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ADULTs 1 > Pre/Intra/Postoperative Care > Flashcards

Pre/Intra/Postoperative Care Flashcards

1
Q

What is the total surgical episode called

A

Perioperative period

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2
Q

What is an ACP

A

Anesthiaa care partner

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3
Q

What is an ASA rating

A

P1-P5 P1 normal healthy person P5 declared brain dead organ harvest given by HCP

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4
Q

What three things should you counsel your patient to do post op general surgery?

A

deep breathing, cough, early ambulation

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5
Q

cefazolin

A

anitbiotic to prevent postoperative infection

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6
Q

atropine glycopyrrolate

A

decrease oral/respritory secretions

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7
Q

scopolamine

A

prevent nausea/vomiting and provide sedation

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8
Q

insulin (humulin r)

A

stablize BG

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9
Q

metoclopramide

A

increase gastric emptying

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10
Q

ondansetron

A

prevent nausea and vomiting

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11
Q

diazepam, lorazepam, midazolam

A

(valium, ativan) decrease anxiety, induce sedation, amnesic effects

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12
Q

labetalol

A

manage hypertension

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13
Q

famotidine, ranitidine

A

decrease hydrochloric acid secretion, increase ph, decrease gastric volume

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14
Q

fentanyl, morphine

A

relieve pain during preoperative procedures

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15
Q

What is an SRE?

A

Serious Reportable Event

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16
Q

What are the three parts of Surgical Care Improvement Project

A

A prophylactic antibiotic statrted w/ in 30-60min before surgical incision

apply warming blanket

apply intermiitent pneumatic compression devices to minimize VTE

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17
Q

When are National Patient Safety Goals used?

A

preprocedure verification process

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18
Q

Why use the Universal Protocol?

A

To prevent wrong site, procedure, and patient.

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19
Q

When can RNs administer anesthesia?

A

Moderate to deep sedation in an emergency outside of the OR (Ex: ER) under physician supervision.

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20
Q

What is MAC?

A

monitored Anesthesia care: includes varying levels of sedation, done inside an OR, must be an ACP

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21
Q

What are the patient effects of general anesthesia?

A

loss of sensation w/ loss of consciousness

combo of hypnosis, analgesia, and amnesia

usually involves use of inhalation agents

skeletal muscle relaxation

elimination of coughing, gagging, vomiting, and sympathetic nervous system responsiveness

requires an advanced airway

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22
Q

What are the patient effects of local anesthesia?

A

loss of sensation w/ out loss of consciousness

induced topically or via infiltration, intracutaneously, or subcutaneously

topical applications may be aerosolized or nebulized

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23
Q

What are the patient effects of moderate sedation/analgesia

A

sedative, anxiolytic (reduces anxiety), and/or analgesic drugs used

does not include inhalation agents

patient is responsive and breathes w/ out assistance

not expected to induce sedation that would compromise airway

usually used for minor therapeutic procedures like a fracture realignment in the ER

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24
Q

What are the patient effects of monitored anesthesia care

A

sedative, anxiolytic (reduces anxiety), and/or analgesic drugs used

might need airway management

GIVES GREATEST FLEXIBILITY TO MATCH SEDATION LEVEL TO PT NEEDS AND PROCEDURAL REQ

often used in conjunction w/ regional/local anesthesia

often used for minor therapeutic/Dx procedures (eye surgery, colonoscopy)

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25
Q

What are the patient effects of regional anesthesia

A

Loss of sensation to region of body w/ out loss of consciousness

Blocks a specific nerve/group of nerves by admin local anesthetic

Includes spinal, caudal, and epidural anesthesia and IV peripheral nerve blocks (interscalene, axillary, infra-/supra-clavicular, popliteal, femoral, sciatic)

26
Q

What kind of drugs are used during the preinduction phase?

A

benzos, opioids, antibiotics, aspiration prophylaxis (H2 receptor blockers, gastric motility agents, anticholinergics)

27
Q

What kind of reversal agents might they use in case of an emergency?

