Perioperative Care POWERPOINT Flashcards
When do you wash with special soap (Chlorhexidine Gluconate- CHG) provided by the surgeon
2 - 3 days 72 hrs
When should you
Not eat for a surgery
Types of beverages you may have up to 5 hrs before surgery
When not to smoke, chew tobacco, or drink alcohol
Not eat for a surgery - 11PM
Types of beverages you may have up to 5 hrs before surgery - Black Coffee, Water, 7-Up
When not to smoke, chew tobacco, or drink alcohol
Day of surgery
Take medication with sip of water
Consult with surgeon if having same-day surgery
True or False
True
Elective
Urgent
Emergent
Give examples
Elective: Hernia, Cataracts, Joint replacement
Urgent
Intestinal / bladder blockage, Kidney Stones, Cholecystectomy
Emergent
Gun/ Stab wounds
Aortic aneurysm
Match
Simple, Minimally Invasive, Radical
Preformed through use of endoscope
Extensive, directed at finding the root cause
Only most overtly affected area involved in surgery
Minimally Invasive Surgery
Preformed through use of endoscope
Radical
Extensive, directed at finding the root cause
Simple
Only most overtly affected area involved in surgery
Halothane, Isoflurane, Sevoflurane, and Desflurane
Are which type of drugs
Anestesia
______ is a genetic disorder that causes a severe reaction to certain anesthesia drugs
, leading to a rapid rise in body temperature and muscle contractions. Other symptoms include:
Rapid heart rate
Abnormally fast breathing
Muscle rigidity
Breakdown of muscle fibers
Increased acid levels in the blood
Bleeding
Dark brown urine
Malignant hyperthermia (MH)
This type of surgery _____
Risk for paralytic ileus, venous Thrombosis
Abdominal
This type of surgery _____
Risk for: pulmonary complications
Chest or high abdominal
This type of surgery _____
Risk for: Airway complications
Neck, oral, facial
Physiological Stress Response
Adrenal glands release _____
Which stimulates _____ to cause gluconeogenesis
Hyperglycemia causes: ( low / high ) Wound healing & (low / high) infection rates
Cortisol
Liver
Low wound healing/ high infection rates
Preoperative care begins & ends when
Begins: Surgery is Scheduled
Ends: time of transfer to surgical site
General anestesia drugs including
Desflurane, enflurane, isoflurane, sevoflurane
Depolarizing neuromuscular junction blocker: Succinylcholine
Can all trigger this life threatening disease
Malignant hyperthermia
Dantrolene at 2.5 mg/kg is used for which disease
Malignant hyperthermia
Malignant hyperthermia S / S
( High / Low ) end-tidal carbon dioxide
(High / Low) oxygen sat.
Brady / Tachycardia
Treatment: Give Dantrolene sodium (skeletal muscle relaxer)
High end-tidal carbon dioxide
Low oxygen sat.
Brady / Tachycardia
S/S of Malignant hyperthermia
Muscle (flacid/rigidity) Jaw/ chest
( Hypotension / Hypertension)
(Bradypenea/ Tachypnea)
(Skin molting/ cyanosis)
This color urine
Muscle rigidity Jaw/ chest
Hypotension
Tachypnea
Skin molting & cyanosis Both
Brown Urine
In Preoperative Phase
Why ask about joint replacement history?
Electrocautery pads over prosthetics will cause burns
What is the most important thing to look at when evaluating Lab Values?
Exp. Do we always call a Dr. if a Na level is 130
Trends
No, if their Na level was 125 a few days ago and has risen to 130 is No need to call the Dr.
Would you always report a lab K value of 3.2 to the perioperative team?
Yes, always report hypo/Hyperkalemia to perioperative team
Forget trending
X rays are used for (back pain prior to spinal surgery/ respitory issues)
CT scans are used for (back pain prior to spinal surgery/ respitory issues)
X rays are used for respitory issues
CT scans are used for back pain prior to spinal surgery
After surgeon explains procedure the nurse may clarify facts and dispel rumors about the surgery
True or False
True
The nurse may not serve as a witness to the singing of an informed consent form
True or False
False
Informed consent
Life threatening scenario (patient unable to give consent)
Requires written consultation of a doctor
True or False
False
2 doctors are required
This type of presurgery prep has the following risk:
Electrolyte imbalance, fluid volume imbalance, vagal stimulation, hypotension
What can happen with vagal stimulation
Intestine prep
What can happen with vagal stimulation: PassOut
What is chlorhexidine gluconate used for
Skin prep for surgery
Two most important areas to Exercise after surgery
Legs & Lungs
DVT deep vein Thrombosis can turn into a PE Pulmonary Emblosim
What are signs and symptoms of DTV
_____ Swelling & pain that increases____
Unilateral swelling & pain that increases with walking
When coughing or sneezing, hold a pillow firmly against your incision with both hands. This is called ____
splinting
Intraoperative phase
Begins
Ends
Begins: client arrives in preoperative holding area
Ends: at time of transfer to Post-Anesthesia Care Unit (PACU)
Why don’t we massage legs with DVT
Embolism can break off and travel to lungs
When are Prophylaxis antibiotics given during the perioperative care
1 hr before surgery
Sedatives/hyponotics/Anxiolytics
Diazepam, lorazepam, midazolam
Are this type of drug
Benzodiazepine
Atropine & glycopyrrolate are this type of drug
Anticholinergic
Promethazine & diphenhydramine are this type of medication
Antihistamines
Chlorpromazine
Prochlorperazine
Metoclopramide
Odansetron
Are these types of drugs
Antimetics
Does the circulating nurse enter the sterile field?
