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NURB 3130 > Perioperative > Flashcards

Perioperative Flashcards

1
Q

elderly considerations

A
  • decrease fatty subq fat makes them more susceptible to temperature changes
  • decrease body and organ functions
  • may need more education
  • respiratory and cardiac problems are the leading cause of post op death
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2
Q

bariatric consideration

A
  • increase fatty tissue increases chance of infection
  • risk for dehiscence
  • low reserve
  • high risk of hypoventilation postop
  • movement restriction
  • increase cardiac and pulmonary functionality problems
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3
Q

disability considerations

A
  • difficulty transferring and positioning
  • may need more pre-op education
  • may have difficulty communicating
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4
Q

main concerns during preop

A
  • decreasing stress and anxiety
  • education
  • decreasing risk for post op complications
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5
Q

preoperative assessment

A
  • physical assessment
  • vitals signs, temperature
  • oxygenation status
  • surgical hx?
  • comorbidities?
  • family hx?
  • medications/allergies?
  • smoke/etoh/drugs?
  • nutritonal fluid status
  • dentition
  • respiratory and cv status
  • risk for VTE
  • hepatic/renal function
  • anxiety/fears?
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6
Q

how coricosteroids (dexamethasone) can affect perioperative

A
  • helps with stress of surgery
  • masks infection
  • decreases wound healing
  • increases glucose levels
  • risks for bleeding
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7
Q

how diuretics (hctz, furosemide) can affect perioperative

A
  • electrolyte imbalance
  • decrease fluid
  • hypotension
  • fall risk
  • monitor ABCs during surgery
  • monitor weight
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8
Q

how BENZOs and tranquilizers (diazepam) affect perioperative

A
  • effects narcotics

- hypotension

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9
Q

how antihypertensives affect perioperative

A

-needed to prevent increase in BP intraoperatively

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10
Q

how anticoags/salicylates/nsaids (warfarin) affect perioperative

A

increases risk for bleeding

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11
Q

how opioids (morphine) affects perioperative

A

affects respiratory system and bp

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12
Q

post op education

A
  • deep breathing, coughing, IS
  • mobility ROM
  • pain management
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13
Q

elderly considerations intraoperatively

A

positioning because of their bony prominences and loss of skeletal mass

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14
Q

role of the circulating nurse

A
  • monitors team
  • delegation (legal and ethical)
  • make sure informed consent is signed
  • specimen tagged correctly
  • aseptic practices
  • time out
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15
Q

scrub tech role

A
  • aseptic technique
  • setting up the sterile field
  • handing the instruments to surgeon
  • counting the instruments
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16
Q

types of anesthesia

A
  • general anesthesia
  • regional anesthesia
  • local anesthesia
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17
Q

general anesthesia

A
  • causes loss of sensation, reflexes, and consciousness
  • can’t breathe on their own, can’t feel painful stimuli, not arousable
  • assessment done by anesthesia providers
  • inhalation agents or iv anesthetic agents
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18
Q

inhalation agents

A
  • halothane, isoflurane, nitrous oxide

- given with oxygen

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19
Q

iv anesthetic agents

A
  • benzo, etomidate, propofol, ketamine
  • can be used to induce or maintain aesthetic
  • neuromuscular blocking agent
  • must have resuscitation or ventilation devices near
  • don’t admin propofol if pt has egg or soybean allergy
20
Q

regional anesthesia

A
  • decrease in feeling in a specific part of the body
  • inject local anesthesia and block peripheral nerves
  • pt is awake
  • spinal anesthesia or epidural
21
Q

local anesthesia

A

injection of local anesthetic into tissues at planned incision site

22
Q

spinal anesthesia

A
  • injected into subarachnoid space (between L4 & L5)

- provides autonomic, sensory, and motor blockade to lower extremities, perineum, and lower abdomen

