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Med-Surg > Pre-Op, Intra-Op, Post-OP > Flashcards

Pre-Op, Intra-Op, Post-OP Flashcards

1
Q

What are some common labs & diagnostic tests ?

A
  • blood studies (RBCs, Hgb, Hct, WBC): we want to see how well the pt is doing on RBCs incase
  • coagulation studies (PT/PTT/INR): INR measures bleeding time so we want to know if they are a bleeding risk
  • Creatinine: measures kidney function and all meds have side effects so we want to ensure they have good kidney function to process the meds
  • Height/Weight: used to know how much anesthesia to give
  • electrolytes
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2
Q

What is some pre-op teaching an RN does ?

A
  • general info, don’t overwhelm
  • food restrictions
  • where will they go after the procedure
  • what does the patient want to know ?: what questions so you have ?
  • early ambulation
  • pain med administration
  • SCDs
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3
Q

What is the RN’s role in legal preparation for surgery ?

A

informed consent
- adequate disclosure
- assess pt’s understanding and comprehension
- give consent voluntarily
- RN: witness & verify pt’s understanding
nursing role=advocacy
- witness (often if guardian signing)
- verify pt’s ability to understand
- verify pt’s understanding
- consent for blood transfusion

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4
Q

What are Benzodiazepine for ?

A

Midazolam/Versed
- every pt is different so reactions can vary
- to reduce anxiety
- to induce sedation
- can cause amnesia

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5
Q

What are opioids for ?

A

fentanyl & dilaudid
- to relieve discomfort during pre-op procedures & sedate
- fentanyl is very potent and a very short half-life so it’s a good options

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6
Q

What are histamine H2 receptor antagonists for ?

A

famotidine
- to reduce stomach acid (prevent reflux)

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7
Q

What are antiemetics for ?

A

ondansetron/Zofran
- decreased nausea and vomiting

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8
Q

What are anticholinergics for ?

A

Atropine
- decreased oral and respiratory secretions so they don’t aspirate
- mouth may feel dry & can cause urinary retention

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9
Q

What are antibiotics for ?

A

Cefazolin
- reduce the risk of infection

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10
Q

What is malignant hyperthermia ?

A

rare disorder characterized by hyperthermia with rigidity of skeletal muscles that can result in death
- genetically determine (to some extent)
- like a allergic reaction to a anesthesia drug

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11
Q

What are the symptoms of malignant hyperthermia ?

A
  • muscle contracture
  • hyperthermia (is a later sign)
  • hypoxia
  • lactic acidosis
  • hemodynamic/cardiac changes
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12
Q

What is the treatment for malignant hyperthermia ?

A

Dantrolene
- slows metabolism
- reduces muscle contraction
- mediates the catabolic processes

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13
Q

What is the pathophysiology of malignant hyperthermia ?

A

hypermetabolism of skeletal muscle resulting from altered control of intracellular calcium
- usually occurs during general anesthesia with Succinylcholine (anectine) & inhaled agent

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14
Q

What are some S&S of pain ?

A
  • increased blood glucose
  • urinary retention
  • decreased GI motility
  • guarded body posture
  • wrinkling face or brow
  • clenched fists
  • moaning
  • diaphoresis
  • increased pulse rate
  • verbal complaints
  • restlessness
  • facial grimacing
  • irritability
  • increased respiratory rate
  • muscle tension
  • pallor
  • anxiety/agitation
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15
Q

What causes obstruction during surgery ?

A

usually caused by the tongue
- happens most often in very sedated patients
- Tx: head tilt to chin tilt

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16
Q

What causes hypoventilation during surgery ?

A

caused by anesthesia agents or pain medications
- Tx: with reversal agents (will try to avoid because it causes them to be fully aware and in deep pain) if severe

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17
Q

What is atelectasis ?

A

impaired gas exchanged related to hypoventilation/obstruction of bronchioles with mucus as evidenced by decreased O2 saturation
- causes diminished breath sounds in the lower lobes
- collapse of alveoli due to mucous plus

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18
Q

Who is at risk for atelectasis ?

A
  • hypoventilation
  • constant recumbent position
  • ineffective coughing
  • history of smoking
  • older adults
  • intubation/general anesthesia
  • thorax surgery
  • immobility/bedrest
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19
Q

How do we treat/prevent atelectasis ?

A
  • assess pt’s O2 saturation and breath sounds
  • early ambulation (if possible)
  • frequent position changes
  • tun, cough, deep breathe
  • incentive spirometer (INHALE)
  • explain why (prevent pneumonia)
  • teach splinting technique
  • administer O2 if necessary
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20
Q

What is the cause of pulmonary edema ?

A

rapid administration and/or high volume of IV fluids or blood products
- also the body’s stress response causes fluid retention (ADH, ACTH)

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21
Q

Who is at risk for pulmonary edema ?

A
  • heart failure (CHF)
  • older adults
  • patients with pre-existing infections
  • renal failure
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22
Q

Which lung sounds are heard in atelectasis and pulmonary edema ?

A
  • Atelectasis: diminished breath sounds in lower lobes
  • Pulmonary Edema: crackles in lower lobes
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23
Q

What is pulmonary edema ?

A

impaired gas exchange related to fluid in lung tissues and alveoli as evidenced by decreased O2 saturation and crackles in lower lobes
- accumulation of extravascular fluid in lung tissue & alveoli

24
Q

What is treatment/prevention for pulmonary edema ?

A
  • monitor & document I/O during and after surgery
  • be aware of high risk pt’s & advocate for reasonable amounts of fluids
  • assess for low O2 sat and crackles
  • administer O2, diuretics if appropriate
25
Q

What are some S&S of pulmonary edema ?

A
  • hypoxemia
  • crackles on auscultation
  • presence of infiltrates on chest x-ray
26
Q

What are the causes of hypotension ?

