Pre-Op, Intra-Op, Post-OP Flashcards
What are some common labs & diagnostic tests ?
- 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
What is some pre-op teaching an RN does ?
- 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
What is the RN’s role in legal preparation for surgery ?
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
What are Benzodiazepine for ?
Midazolam/Versed
- every pt is different so reactions can vary
- to reduce anxiety
- to induce sedation
- can cause amnesia
What are opioids for ?
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
What are histamine H2 receptor antagonists for ?
famotidine
- to reduce stomach acid (prevent reflux)
What are antiemetics for ?
ondansetron/Zofran
- decreased nausea and vomiting
What are anticholinergics for ?
Atropine
- decreased oral and respiratory secretions so they don’t aspirate
- mouth may feel dry & can cause urinary retention
What are antibiotics for ?
Cefazolin
- reduce the risk of infection
What is malignant hyperthermia ?
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
What are the symptoms of malignant hyperthermia ?
- muscle contracture
- hyperthermia (is a later sign)
- hypoxia
- lactic acidosis
- hemodynamic/cardiac changes
What is the treatment for malignant hyperthermia ?
Dantrolene
- slows metabolism
- reduces muscle contraction
- mediates the catabolic processes
What is the pathophysiology of malignant hyperthermia ?
hypermetabolism of skeletal muscle resulting from altered control of intracellular calcium
- usually occurs during general anesthesia with Succinylcholine (anectine) & inhaled agent
What are some S&S of pain ?
- 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
What causes obstruction during surgery ?
usually caused by the tongue
- happens most often in very sedated patients
- Tx: head tilt to chin tilt
What causes hypoventilation during surgery ?
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
What is atelectasis ?
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
Who is at risk for atelectasis ?
- hypoventilation
- constant recumbent position
- ineffective coughing
- history of smoking
- older adults
- intubation/general anesthesia
- thorax surgery
- immobility/bedrest
How do we treat/prevent atelectasis ?
- 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
What is the cause of pulmonary edema ?
rapid administration and/or high volume of IV fluids or blood products
- also the body’s stress response causes fluid retention (ADH, ACTH)
Who is at risk for pulmonary edema ?
- heart failure (CHF)
- older adults
- patients with pre-existing infections
- renal failure
Which lung sounds are heard in atelectasis and pulmonary edema ?
- Atelectasis: diminished breath sounds in lower lobes
- Pulmonary Edema: crackles in lower lobes
What is pulmonary edema ?
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
What is treatment/prevention for pulmonary edema ?
- 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
What are some S&S of pulmonary edema ?
- hypoxemia
- crackles on auscultation
- presence of infiltrates on chest x-ray
What are the causes of hypotension ?
- unreplaced fluid/blood loss
- cardiac dysfunction
What are some S&S of hypotension ?
- hypo-perfusion leads to confusion
- decreased urine output
- weakness/fainting
- chest pain
- hypoxemia
- SBP <90
What are some RN interventions for hypotension ?
- assess BP, I/O, urine output and document
- O2
- IV fluids
- monitor incision for bleeding
What are some causes of hypertension ?
- pain, anxiety, bladder distention (SNS)
- body’s response to stress often encourages fluid retention
- preexisting hypertension
What is a common S&S of hypertension ?
headache
What are some RN interventions for hypertension ?
- assess BP, I/O, urine output and document
- treat the cause
- administer anti-hypertensives as ordered
What are some causes of dysrhythmias ?
- hypoxemia, hypercapnia
- fluid & electrolyte imbalance (like K)
- preexisting conditions
- anesthesia
What are some S&S of dysrhythmias ?
- chest discomfort
- anxiety
What is the treatment of dysrhythmias ?
- assess cardiac rhythm
- O2
- administer anti-arrhythmic if ordered
Who is at risk for venous thromboembolism (VTE) ?
- 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
What are some S&S of venous thromboembolism (VTE) ?
- swelling unilateral
- redness
- throbbing pain
What are the diagnostic tests for VTE ?
venous doppler determines venous flow in deep femoral, popliteal, and posterior tibial veins
What are some prevention/treatment for VTE ?
- EARLY ambulation
- SCDs
- Heparin (SQ or IV)
- Lovenox/Enoxaparin (SQ)
- Coumadin (PO)
What labs do you monitor for with heparin ?
- prothrombin time (PT)
- Partial Thromboplastin Time (PTT)
What is the antidote for heparin ?
protamine
What is the antidote for Coumadin ?
vitamin K
What do you need to monitor for with heparin and lovenox ?
- bleeding, petechiae, brusing or rash
- heparin induced thrombocytopenia is a serious side effect of heparin therapy
What is a pulmonary embolism ?
a blockage of a pulmonary artery by a thrombus
What are some S&S of pulmonary embolism ?
- SOB
- anxiety
- chest pain
What are some causes of nausea & vomiting ?
- action of anesthetics or narcotics
- delayed gastric emptying/slowed peristalsis
- length and type of surgery
- potential history of N/V
- female
What is some prevention for nausea & vomiting ?
- 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
What are some causes of paralytic ileus ?
- abdominal surgery
- peritoneal injury
- opioid pain medication during/after surgery
What are some interventions for a paralytic ileus ?
- assess bowel sounds, passing gas
- NPO until ileus resolved
- maintain nasogastric/NG tube
- IV fluids for hydration, calories
- early ambulation (if possible)
Is low urine expected in the few hours after surgery ?
- 800-1500mL is normal and expected
- low output is expected
Why may someone have urinary retention after surgery ?
- 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
What are some RN interventions for low urine output or retention ?
- 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
Who is at risk for impaired wound healing ?
- preexisting nutritional deficits: diabetes, ulcerative colitis, alcoholism, malnourished/obesity
- older adult
- immunosuppressed
- prolonged hospital stay
- lengthy surgical procedure
What is dehiscence ?
separation and disruption of previously joined wound edges
- may be preceded by a sudden discharge of brown, pink or clear drainage
What is evisceration ?
organ protruding through incision/opening in pt’s skin
- cover with sterile and moist dressing and call the physician (emergent)
What are the causes of delirium and confusion ?
risk for injury related to falls
- fluid and electrolyte imbalances
- hypoxemia
- drug effects (anesthesia, opioids)
- sleep deprivation
- sensory alteration, deprivation or overload
What is the treatment for hypothermia ?
often resolves in time as anesthesia wears off and commonly occurs after surgery
- warm blankets/bear hugger
What is the treatment for hyperthermia ?
- careful assessment & monitoring
- EARLY ambulation
- deep breathing exercises
- notify advanced practice for possible antibiotics
