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3130 > Perioperative Care > Flashcards

Perioperative Care Flashcards

1
Q

Special considerations for gerontologic

A
  • less physiological reserve (CO, sleep apnea, COPD, lung capacity)
  • decrease subQ fat
  • decreased mental status
  • respiratory and cardiac leading cause of mortality
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2
Q

Special considerations for bariatric

A
  • wound dehiscence, infection
  • immobility
  • increased cardiac demand
  • increased O2 demand
  • hypoventilation
  • increased risk of pulmonary complication
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3
Q

Special considerations for disabled

A
  • transfer and position
  • mental status
  • communication
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4
Q

Special consideration for ambulatory surgery

A
  • someone has to drive them home
  • > 24hrs
  • condensed
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5
Q

Special considerations for emergency surgery

A
  • not a lot of prep time

- not a lot of consent

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6
Q

Informed consent

A
  • provider: obtains (out of scope for nurse to explain procedure/risk)
  • pt: give (has to be autonomous, age, right to refuse, confident answ)
  • nurse: witness (pt understand, clarify, call MD if pt change mind)
  • any invasive procedure needs a consent form
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7
Q

Preoperative assessment

A
  • baseline data
  • meds/allergies (shellfish, px, OTC, supplements, herbal)
  • nutritional,fluid status: always hydrate before surgery
  • dentition: intubation/airway, increased infection with poor teeth
  • resp and CV status
  • hepatic, renal function: insufficiency increased mortality
  • endocrine function
  • immune function
  • psychosocial: anxiety**
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8
Q

Diagnostics

A
  • electrolyte**
  • CBC**
  • Cr and BUN
  • blood type
  • clotting
  • urinalysis
  • ABG
  • pregnancy
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9
Q

Meds that can affect perioperative period

A
  • corticosteroids (dexamethasone): help with stress, delay wound heal, mask infection, increase glucose, never DC abruptly**
  • diuretics (HCTZ and furosemide): have enough electrolytes, holding before surgery
  • tranquilizers (diazepam): decrease anxiety
  • insulin: glycemic control = better healing
  • antibiotics
  • anticoagulant/salicylates/NSAIDS: stop 2wk before surgery
  • anti seizure (carbamazepine)
  • thyroid (levothyroxine): hypothyroidism, give before surgery
  • opioids
  • OTC/alcohol
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10
Q

Preoperative nursing interventions

A
  • pt edu: deep breathe, cough, mobility, pain mgt
  • consent
  • NPO
  • skin prep
  • warm blanket: thermo reg
  • VS
  • minimize anxiety
  • DVT prevention
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11
Q

Preoperative complications

A
  • opioids: respiratory distress, decrease CNS, safety risk
  • sedatives (BENZOs): safety, decreased CNS
  • IV infusions: avoid fluid overload (crackles, edema)
  • GI meds: antiemetic**, antacids, H2 receptor blockers
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12
Q

Circulation nurse responsibilities

A
  • responsible for team
  • setting up OR
  • counting
  • specimen collection
  • documents
  • privacy
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13
Q

General anesthesia

A
  • general anesthesia: less of protective reflexes, not arousable
  • assessment: type of procedure, age*, length of time, comorbidites
  • inhalation agents: halothane, isoflurane, nitrous oxide (add O2)
  • IV anesthetic agents: propofol (egg/soybean allergy, short half life)
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14
Q

Regional anesthesia

A
  • injected in certain area around the nerve
  • effect depends on type of nerve
  • spinal: provides autonomic, sensory, motor, no movement
  • complications: headache (size of needle, fluid leak, dehydrated)
  • epidural: blocks pathways but motor function intact (check for epinephrine)
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15
Q

Anticholenergics

A
  • atropine (increases heart rate)

- bradycardia, heart block

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16
Q

Neuromuscular blocking agent

A
  • AIRWAY!! They will not be able to breathe!!
  • succinylcholine/vecuronium
  • block impulse to nerve muscles relaxes
17
Q

Intraoperative complications

A
  • anesthesia awareness: they stay asleep
  • N&V: risk for aspiration (roll onto side or turn head)
  • respiratory: intubation, ventilation, hypoventilation, air occlusion)
  • malignant hyperthermia
18
Q

Malignant hyperthermia

A
  • can happen immediately
  • dantrolene
  • trigger: inhalation anesthetic agents and succinylcholine**
  • early signs: tachycardia, increased CO2, decreased O2, musicale rigidity
  • treat by lowering room temp, ice, ventilation, cold gas
19
Q

Intraoperative nursing interventions

A
  • reduce anxiety
  • safety
  • monitoring, managing potential complications*
  • pt advocate
20
Q

Initial PACU assessment

A
  • priority ABCs FIRST**
  • keep them awake and breathing
  • are they breathing and is it effective
  • supplemental O2: meets O2 demand from blood loss or increase metabolism
  • O2 sat EARLY WARNING**
  • assess tissue perfusion, peripheral pulses, cap refill
21
Q

Maintaining patent airway

A
  • provide supplement O2
  • assess breathing
  • positioning: HOB elevated 15-30 unless
  • TCDB
  • unable to cough?- may require suctioning
  • vomiting: reposition left lateral
22
Q

When do you remove an oral airway

A

Until evidence of gag reflex returns

23
Q

Maintaining cardiovascular stability

A
  • potential for hypotension, shock: common cause I replaced fluid/blood loss
  • potential for hemorrhage
  • potential for HTN (brain, heart, kidneys): from sympathetic stimulation from pain, anxiety, bladder distention, respiratory comp

-leading cause of dysrhythmias: hypokalemia**, hypoxemia, alteration in pH, circulatory instability, preexisting heat disease, hypothermia, pain surgical stress, medications

24
Q

Indicators of hypovolemic shock/hemorrhage

A
  • changes in LOC
  • pallor
  • cool, moist skin
  • tachypnea
  • cyanosis
  • rapid, weak, threads pulse
  • hypotension
  • narrowed pulse pressure
  • concentrated urine
25
Q

Relieving pain and anxiety

A
  • assess reassess
  • control environment: low lights, noise level**
  • nonpharmacologic approaches to pain
  • anxiety: BENZOs**
  • splinting
  • positioning
26
Q

Response to anesthesia

A
  • sedation: hepatic and renal insufficiency can cause oversedation, safety
  • N/V: needs to be treated immediately
27
Q

Genitourinary- I&O

A
  • monitor I&O Intraoperative and PACU (urine 30/mL)
  • postop lab
  • skin turgor
  • admin IV fluids as indicated
  • blood products
  • bladder distention
  • adequate UO
28
Q

Managing potential complication nursing interventions

A
  • airway obstruction: resp assessment—low O2 sat, irregular resp, cyanosis; pull tongue forward and open airway; resuscitation equipment
  • hypoxia: elevate HOB, TCBD, frequent repositioning, monitor O2 sat
  • hypovolemic shock: decreased BP?UO, increase HR/RR, narrowing pulse pressure, slow cap refill; O2, supine with legs up, IV fluids, vasopressors
  • paralytic ileus: bowel sounds, ambulating, advance diet, metoclopramide (increase GI emptying), NG tube
  • wound dehiscence: cover with moist sterile saline, reassure pt, get help, low Fowler with knees flexed, monitor for shock, call HCP

3130 (13 decks)

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