periop Flashcards
pre op: what happens
pre anesthesia
nursing and anesthesia assessment
planning of care -> collab with pt
interventions to prep for sx (mark site)
anx!
3 phases
preop/pre anesthesia
intra op
post op/post anesthesia - PACU and beyond
intra op: what happens
wheeled into OR -> immediate post op nursing recovery area
nc: rnfa, scrub nurse, circulating nurse
post op: what happens
post op, usually pacu
nc focused on anesthesia recovery - pt is hemodynamically unstable so watch VS, can change fast!
airway!
pain, close observation of physiologic indicators
ongoing post op in ICU, step down or med surg units
purposes of sx
diagnose, cure, palliation, prevention, exploration, cosmetic
types of sx: abulatory
home same day
types of sx: same day admit
go to post op
types of sx: inpt
admitted -> sx -> stays post op
timing of sx: elective
to increase qol (phys or psych)
ex: cataract, breast reduction
time not of the essence in scheduling
gernal risks: bleed, infect, anesthetic exposure
relatively low mortality/morbidity risk
timing of sx: semi elective
more time sensitive - not w/n 24 hrs but should be priority
ex: gallstone removal (cholecystectomy), uterine artery ablation for post menopausal bleed from fibrosis
low morbidity/mortality
timing of sx: urgent
w/n 24hrs of diagnosis, to prevent unnecessary complications that occur with waiting
ex: hip fracture, appendectomy
timing of sx: emergency
dont delay, w/n 24hr, scheduled w/n 2hr -> delay may promote critical injury or systemic deterioration, required as a result of urgent medical condition
stabilize GI bleed, subdural hematoma
assessment of preop pt: subjective - pt interview and hx
check documentation before interview -> avoid repetition (+ document new things)
can happen in advance (phone) or day of sx
purpose: obtain health info, determine expectations, provide and clarify info on procedure, assess emotional state and readiness
assessment of preop pt: subjective - pt interview and hx -> steps!
explore understanding of sx need -> teach back
previous sx and anesthetics? -> anticipate problems
fam health hx: SE to anesthesia (malignant hypertherm)
current med use: rx, vits, herbal, otc
med allergies and intol, include latex!
ilicit drug use, abuse, addiction -> ask in same way you asked about meds
tobacco use -> decreased O2 carrying capacity bc CO- attached to hbg, stop 6 wk prior to sx or anytime will improve outcome
pregnant possibility: date of LMP, dont want general anesthesia
is there anything else you would like to share or think I should know
latex allergy rf
hx of anaphylactic rxn during procedure
multiple sx procedures
food allergies (kiwi, bananas, avocados, chestnuts)
allergy to poinsettia plant
daily exposure to latex
hx rxns to latex (balloons, condoms)
hx allergies or asthma
pre op: review of systems
series of q seeking to identify s/s that confirm presence v absence of disease
assess rf for: pulm issues, cardiac, neuro, GU, endocrine, hepatic, integument, MS, immune, F+E, nutrition
pre op: review of systems - pulmonary
atelectasis, infection, prolonged mechanical vent, resp fail, bronchospams, exacerbation of underlying chronic lung disease
pre op: review of systems - cardiac
d/t increased myocardial o2 demands (we dont want to increase demands)
pre op: review of systems - neuro
hearing, vision, cognition
know baseline!
pre op: review of systems - GU
renal function (cre), preg (current or past)
pre op: review of systems - endocrine
DM, thyroid problems -> adjust meds?
pre op: review of systems - hepatic
clot, metabolism
pre op: review of systems - integument
rashes, P ulcer
pre op: review of systems - MS
mobility restrict (intra - and post op)
during sx we put them in weird and wide ROM positions
pre op: review of systems - immune
steroid -> SE! (BS, slow wound heal, impaired skin)