perioperative/intraoperative assessments, risks and IV therapy. Flashcards
What is IV therapy and what are the two main types (also sites etc.)
IV can be administered continuously or intermittent (bag or burette directly into vascular access device)
Sites: commonly used with peripheral IV therapy in the hands and arms. Scalp veins are common for new-borns and infants •
Two categories: crystalloids and colloids
• Crystalloids are divided based on tonicity: hypertonic, isotonic, hypertonic
• Colloids are solutions that contain protein or starch. Particles remain intact in the solution and are unable to pass through the capillary membrane. They are used to re-establish circulating volume and oncotic pressure
describe the types of Crystalloids.
Isotonic-
○ Solution same osmolarity as blood plasma
○ Expands the body’s fluid volume without causing a fluid shift
○ Solution with exactly same water concentration as the cell
○ 0.9% sodium chloride (normal saline), glucose 5% in water, Hartmanns solution
Hypotonic-
○ Solution of lower osmolality pressure. Solution moves fluid into cells
○ Dilute solution with a higher water concentration than the cell
○ Cell will gain water through osmosis
○ 0.45% sodium chloride
Hypertonic-
○ A solution of higher osmotic pressure
○ Solution pulls fluid from cells
○ Cells will lose water by osmosis
○ Causes cells to shrink
○ 10% Dextrose in water , Glucose 5% in 0.9% sodium chloride
What is the flow rate formula?
Gravity flow:
volume to be infused/ time X drop rate/60min = drops per min
Macro- 20 drops per ml
Micro- 40 drops per ml
Infusion pump total volume (ml) / time (hours) = rate (ml/hr)
What are some complications of IV therapy?
- Most common cause of infiltration is due to damage to the wall during insertion or angle of placement. It is the leaking into the surrounding tissues. When this occurs lift the arm up, take out cannula, and call doctor and document that it was ceased.
- Phlebitis/Thrombophlebitis- Chemical, Mechanical, Bacterial. Inflammation of the vein. Can be due to the drug, the cannula, bacteria getting into vein
- Cellulitis: inflammation of loose connective tissue around insertion site, caused by poor insertion, red swollen area spreads, treated with antibiotics,
- Septicaemia: severe infection that occurs to a system or body, most often caused by poor insertion technique or poor care. Discontinue device immediately, culture and treat.
- Pulmonary oedema- caused by rapid infusion (fluid volume excess)
Why do we do pre-operative assessments?
To:
• Check patients physical and psychological status
• Identify potential problems
• Perform pre-operative preparation
• Identify the need for further investigations
• Plan care
• Develop a rapport with the patient
What are some potential risks to patients having surgery ?
Anesthetic Burns Positioning injuries Retained surgical items Incorrect procedure post operative infection Bleeding
What is the ASA physical status classification assessment?
A tool to evaluate the patient’s risk for anaesthesia.
ASA 1 to 6 classifications
1. healthy/normal patient
2. patient with mild systemic disease
3. patient with severe systemic
4. patient with severe systemic disease that is a constant threat to life
5. Moribund patient who is not expected to survive with surgery
6. a declared brain dead patient whose organs are being removed for donor purposes
What does an assessment of airway in pre-op prep consist of?
AIRWAY: • Fasting - Nil by mouth • Solids • Fluids • Feeds • Medications • What happens if do/don’t
What are some reasons for premedication that also help with pre-op anxiety ?
- Pre-emptive analgesia and/or nausea
- Reduce secretions to reduce risk of aspirating
- Reduce anxiety e.g. valium
- Induce amnesia
- Attenuate vagal reflexes
- Increase volume/decrease PH of gastric juices (more for pregnant women)
- Treat pre-existing conditions that may be present
What do we do and have to know in pre-operative preparations (summary)?
What surgery is the patient having?
How much prep is needed?
What is the significant prognosis? - informed consent e.g. pros and cons of surgery and alternative options
Previous experience e.g. previous surgical history that may be distressing
Level of Knowledge- if they understand consent, the procedure
What do the patients expect? - to reduce anxiety
Check allergies e.g latex, anaesthesia, iodine
Psychological prep
What anaesthetic process occurs when patients are being admitted to the operating theatre?
- Patients will be taken to the anaesthetic bay or waiting area
- Anaesthetic will be administered in the aesthetic bay OR the Anaesthetic Triad
Anaesthetic Triad:
• Three components: narcosis, analgesia, relaxation
• A general anaesthetic always involves an hypnotic agent, usually analgesic and may also include muscle relaxation
Why may patients be at risk of Venous thrombosis and what are ways to reduce the risk?
Why patients are at risk
• Immobility
• Positions needed to be put in for surgery or post op
• Positive pressure ventilation - (Positive-pressure ventilationmeans that airwaypressureis applied at the patient’s airway through an endotracheal or tracheostomy tube)
Ways to reduce risk
• Compression socks/stockings
• Calf compressions
• Heparin
Define time out.
suspension of activity immediately before commencing a procedure to undertake final verification
The Joint Commission defines as “an immediate pause by the entire surgical team to confirm the correct patient, procedure, and site.”
Who is involved in time out?
Everyone in the surgical suite:
Clinicians, proceduralist, anaesthetist, radiologist, nursing staff, technicians
What is infection control in intraoperative settings? what does it involve?
Infection control is being constantly vigilant in an operative setting, meaning
:equipment sterilisation (e.g. use by date, packaging is intact) = aseptic technique. Even the most spacious theatre can become crowded one surgery commences
