Perioperative Pats Flashcards
under strict conditions designed to enhance patient safety
Modern surgery is defined
before (preop phase), during (intraop phase), and after (postop phase) all types surgeries - togethers known as perioperative experience
Provide critial patient care in periods
Consistently anticipate safety needs prior to, during, and after surgery, and carry out ways for patient well-being
Interventions can prevent anticipated problems
Surgical care improvement project
Safety during the surgical experience
SCIP - set core compliance measures; reduces surg comps
Surgical care improvement project
Inherited muscle disorder, acute and life-threatening comp of certain drugs for gen anesthesia
Characterized by many probs including inad thermoreg
Rxn begins in skeletal muscle exposed to drugs causing increase Ca levels in muscle cells and increased muscle metabolism; serum Ca and K levels rise as is metabolic rate leading to acidosis, cardiac dysrhythmias, and high body temp
Symp: tachycardia, dysrhythmias, muscle rigidity of jaw and upper chest, hypotension, tachypnea, skin mottling, cyanosis, myoglobinuria (muscle proteins in urine)
Dantrolene Na - muscle relaxant only one for MH
Malignant hyperthermia (MH)
Perform one well in advance or immediately before surgery
Compare findings with history and review sys collected to identify new/immediate health probs, info that indicates potential anesthesia comps, risk for concerns that may occur during surgery
Begin with complete set VS
Older adult/pat with chronic health condition increased risk for comps during and after surgery: numbers serious diseases (morbidity) and deaths (mortality) during/after surgery higher in older/chronically ill
Assess CV status, respiratory status, kidney func, neurologic status, MS status, nutrition status, skin assessment
Phys assessment
Most have anxiety/fear before surgery
Varies from type, perceived effects and outcome, and personality
Affect ability learn, cope, cooperate with teaching and operative procedures
Perform assessment to know level anxiety, coping ability and support sys
Provide info as needed
Psychosocial assessment
Provide baseline data about patient’s health and can help predict potential comps
Choice testing dependings on age, history, type anesthesia planned
Report electrolyte imbalances/abnorm labs to team before surgery: hypokalemia: increases risk toxicity if taking digoxin, slows recovery from anesthesia, increases cardiac irritability; hyperkalemia: increases risk dysrhytmias, esp with anesthesia
Lab assessment
CXR - pats with history resp probs; presence pneumonia/TB; emergency helps select anesthesia type
Other depend on history and nature of surgery
Imaging assessment
ECG - history of/risk of CVD who need gen anesthesia
Prior consultations depending on if have prior prob
Drugs (nitro, beta blockers, antibiotics) for prob prevention may be needed periop phase to reduce/prevent stress on the heart
Other diagnostic assessment
Day surgery - drug schedule may be altered; some drugs must be stopped until certain amount time passes
Regularly scheduled drugs
Prevent injury to colon and reduce number intestinal bacteria
Bowel evac: major ab, pelvic, perineal, perianal surgery
Electrolyte imbalance, fluid volume imabalce, vagal stim, orthostatic hypo may occur
Intestinal prep
Before surgery first step to reduce risk for surgical site infection
Pat may be asked to shower in antiseptic solution: chlorhexidine gluconate - reduces contamination of surgical field and number organisms at site; clean well around proposed surgical site
Remove soil/debris from surgical site/surrounding area
Increase wound contamination: bacteria in hair follicles, disruption of norm protective mechanisms of skin, nicks in skin
Skin prep
Teach about potential presence and purpose to reduce anxiety
Tubes common after surgery - often placed during surgery
Drains - various shapes and sizes; often placed during surgery to remove fluid from surgical site; not kinked/pulled
Vascular access - for gen anesthesia and for most receiving other anesthesia; give drugs and fluids periopative phase
IV access - placed in arm using large-bore, short catheter (18-gauge, 1-in catheter) or in back of hand with 20-gauge; larger vein provides least resistance to fluid/blood infusion esp in emergency; can be placed whenever
Prep for tubes, drains, and vascular access
Completion surgery and transfer of pat to specialized area for monitoring (PACU/ICU)
May extend beyond discharge until activity restrictions lifted
Postop phase