A

Anticholinesterases (neostigmine), opiod antagonists (naloxone), benzodiazepine antagonist (flumazenil), neuromuscular block reversal of rocuronium (zemuron) and vecuronium (norcuron) and sugammadex (bridion)

Supplemental opiods

Antiemticis

28
Q

The IV agent methohexital (brevital) is a barbituate used for ________

A

general anesthesia. It has advantage of rapid induction, usually under 5min. It may cause myocardial depression, hypotension, excitation, or involuntary movement. It has a short duration of action and usually has minimal effects on pt post-op. Causes nausea in pts that are sensitive to barbiturates and/or have high histamine.

29
Q

The IV agent etomidate (amidate) is a non-barbituate hypnotic used for ________

A

general anesthesia.

Benefit is that it has little effect on cardio function (unlike methohexital) and is used on hemodynamically unstable pts. It has minor respiratory depression and does not cause histamine release.

it can cause myoclonia (quick, uncontrollable jerking) nausea, vomiting, hiccups, and inhibits adrenocortical processes (aka, stops release of polycyclic steroid hormones that have a variety of roles that are crucial for the body’s response to stress (for example, the fight-or-flight response), and they also regulate other functions in the body. Threats to homeostasis, such as injury, chemical imbalances, infection, or psychological stress, can initiate a stress response. Examples of adrenocortical hormones that are involved in the stress response are aldosterone and cortisol. These hormones also function in regulating the conservation of water by the kidneys and glucose metabolism, respectively.)

30
Q

The IV agent propofol (diprivan) is a non-barbituate hypnotic used for ________

A

general anesthesia

Ideal for short, outpatient procedures b/c of rapid onset action/metabolic clearance. May be used for induction/maintenance of anesthesia.

Can cause bradycardia, dysrhythmias, hypotension, apnea, transient phlebitis (the inflammation of the internal lining, tunica intima, of a vein. It is associated with pain, swelling and erythema around the intravenous cannula insertion site or along the course of the vein without systemic involvement.4 In severe cases, it may lead to thrombosis of the vein which manifests as a small lump.) nausea, vomiting, hiccups, and hypertriglyceridemia

31
Q

The inhalation agent nitrous oxide is a gas used for ________

A

General anesthesia.

Is liquid at room temperature, but evaporating easily for administration by inhalation (volatile agent) which speeds induction with reduced total dosage and side effects.

it is a weak anesthetic that is rarely used alone although it has good analgesic potency.

It has little to no toxicity at therapeutic concentrations.

Should be avoided in pts w/ bone marrow depression. Pt must be given O2 to prevent hypoxemia. Avoid in pts w/ history of nausea/vomiting.

32
Q

The inhalation agent nitrous oxide is a volatile liquid used for ________

A

general anesthesia

All cause skeletal muscle relaxation and Resp depression, myocard depression, hypotension

Desflurance: fastest onset/emergence and is widely ised in amb settings d/t its least postoperative cognitive dysfunction. is a potential airway irritant. Resp depression, myocard depression, hypotension

Isoflurane: no increase in ventricular irritability and does not cause renal/liver toxicity. Is resistant to metabolic breakdown. Not good for coronary art disease pts

Sevoflurane: predictable effect of cardio/resp systems and is rapid acting. Preferred for inhalation induction d/t nonirritating to resp tract. Can cause emergence delirium/seizure

33
Q

The dissociative anesthetic ketamine is a drug used for ________

A

general anesthesia

Given IM/IV and is a potent analgesic/amnesic

May cause hallucinations/nightmares.

increases intracranial/intraocular pressure.

Increases HR and BP

May need benzos post op to manage agitation. Need calm, quiet atmosphere.

34
Q

Describe some antiemetics that you may use in adjunct to general anesthesia

A

Aprepitant (emend), granisetrinmetoclopamide (reglan), ondansetron (zofran), palonosetron, prochlorperazine, promethazine, rolapitant (varubi)

Counteracts nausea/vomiting r/t histamine release, vagal stimulation, vestibular disturbance, procedure (abdominal laparoscopy). Can be used prophylactically.