A
  • unreplaced fluid/blood loss
  • cardiac dysfunction
27
Q

What are some S&S of hypotension ?

A
  • hypo-perfusion leads to confusion
  • decreased urine output
  • weakness/fainting
  • chest pain
  • hypoxemia
  • SBP <90
28
Q

What are some RN interventions for hypotension ?

A
  • assess BP, I/O, urine output and document
  • O2
  • IV fluids
  • monitor incision for bleeding
29
Q

What are some causes of hypertension ?

A
  • pain, anxiety, bladder distention (SNS)
  • body’s response to stress often encourages fluid retention
  • preexisting hypertension
30
Q

What is a common S&S of hypertension ?

A

headache

31
Q

What are some RN interventions for hypertension ?

A
  • assess BP, I/O, urine output and document
  • treat the cause
  • administer anti-hypertensives as ordered
32
Q

What are some causes of dysrhythmias ?

A
  • hypoxemia, hypercapnia
  • fluid & electrolyte imbalance (like K)
  • preexisting conditions
  • anesthesia
33
Q

What are some S&S of dysrhythmias ?

A
  • chest discomfort
  • anxiety
34
Q

What is the treatment of dysrhythmias ?

A
  • assess cardiac rhythm
  • O2
  • administer anti-arrhythmic if ordered
35
Q

Who is at risk for venous thromboembolism (VTE) ?

A
  • smokers
  • older adults
  • bedrest/immobility
  • dehydration or malnutrition
  • high dose estrogen therapy
  • surgical pt’s (ortho)
  • hx of DVT
  • trauma
  • obesity
  • hx of a.fib or other dysrhythmias
36
Q

What are some S&S of venous thromboembolism (VTE) ?

A
  • swelling unilateral
  • redness
  • throbbing pain
37
Q

What are the diagnostic tests for VTE ?

A

venous doppler determines venous flow in deep femoral, popliteal, and posterior tibial veins

38
Q

What are some prevention/treatment for VTE ?

A
  • EARLY ambulation
  • SCDs
  • Heparin (SQ or IV)
  • Lovenox/Enoxaparin (SQ)
  • Coumadin (PO)
39
Q

What labs do you monitor for with heparin ?

A
  • prothrombin time (PT)
  • Partial Thromboplastin Time (PTT)
40
Q

What is the antidote for heparin ?

A

protamine

41
Q

What is the antidote for Coumadin ?

A

vitamin K

42
Q

What do you need to monitor for with heparin and lovenox ?

A
  • bleeding, petechiae, brusing or rash
  • heparin induced thrombocytopenia is a serious side effect of heparin therapy
43
Q

What is a pulmonary embolism ?

A

a blockage of a pulmonary artery by a thrombus

44
Q

What are some S&S of pulmonary embolism ?

A
  • SOB
  • anxiety
  • chest pain
45
Q

What are some causes of nausea & vomiting ?

A
  • action of anesthetics or narcotics
  • delayed gastric emptying/slowed peristalsis
  • length and type of surgery
  • potential history of N/V
  • female
46
Q

What is some prevention for nausea & vomiting ?

A
  • no eating until pt fully awake
  • no eating until passing gas/return of bowel sounds
  • anti-emetics
  • start slow and small: advance from clear liquids to solids gradually
  • continue IV fluids until tolerating oral liquid/food
47
Q

What are some causes of paralytic ileus ?

A
  • abdominal surgery
  • peritoneal injury
  • opioid pain medication during/after surgery
48
Q

What are some interventions for a paralytic ileus ?

A
  • assess bowel sounds, passing gas
  • NPO until ileus resolved
  • maintain nasogastric/NG tube
  • IV fluids for hydration, calories
  • early ambulation (if possible)
49
Q

Is low urine expected in the few hours after surgery ?

A
  • 800-1500mL is normal and expected
  • low output is expected
50
Q

Why may someone have urinary retention after surgery ?

A
  • anesthesia: depresses NS and lets bladder fill completely then normal before urge to void is felt
  • anticholinergics: interfere with ability to start voiding
  • opioids
  • prolonged catheterization
  • pelvic surgery: spasms or guarding of the abdomen and pelvic muscles interferes with their normal function
51
Q

What are some RN interventions for low urine output or retention ?

A
  • assess I/O
  • assess urine characteristics
  • remove indwelling urinary catheter ASAP
  • encourage early ambulation
  • bladder scan to determine volume of urine retained
  • catheterize if necessary (volume per scan >300mL): prefer in/out over indwelling
52
Q

Who is at risk for impaired wound healing ?

A
  • preexisting nutritional deficits: diabetes, ulcerative colitis, alcoholism, malnourished/obesity
  • older adult
  • immunosuppressed
  • prolonged hospital stay
  • lengthy surgical procedure
53
Q

What is dehiscence ?

A

separation and disruption of previously joined wound edges
- may be preceded by a sudden discharge of brown, pink or clear drainage

54
Q

What is evisceration ?

A

organ protruding through incision/opening in pt’s skin
- cover with sterile and moist dressing and call the physician (emergent)

55
Q

What are the causes of delirium and confusion ?

A

risk for injury related to falls
- fluid and electrolyte imbalances
- hypoxemia
- drug effects (anesthesia, opioids)
- sleep deprivation
- sensory alteration, deprivation or overload

56
Q

What is the treatment for hypothermia ?

A

often resolves in time as anesthesia wears off and commonly occurs after surgery
- warm blankets/bear hugger

57
Q

What is the treatment for hyperthermia ?

A
  • careful assessment & monitoring
  • EARLY ambulation
  • deep breathing exercises
  • notify advanced practice for possible antibiotics

Med-Surg (23 decks)

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