Increase risk of infection and delayed wound healing after surgery
how does Abuse of street drugs increase risk of surgery
o May have underlying disease (HIV, Hepatitis), which can affect response of anaesthesia and surgery and the healing process
how does Chronic pain increase risk of surgery
Regular use of pain meds may = higher tolerance, reduced effect from repeated doses of the same analgesics class o Increased doses of analgesics may be required to achieve post-op pain control
what is regional anesthesia
blocks pain in an area of the body, such an arm or leg. A common type is epidural anesthesia, which is often used during childbirth.
what is General anesthesia
makes you unconscious. You do not feel any pain, and you do not remember the procedure afterwards.
a patient wirh pre-existing bronchitis who has abnormal breath sounds and a productive cough will be at risk for? (nursing diagnosis)
ineffective airway clearance
what are the Post-op exercises you should teach your pt? and why are they important?
Deep Breathing, Coughing, and Moving After Surgery
- help your breathing, clear your lungs, and lower your risk of pneumonia.
what does the Positive expiratory pressure (PEP) device do?
Creates pressure in the lungs and keeps airways from closing, it helps move mucus up
1) The incentive spirometer is used to provide information about pt’s…?
2) It is used to increase?
3) may assist in strengthening…?
4) Prevents..?
1) inspiratory effort by measuring the air flow and the air volume
2) inspiratory volume
3) strengthening inspiratory muscle performance
4) Prevents atelectasis
Ambulation post-op helps prevent
DVT
Post-op patients will generally be put on either mechanical or chemical VTE prophylaxis.
What is chemical and what is mechanical?
they are all helping with..?
Chemical - either heparin, enoxaparin, dalteparin injection.
Mechanical - SCD’s/Anti-embolism stockings
All helping with circulation and prevention of blood clots forming
what vitals will you see in a hemorrhage complication? what should you assess?
o You will see drop in BP, hypotension and tachycardia
o Look at surgical site – dressing or bed saturated in sanguiness drainage?
o Check vital signs and LOC
How do you assess for pneumonia, atelectasis?
Breathing effectively? Are there signs of pneumonia – are they requiring more oxygen? Can you ascultate breath sounds to the base of their lungs or not?
Why is it important to assess pain post-op and keep it managed?
Want to keep the px tolerable for pt to participate in rehabilitation
If pt in too much pain – they don’t want to take deep breaths and that predisposes them to Pneumonia
Don’t want to get up and move because it’s too painful – at risk for VTE/DVT