Can cause headache, dizziness, dysrhthmias, dysphoria, dystonia (neuromuscular spasms, abnormal postures), CNS sedation, dry mouth

35
Q

Describe some benzodiazepines that you may use in adjunct to general anesthesia

A

Diazepam (valium)
Lorazepam (ativan)
midazolam (versed)

Reduces anxiety, induces/maintain anesthesia, treats emergence delirium, supplements sedation in local/regional anesthesia and MAC

Has a synergistic effect w/ opioids which may cause significant respiratory depression, hypotension, and tachycardia. May cause prolonged sedation/confusion.

Reduce respiratory depression with flumazenil (rumazicon)

36
Q

Describe some DEPOLARIZING neuromuscular blocking agents that you may use in adjunct to general anesthesia

A

Succinylcholine (anectine)

promotes endotracheal intubation and access to surgical sites d/t skeletal relaxation (paralysis)

Causes apnea r/t paralysis of resp muscles. Action of depolarized agents may take longer than the surgery to fade.

37
Q

Describe some NON-DEPOLARIZING neuromuscular blocking agents that you may use in adjunct to general anesthesia

A

Atracurium, cisatracurium, pancuronium, rocuronium

effects can be reversed toward end of surgery w/ anticholinesterase agents (neostigmine) unlike depolarized agent.

The reversal agent still may not completely reverse the effects.

Correction of hypothermia may increase muscle weakness.

May cause confusion and nausea.

38
Q

Describe some opioids that you may use in adjunct to general anesthesia

A

Used to induce and maintain anesthesia by reducing stimuli from sensory nerve endings. it provides analgesia during surgery and recovery in the PACU.

it causes respiratory depression, vomiting, bradycardia, peripheral vasodilation (when combined w. anesthetics), and it high risk for pruritus w/ both regional and IV admin.

Usually coincides w/ standing order for antiemetics and antipruritics.

Have naloxone on hand by keep in mind use also reverses analgesic effects.

39
Q

Describe the balanced technique

A

using adjunctive drugs to complement an induction for general anesthesia

40
Q

Describe the steps of putting a patient under routine general anesthesia

A

You begin with an IV induction agent (hynotic, anxiolytic, dissociative agent). These agents induce sleep rapidly. However, a single dose only lasts a few minutes. This is long enough to place an advanced airway. Once this is done the ACP give the inhalation and IV agents.

41
Q

What are two types of advanced airways that may be used during general anesthesia?

A

LMA (Laryngeal mask airway, option for difficult airways by do not provide access to trachea/airway protection w/ same certainty as ET) or ET (endotracheal tube).

42
Q

What are two types of inhalation agents

A

volatile liquids or gas

43
Q

Define drug adjuncts

A

Drugs other than the inhalation anesthetic in general anesthesia

44
Q

Define dissociative anesthesia

A

dissociative anesthesia interrupts associative brain pathways while blocking sensory pathways.

Pt may appear catatonic, is amnesic, and has profound analgesia that lasts into the postoperative period.

Ex: Ketamine is given to trauma pts to increase heart rate and maintain cardiac output. It also is given to asthmatic pts to promote bronchodilation. It causes hallucinations/nightmares by that can be counteracted w/ midazolam (versed)

45
Q

What is the physiology of local anesthesia?

A

Ex: lidocaine

Interrupts generation of nerve impulses by changing the flow of sodium into nerve cells. Results in autonomic nervous system blockade that presents as skeletal muscle flaccidity/paralysis.

Can be topical, ophthalmic, nebulized, injected

Does not involve sedation/loss of consciousness

46
Q

What is the physiology of regional anesthesia?

A

otherwise known as a “block”

Always injected

Involves a central nerve (spinal) or group of nerves (plexus) that innervate a site remote to the point of injection.

