Operative Care Flashcards
key points from pre op
report any out of range H/P, VS or labs to surgeon
surgical care improvement plan
measures hospitals must meet (interventions to reduce surgical site infections)
minimally invasive/robotic surgery
more expensive and accurate with less blood loss and faster recovery times
robotic surgery is preferred for
cholecystectomy, joint, cardiac, splenectomy, spinal
anesthesia
induced state of partial/total loss of sensation, occurring with or without loss of consciousness
anesthesia is used
to block nerve impulses, supress relfexes, paralysis, muscle relaxation, controlled level of conciousness
general anesthesia
reversible loss of consciousness induced by inhibiting neuronal impulses in CNS
inhalation of general anesthesia
commonly induces post op N/V
IV injection general anesthesia
do not give if you have kidney or liver problem
balanced anesthesia for general anesthesia
Combination of IV drugs and inhalation agents
examples of balanced anesthesia
Thiopental for induction, nitrous oxide for amnesia, morphine for analgesia, pancuronium for muscle relaxation
adjuncts to general anesthetic agents
hypnotics, opioid analgesics, neuromuscular blocking agents
local anestheisa
briefly disrupts sensory nerve impulse transmission from a specific body area but pt remains concious
local anesthesia is delivered
topically and by local infiltration (lidocaine)
regional anesthesia
type of local anesthesia that blocks multiple peripheral nerves in a specific region
example of regional anesthesia
field block, nerve block, spinal block, epidural block
conscious sedation
IV delivery of sedative, hypnotic, opioid drugs to reduce level of conciousness with patent airway able to respond
examples of conscious sedation
Etomidate, diazepam, midazolam, meperidine, fentanyl, alfentanil, and morphine sulfate
preventing injury
proper body position, prevent pressure ulcers, prevent obstruction of circulation/resp/nerve conduction
interventions for older adults
hold onto aids/glasses, small pillow under head, lift pt, head cap, monitor I/O + blood loss
postoperative phase
begins w completion of surgery and transfer to PACU/ICU
phase 1 of post op
PACU or ICU till stable
Phase 2 of post op
prep for lower level of care
phase 3 for post op
at home w no restriction on ADLs
PACU recovery room
allows for ongoing eval and stabilization of pt to prevent and treat complications after surgery
PACU nurses
skilled in care of patients with multiple probs after surgery and helps w discharge
assessment phase
review pre op assessment, pt hx, identify potential surgical comps
respiratory assessment
patent airway, adequate gas exchange, o2 delivery device, lungs every 4 hrs, any artificial airways
cardiovascular assessment
VS compared with baseline, cardiac monitor, peripheral vascular assessment, antiembolism stockings to prevent DVT, prophylactic drugs
nurse must report BP changes that are at 25% higher or lower than baseline because it cause
blood loss, fluid loss, low BP, shock, pain, hemorrhage
neuro assessment
LOC, A/O x 4, prevent delirium, motor and sensory assessment with return of SNS
fluid electrolyte and acid base balance assessment
I/O, hydration status, color, IV fluids, acid bases, NG tube
before oral feedings are given
check bowel sounds and voiding and that no paralytic ileus is present
post op IV fluids provide
hydration and electrolytes not nutrients/calories
renal assessment
return of urination, retention s/s, report if UO under 30 ml/hr
GI assessment
post op N/V, assess peristalsis return, NG drainage, constipation, bowel sounds
constipation may be related to
anesthesia, opioid analgesia, decreased movement, decreased oral intake
NG tube inserted during surgery to
decompress/drain stomach, GI rest/healing, provide entereal feeding, monitor bleeding and prevent obstructions
NG tube drainage must be assessed
every 8 hours
oral feedings
allows more needed nutrients and stimulates action of GI tract only if bowel sounds return
diets must progress from
clear to full liquids, soft to reg diet
affect on nutrition
nutrient loss great, food intake diminished, protein loss for tissue breakdown/blood loss
catabolism after surgery
tissue breakdown and loss exceeds tissue buildup
negative nitrogen balance
poor nitrogen means poor ingestion of protein as it controls protein metabolism
skin assessment
tissue integrity, drainage color/amount/smell, impaired wound healing
dehiscence
opening of a wound
evisceration
organs pop out of wound opening
pain assessment
pain is expected so it should be continuously monitored
drug therapy for pain
opioid/non opioid analgesics
complimentary therapies to manage pain
position, massage, relaxation, music
psychosocial assessment
anxiety, fear, safety, provide reassurance
lab assessment includes
electrolytes, CBC, urine/renal tests, serum amylase, blood glucose, urinalysis, ABG
“left shift” CBC
immature neutrophils released due to lack of mature WBCs to fight infection
patient problems
decreased gas exchange, infection/delayed healing, pain, decreased peristalsis, post op hemorrhage
improving gas exchange interventions
O2 sat, sit pt up, O2 therapy, incentive spirometer, cough, deep breathing, ambulation
prevent wound infection/delayed healing
dressing, drains, antibiotics, manage dehiscence/evisceration
promote peristalsis interventions
monitor abdomen, adequate hydration, increased mobility, metoclopramide
prevent post op bleeding
assess underneath patient, drains, recognize warning signs, color, cap refill
transition management
safety, fam availability, adherence to plan, activity, drug reconcilition, high protein/iron/zinc diet
outcomes
maintain adequate lung expansion/resp function, good wound healing, pain management, peristalsis return