23
Q

complications of spinal anesthesia

A
  • headache from csf leakage, size of needle, or dehydation
  • instruct to lay flat and stay hydrated
  • n/v
  • pain
24
Q

epidural anesthesia

A
  • injected in epidural space in thoracic or areas of spine

- blocks sensory pathways but motor function stays intact

25
Q

intraoperative complications

A
  • anesthesia awareness
  • respiratory
  • hypothermia
  • malignant hyperthermia
26
Q

possible respiratory problems intraoperatively

A
  • intubations problems
  • inadequate ventilation, occluded airway (o2 stat, auscultate, skin, respirations)
  • esophageal intubation (distended abdomen)
  • unrecognized hypoventilation (can affect major organs)
27
Q

hypothermia

A
  • decrease in cellular oxygen
  • from warm gasses
  • decreases in muscle activity
  • place warm blankets
28
Q

malignant hyperthermia

A
  • medical emergency
  • hypermetabolic condition: alter in ca activity in skeletal muscle cells
  • trigger: inhalation anesthetic agents and succinylcholine combo
  • treat sx
  • early identification is key!
29
Q

sx of malignant hyperthermia

A
  • early signs: tachycardia, increased co2, generalized muscle rigidity
  • late sign: hyperthermia
  • decreased o2
30
Q

initial PACU assessment

A
  • airway: check for patent airway
  • breathing: place hand near mouth, auscultate, assess respirations, check o2 saturation, give supplemental 02
  • circulation: monitor ecg, measure bp frequently, assess skin color & temp, assess tissue perfusion (peripheral pulses, capillary refill)
31
Q

how to maintain patent airway

A
  • provide o2
  • assess breathing
  • positioning: hob elevated 15-30
  • tcdb
  • suction if cant cough
  • reposition to side if vomiting
  • stay at bedside of pt with oral airway
32
Q

maintaining cv stability

A

-monitor for hypotension, shock, hemorrhage, hypertension, dysrhythmias

33
Q

monitoring/managing hypotension, shock

A
  • low bp, high hr (commonly from fluid or blood loss)
  • increase iv fluids
  • assess surgery site
  • monitor h&h levels
34
Q

managing/monitoring hemmorhage

A
  • monitor hr
  • monitor surgery site
  • not drainage increase
  • restore circulating volume
35
Q

monitoring/managing htn

A
  • from sympathetic stimulation from pain, anxiety, bladder distention, resp. compromise
  • hypothermia or pre-existing htn
  • possible result of revascularization
36
Q

monitoring/managing for dysrhythmias

A
  • leading causes: hypokalemia, hypoxemia, change in pH balance, circulatory instability, pre-existing heart disease
  • other causes: hypothermia, pain, surgical stress, meds
37
Q

s/s of hypovolemic shock/hemorrhage

A
  • changes in loc
  • pallor
  • cool, moist skin
  • tachypnea
  • cyanosis
  • rapid, weak thready pulse
  • hypotension
  • narrowed pulse pressure
  • concentrated urine
38
Q

what to do when pt has hypovolemic shock or hemorrhage

A

place with head down and legs elevated

39
Q

managing airway obstruction

A
  • assess respiratory
  • head tilt/chin lift, pull tongue forward and open airway
  • resuscitation equipment
40
Q

managing hypoxia

A
  • elevate hob
  • tcdb
  • frequent reposition
  • monitor o2 sat
  • give o2 as indicated
41
Q

managing hypovolemic shock

A
  • admin o2
  • supine with legs up, head down
  • iv fluids
  • vasopressors (tightens vessels and increases bp)
42
Q

managing paralytic ileus

A
  • assess bowel sounds
  • ambulation
  • advance diet as tolerated
  • metoclopramide: stimulate peristalsis
  • ng tube if needed
43
Q

managing dehiscence/evisceration

A
  • cover with moistened saline, reassure pt, get help

- low fowlers, knees flexed, monitor for shock, call HCP

44
Q

risk factors for dehiscence/evisceration

A
  • obesity
  • coughing
  • no splinting
  • dm
  • infection
  • hematoma
45
Q

managing dvt

A
  • ted, sed hose
  • heparin if needed
  • early ambulation
  • hydration
  • no pressure behind knees
46
Q

dvt risk factors

A
  • dehydration
  • hypercoagulability
  • immobility
  • obesity
  • trauma
  • hormones

NURB 3130 (7 decks)

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