No
lidocaine, mepivacaine, prilocaine, bupivacaine, etidocaine, and ropivacaine and levobupivacaine.
All do what
Temp stop pain in a particular part of body
Regional anestesia
Numbs only part of the body that will undergo surgery
Give examples
Spinal / Epidural
Spinal or Epidural
Location
Outside Cerebralspinal Fluid
Inside Cerebralspinal Fluid
Onset:
Immediate
10 - 20 minutes
Spinal
Inside Cerebralspinal Fluid
Immediate
Epidural
Outside Cerebralspinal Fluid
10 - 20 minutes
Post Dural Postural Headache
PDPH is a postural headache (ie, worse when upright, improved when supine)
How does this happen
that usually occurs within 72 hours of dural puncture
Spinal / Epidural
Type of Sedation used for
Minor surgical procedures
Endoscope
Cardiac Catheterization
Cardioversion
Airway maintained
Rapid return to normal
Moderate Sedation
Conscious Sedation
General anesthesia
Methohexital (Brevital)
Is this type of drug
Barbiturates
Droperidol
Etomidate
Ketamine
Midazolam
Proposal
Are all this type of drug
Nonbarbiturate general anestesics
Anesthesia adjuncts
Causes paralysis
Work on blocking Acetylcholine
2 forms
Non- depolarizing
Pancuronium
Atracurium
Cisatracurium
Rocuronium
Vecuronium
Depolarizing
Succinylcholine
Neuromuscular junction blocking agents
Neostigmine (anticholinesterase) + glycopyrrolate or atropine
Sugammadex
Are which type of drug with what affects
Neuromuscular reversal agents
Reverse the affects of paralysis
Nalbuphine
Pentazocine
Meperidine
Fentanyl
Are all this type of Anesthesia Adjunct
Narcotics
Reversal agent for Narcotics
Naloxone
Narcan
Stage 1 - 4
Medullary paralysis, very deep CNS depression, loss respiton, death can occur rapidly
Excitement stage: sympathetic stimulation (may be combative)
Surgical anesthesia, skeletal muscle relaxation, surgery can be safely done
Analgesia stage: losss of pain, patient conscious
- Analgesia stage: losss of pain, patient conscious
- Excitement stage: sympathetic stimulation (may be combative)
- Surgical anesthesia, skeletal muscle relaxation, surgery can be safely done
- Medullary paralysis, very deep CNS depression, loss respiton, death can occur rapidly
3 phases of anesthesia
Induction
Maintenance
Recovery
During the maintenance phase of anesthesia
Stage 3 is maintained via which type of medication
Gas
Immediate Postoperative Period
Is referred to as…
PACU
Aldrete Scale is used for…
Discharge from the PACU
In disseminated intravascular coagulation.
Possible problems with this
abnormal clumps of thickened blood (clots) form inside blood vessels. These abnormal clots use up the blood’s clotting factors, which can lead to massive bleeding in other places
Post op Neurological education
Headache
Vision changes
Increasing back pain while coughing
Chart or Report Immediate
Report Immediate
Wound Dehiscence is
a partial or total separation of previously approximated wound edges, due to a failure of proper wound healing
Wound Evisceration is …
the uncontrolled exteriorization of intraabdominal contents through the dehisced surgical wound outside of the abdominal cavity
Wound dehiscence / evisceration
Which is a Surgical emergency
Which is a report immediately
Which is a Surgical emergency: evisceration
Which is a report immediately: dehiscence
Serous vs Purulent drainage
Serous = Clear / White Normal
Purulent = Yellow, Foul smelling, Infection
Give an example of a gravity drain (2)
Penrose / T-tube
Two types of surgical drains
Jackson Pratt
Hemovac
Report which urine output
<30 mL/hr
Monitor this with NSAID use
GI tolerance
For most Opiods monitor this first.
However
Oxycodone w/ aspirin measure this
Oxycodone w/ Acetaminophen
normal measure RR
Oxy w/ aspirin = GI
Oxy w/ acetaminophen = BP
First 3 things to do in OD of Opiods
- Maintain airway open
- Call rapid response
- Administer Naloxone
Incase of Opiods OD
- Maintain airway open
- Call rapid response
- Administer Naloxone
Admin Ox if …
Hypoxia present /RR <10
Why would you obtain suction equipment in case of an OD
Naloxone can make you vomit
Suffix
- flurane
General anesthesia
Suffix
- ium
Neuromuscular blockers
Also, Succinylcholine
Suffix
Pam / lam
Benzodiazepine
Suffix
Zine/ mide
Antimetics
Also, ondansetron
physostigmine salicylate is used for…
Antidote for anticholinergic
Flumazenil (Romazicon) is used for
Antidote for Benzodiazepine
