Module 1 - Perioperative & PSR Flashcards by Unknown Unknown

3 Operative stages

Pre-operative
Intraoperative
Post-operative

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Pre-operative phase

before surgery –> pt admitted to OR room

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Intraoperative phase

OR room –> pt admitted to PACU

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Post-operative

once pt has been admitted to PACU –> discharge

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What is contained in a CBC

RBC
Hgb
Hematocrit
Mean Corpuscular volume
WBC count & differential 
Platelets

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General Adaptation Syndrome

alarm
resistance
exhaustion

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Negative consequences of stress & healing

reduced sleep
reduced appetite
release of stress hormones 
impaired perfusion
increased metabolic demand 
hyperglycemia (impairs wound healing)

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Types of stress

acute
chronic
episodic

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Stress hormones

cortisol
epinephrine/norepinephrine
growth hormone
glucagon
antidiuretic hormone 
RAAS activation --> angiotensin II/aldosterone

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Physiologic stress mechanisms

SNS activation
SAM (Sympathetic NS Adrenal Medulla)
HPA Axis (Hypothalamic-APG-Adrenal cortex)

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PSR

Physiologic Stress Response

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Types of anesthesia

General (IV, inhaled, volatile liquid)
Regional (epidural or spinal)
Local (nerve block)

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Types of surgery

emergent (asap)
urgent (wi 24-30 hrs)
required (should do it, weeks-months)
elective (optional, but may be recommended)
optional (cosmetic)

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Reasons for surgery

diagnostic 
curative (cure pathology)
reparative (restore function)
cosmetic
palliative

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Fasting Guidelines

solid meals >6 hrs before surgery
clear liquids 2 hrs before surgery
fasting from all intake 2 hrs before surgery

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Clear liquids pre-op

prevents dehydration, hypoglycemia (carb loading decreases insulin resistance), caffeine withdrawal (increases stress)

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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)

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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