Perioperative Flashcards
3 phases
pre
intra
post
pre phase
time pt decides to have surgery to OR table
intra phase
OR to PACU
PACU
post anesthesia care unit
post phase
PACU to complete recovery
3 types of urgencies
elective
urgent
emergency
elective
scheduled, not urgent
urgent
perform soon
emergency
perform STAT
ambulatory surgery
reduces length of stay
cuts costs
reduces pt stress
*stay home night before and come in for same day surgery
risks: minor or major
what contributes
surgery length
under longer=greater risk
6 purposes
diagnostic
curative
ablative
palliative
reconstructive
transplantation
diagnostic
to diagnose
ablative
removal of organ
palliative
reduce intensity
reconstructive
restore function
transplantation
organs
a biopsy is
diagnostic
a hip replacement is
reconstructive
debridement of injury is
palliative
an appendectomy is
ablative
main priority for preop
screening
teaching
what is screening
identify risks so they don’t occur in OR
risk factors to assess during screening
allergies
lab results
abnorm results
signed consent
teaching is performed when
pre op phase
teaching is reinforced when
post op phase
preop meds/skin preps
sedatives
anticholinergics
histamine receptor antihistamines
narc analgesics
antibiotics
hygiene and skin prep
what do we teach
pain management
coughing and deep breathing
incentive spirometer
meds
what do coughing and deep breathing do
prevent pneumonia and atelectasis
*anesthetics decrease ciliary movements- causes secretions to sit and lead to resp problems
teach patient with midline abdominal surgery to
splint
what meds to discontinue before surgery
blood thinners
what meds do you continue
blood pressure
beta blockers
what do chest xrays tell us
infection
heart failure
lung info
what does an EKG tell us
arrthymias
what does a CBC tell us
WBC
HCT
HB
*infection, anemia, platelets
electrolytes tested
NA
K
CA
CL
what does K tell us about
heart
what does NA tell us about
dehydration
what does atelectasis turn into
pneumonia
what do we need to know about illicit drug use
what type
last use
*to avoid withdrawals
what is an advanced directive
legal document for pt specific instructions post op
AND
allow natural death
what risks do we want to minimize
aspiration
intraoperative positioning injuries
imbalanced body temp
when are antibiotics hung
1 hour prior to first cut
clear liquids up to ___ hours before surgery
2
light breakfast ___ hours before surgery
6
heavier meal allowed ___ hours before surgery
8
main goal intraop
safety and monitoring
how to prevent aspiration
fluids
positioning
bleeding/shock vital signs
increase HR
decrease BP
what does hypothermia lead to
decreased blood flow= less O2 to site= less nutrients
what does general anesthesia affect
LOC
analgesia
relaxation
loss of all reflexes
what does regional anesthesia affect
analgesia
loss of reflexes below site
what does conscious anesthesia affect
analgesia
amnesia
what do topical/local anesthesia affect
analgesia
example of regional
spinal block
epidural
which anesthesia has the greatest risk
general
malignant hyperthermia
autosomal dominant trait
*reaction to general anesthesia and neuromuscular blocking agents
reactions from malignant hyperthermia
increased HR and RR
leads to:
hyperthermia
dysrhythmias
respiratory/metabolic acidosis
malignant hyperthermia treatment
dantrolene
main priority in PACU
assessment
prevention of complications
how long is normal stay in PACU
1 hour
what reflexes do we need to see
cough and gag
*protect airway
nursing interventions for hemorrhage and shock
monitor BP and HR
monitor I&O
assess dressings and drainage
monitor hgb and hct
lung complications
thrombophlebitis
pulmonary embolus
what is a saddle embolism
goes into both pulmonary arteries and veins
