Module 1 - Perioperative & PSR Flashcards
3 Operative stages
Pre-operative
Intraoperative
Post-operative
Pre-operative phase
before surgery –> pt admitted to OR room
Intraoperative phase
OR room –> pt admitted to PACU
Post-operative
once pt has been admitted to PACU –> discharge
What is contained in a CBC
RBC Hgb Hematocrit Mean Corpuscular volume WBC count & differential Platelets
General Adaptation Syndrome
alarm
resistance
exhaustion
Negative consequences of stress & healing
reduced sleep reduced appetite release of stress hormones impaired perfusion increased metabolic demand hyperglycemia (impairs wound healing)
Types of stress
acute
chronic
episodic
Stress hormones
cortisol epinephrine/norepinephrine growth hormone glucagon antidiuretic hormone RAAS activation --> angiotensin II/aldosterone
Physiologic stress mechanisms
SNS activation
SAM (Sympathetic NS Adrenal Medulla)
HPA Axis (Hypothalamic-APG-Adrenal cortex)
PSR
Physiologic Stress Response
Types of anesthesia
General (IV, inhaled, volatile liquid)
Regional (epidural or spinal)
Local (nerve block)
Types of surgery
emergent (asap) urgent (wi 24-30 hrs) required (should do it, weeks-months) elective (optional, but may be recommended) optional (cosmetic)
Reasons for surgery
diagnostic curative (cure pathology) reparative (restore function) cosmetic palliative
Fasting Guidelines
solid meals >6 hrs before surgery
clear liquids 2 hrs before surgery
fasting from all intake 2 hrs before surgery
Clear liquids pre-op
prevents dehydration, hypoglycemia (carb loading decreases insulin resistance), caffeine withdrawal (increases stress)
Medications held pre-op d/t risk of bleeding
NSAIDs (increase risk of bleeding by inhibiting COX-1)
antiplatelet meds (increase clotting time)
anticoagulants (inhibit clotting cascade)
herbal supplements (drug-drug interactions)
Balanced anesthesia
use of anesthesia + another agent to maximize therapeutic fx and minimize amount of drug
anesthetic agents, opioids, sedatives, neuromuscular blocking agents
3 stages of General Anesthesia
Induction
Maintenance
Recovery
Complications of regional anesthesia
hypotension, bradycardia (sympathetic block) urinary retention (blocks sensation) hypothermia backache (insertion site) spinal epidural hematoma
Causes of post-op stress
pain tissue injury blood loss/hemorrhage (hypovolemia) complications sleep disturbances hospital environment fear/anxiety loss/grief
Cortisol function
increase blood glucose levels (glycogenolysis, gluconeogenesis)
inhibit inflammation & immune system (LOX pathway)
mineralocorticoid function –> increase fluid retention
decrease protein synthesis
increase fat & protein catabolism
increase bone resoprtion
increase clotting factors & platelet synthesis (prepare for injury)
increase appetite
Angiotensin II effects
stimulate rls of aldosterone & ADH vasoconstriction Na+ reabsorption @ PCT water retention enhance sympathetic response
ADH (Vasopressor) effects
insertion of aquaporins in collecting duct –> increase water retention
vasoconstriction
Glucagon
stimulated by sympathetic activation NOT hypoglycemia
increase glycogenolysis, gluconeogenesis, lipolysis
high levels of glucagon = increase HR & contractility
Growth hormone function
increase glycogenolysis
increase lipolysis
Aldosterone function
retain Na+ @ DCT –> increase water retention
increase loss of K+
Epinephrine/Norepinephrine function
increase heart rate & contractility
vasoconstriction in skin, GI tract, kidneys
vasodilation bronchioles, skeletal muscle, heart
decrease GI motility & secretion (increase risk of peptic ulcers)
increase alertness, arousal, vigilance
increase muscle tension (minimize injury)
increase glycogenolysis, lipolysis
decrease insulin release
increase sweating
pupil dilation
increase RR & bronchodilation
increase blood coagulability
Common post-op respiratory problems
atelectasis
pneumonia
pulmonary edema
pulmonary emboli
PSR CV complications
dysrhythmia
angina (increased HR & contractility –> ischemia)
MI
CHF
tachycardia
hypertension
blood hypercoagulability (increase inflammatory/clotting proteins)
PSR Resp complications
hypoxemia hypercapnia --> respiratory acidosis atelectasis --> pneumonia DVT --> PE hypoventilation d/t pain hyperventilation (s/t hypoxemia) --> respiratory arrest
PSR Endocrine complications
protein catabolism
hyperglycemia
excess fluid volume (d/t prolonged RAAS)
vasoconstriction
PSR immune complications
decreased immunity –> increased risk of infection
sepsis
increased inflammation
PSR GI complications
paralytic ileus
increased sphincter tone
decreased smooth muscle tone
indigestion
PSR GU complications
urinary retention (increased sphincter tone, relaxed detrusor muscle) acute renal failure
PSR Cognitive complications
insomnia
anxiety
decreased appetite
feelings of helplessness
Negative fx of hypoventilaiton
build up of alveolar secretions
decreased surfactant production
decreased collateral ventilation thru pores of Kohn
PSR & hypercoagulability
increased circulating coagulation proteins
increased platelet reactivity
decreased coagulation inhibitors
decreased fibrinolysis
Obesity RF
increased risk of infection increased risk of dehiscence increased vascular demand (30 lbs = 25 extra miles of blood vessels) shallow breathing obstructive sleep apnea
Phospholipase
enzyme that release arachidonic acid from plasma membrane of cells
Where is histamine concentrated?
skin
airways
GI tract
H2 receptors
concentrated in gastric glands
stimulate parietal cells to produce Hcl
Fx of histamine
pruritis, urticaria
bronchoconstriction, narrowing of airways
increased mucous production
vasodilation, vascular permeability
increase gastric secretions (hydrochloric acid)
increase wakefulness
increase GI motility –> diarrhea