May involve MAC. Can be done before, during, after operation. Pump can be implanted during surgery for continuous pain relief up to 72 hours after the procedure.

47
Q

Pros/cons of using local/regional anesthesia over general anesthesia

A

PROS
Rapid recovery
Discharge w/ post-op anesthesia w/ out any accompanying cognitive dysfunction
Safely used in patients w/ comorbidities

CONS
technical problems, difficulty matching duration of action w/ duration of procedure, risk for inadvertent vascular injections that could led to LOCAL ANESTHETIC SYSTEMIC TOXICITY (LAST) which presents as confusion, metallic taste, oral numbness, and dizziness.

48
Q

Why mix epinephrine with a local anesthetic cream?

A

To cause localized vasoconstriction that decreases absorption and extends the action of the agent

49
Q

What would be the symptoms of a patient with local anesthetic in their general circulation?

A

tachycardia, hypertension, general feeling of panic

50
Q

Spinal and epidural anesthesia is a type of ______ anesthesia

A

regional

51
Q

Where is spinal anesthesia anatomically placed?

A

injection into the cerebrospinal fluid in the subarachnoid space, usually below L2.

Used for extremities, joint replacements, lower GI procedures, prostate/gynecological procedures.

52
Q

Where is epidural anesthesia anatomically placed?

A

injection into the epidural space via a throacic or lumbar approach. The anesthetic does not enter the cereospinal fluid, but binds to nerve roots as they enter and exit the spinal cord. Sensory pathways are blocked but motor fibers are still intact in lower doses. higher doses both sesnory and motor are blocked.

53
Q

What are symptoms of a autonomic nervous system blockade

A

seen in spinal/epidural anesthesia

hypotension, bradycardia, nausea, vomiting

54
Q

Describe malignant hyperthermia

A

MH is an adverse affect that some people have to certain anestheitc agents, especially volatile inhalation agents. Stress. trauma, and heat can also trigger.

Usually occurs during general anesthesia. Can also occur post-op.

Its a dominant genetic trait. Happens because skeletal muscle cells hypermetabolize which eventually destroys them

Treated w/ dantrolene which slows the metabolism and reduces muscle contraction

55
Q

What are the most common causes of airway compromise?

A

obstruction (pt’s tongue, laryngeal edema/spam, thick secretions), hypoxemia (atelectasis, pulmonary edema/embolism, aspiration, bronchospams), hypoventilation (depress CNS, mechanical restriction, pain, poor resp muscle tone)

56
Q

How should you prevent respritory problems in the PACU

A

supine position w/ elevated head, O2 therapy can help eliminate gasses, encourage deep breathing to decrease atelectasis, effective coughing, change position every 1-2 hours,

57
Q

What is the goal of a preoperative nursing assessment?

A

Identify risk factors and plan care to ensure safety
throughout the surgical experience.

58
Q

What are the three types of consent taken preoperatively?

A

– Surgical consent
– Anesthesia
– Blood products

59
Q

What is the purpose of a surgical time-out?

A
  • To prevent wrong site, wrong
    procedure, and wrong surgery
  • Components:
    – Pre-procedure verification process
    – Mark the procedure site
    – Perform a time-out
60
Q

How do you conduct a pre-procedure verification process?

A

Verify correct site,
procedure, and patient

Verify critical items are present (documentation, lab results, blood, special equipment)

61
Q

What are 6 key things the HCP must disclose prior to a procedure?

A

There must beadequate disclosureof the (1) diagnosis; (2) nature and purpose of the proposed treatment; (3) risks and consequences of the proposed treatment; (4) probability of a successful outcome; (5) availability, benefits, and risks of alternative treatments; and (6) prognosis if treatment is not instituted.

62
Q

What is the number one risk to look out for in a patietn under general anesthesia?

A

malignant hyperthermia, Treated with Dantrolene (Dantrium)

Succinylcholine (Anectine), especially when given with volatile inhalation agents, is the primary trigger of MH

ADULTs 1 (21 decks)

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