periop, f/e, a/b, shock, respiratory Flashcards
perioperative
the whole system - the moment a patient is scheduled for surgery until recover unit/admission/discharge
Goals: prevention of DVT/PE, prevention of respiratory infections/improving gas exchange, pain management, promoting peristalsis/comfort w/o N/V, promote wound healing/tissue integrity.
Key points: safety checks, teamwork, pt centered care, ethics, EBP, clinical judgement
Expected outcomes: the pt… attains/maintains adequate lung expansion & respiratory function, has appropriate wound healing w/o complications, has acceptable pain management, has return of peristalsis.
Pre-op
From when surgery is scheduled until arrival to surgical suite.
Prioritization: pt ID, allergies, confirmed ride, interpreter, surgery checklist, informed consent & site marked (by surgeon), pt hx, Interprofessional collaboration and teamwork.
intra-op
arrival in surgical suite until transferred to PACU.
Prioritization: critical time out (stop all moment prior to surgery w/ all remembers present), monitor subtle changes, acknowledge high risk patient issues.
fires in surgery
caused by oxidizers, electrosurgical units, fiber optic light sources or laser surgery, acohol based surgical preps. Prevention, communication, fire - risk assessment & awareness
Malignant hyperthermia
acute life threatening complication. Skeletal muscle exposed to specific agent causing increase metabolism, increase Ca levels into muscle cell leading to acidosis, critical high fever (>110), dysrhythmias. Genetic component (pt hx!)
S/S = tachycardia, skin mottling, tachypnea, cyanosis, increase end total volume, sudden rise in temperature
post-op
arrival to PACU for recovery until admission, transfer, or discharge.
Phases: when they come out, 2 hr after surgery, when they leave
Prioritization: full assessment, critical VS, subtle changes, skin assessment/wound, pain management, postop GI system.
Education: pain management, drug therapy, safety, prevention of infection, management of drains/catheters, nutrition therapy, follow-up w/ surgeon
Normal Sodium
136-145
Where sodium goes, water follows. Major cation in ECF.
Hyponatremia
<136
Causes: diuretics, NPO, low salt diet, excessive ingestion of hypotonic fluids
Assessment: thirst, cerebral changes (confusion, altered LOC), NM changes (weak in arms/legs, Respiratory muscle weakness), intestinal (increase motility, diarrhea, nausea, cramping), CV (weak pulse, thready, decrease BP, orthostatic hypotension, postural dizziness, decrease skin turgor).
Priorities: monitor response to therapy and prevent fluid overload
Interventions: find cause, drug therapy (IV saline, tolvaptan if severe), nutrition (increase salt, limit fluid intake), patient safety (high risk for falls), skin protection.
