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
