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nur 112 > Preop > Flashcards

Preop Flashcards

1
Q

Health Care Proxy Vs. Living Will

A

Health Care Proxy
Statement by the patient appointing someone to manage health care
treatment decisions in the event that the patient is unable to do so
nA copy of these must be put in the chart treatment decisions in the event that the patient is unable to do so
nA copy of these must be put in the chart
n
Living Will
Document prepared by the patient & Lawyer providing specific
instructions about what medical treatment the patient chooses to
accept or refuse in the event that the patient is unable to make such
decisions.

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2
Q

Restorative/ reconstruction

A

restores function or appearance to traumatized tissue

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3
Q

pallative

A

reduce pain/symptoms, does not produce a cure

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4
Q

comestic/plastic

A

performed to improve personal appearance ( plasty)

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5
Q

laparoscopic cholecystectomy

A

surgical removal of gallbladder through open incision

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6
Q

Emergent

A

immediate need

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7
Q

urgent

A

within 24 hrs-48 hrs ( find a tumor…)

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8
Q

required

A

scheduled surgery

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9
Q

elective

A

recommended - not required ( cataracts) (tonsils ) (back surgery)

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10
Q

optional

A

patients’ desire or choice ( breast augmentation) (face lift)

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11
Q

Preoperative Risk Factors

A

A potential or actual problem or condition that could cause an
adverse reaction, complication, or fatality to the patient during the
peri-operative period

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12
Q

Pre-Operative Risk Factors:

A

nDrugs
nSteroids
nNSAIDS
nChemotherapy
nImmunosuppressive
nAnticoagulants
nChronic Disease
nLifestyle

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13
Q

Time Out Sheet

A

Patient safety:
Universal Protocol/Surgery Procedure Record:
nEnsures that patient is prepared for surgery
nVerification of surgery/procedure
nLocation of surgery (part of body)
nConfirm patient identity
nReduces chance for potential error

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14
Q
  1. Malignant Hyperthermia

first sign is

A

vSusceptible pts exposed to certain general anesthetic agents-
succinylcholine (Anectine) and inhalation agents)

Life threatening
vInitial s/s: increased expired CO2, muscle and jaw rigidity,
tachycardia, tachypnea, dysrhthmias, hypoxemia, metabolic acidosis

( blood PH d/t hypoxemia), unstable blood pressure, high fever-

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15
Q

Malignant Hyperthermia
TREATMENT: ( medications stated 2)

A

nOxygen (hyper-oxygenate) * 100% oxygen*
nOR Nurse- Initiate active cooling (chilled IV fluids, cooling
blanket)

nDantrium (dantrolene sodium) IV

nSodium Bicarbonate IV (for met. acidosis-low PH)

nProtocol displayed in ALL Surgical suites

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16
Q

Malignant Hyperthermia (cont.)
PREVENTION:

A

v during preop assessment obtain a thorough patient history of
previous reactions to anesthesia
vas well as any family history of reactions to anesthesia (including hx
of MH)
vnotify anesthesia provider immediately

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17
Q

Latex Allergy

A

nHigh Risk Groups- add healthcare workers to list
nSigns and Symptoms (S&S):
nLocalized
nSystemic
nTreatment: epinephrine, antihistamines (Benadryl), latex-free
environment
nThorough pre-op questioning
nIdentify all patients with actual or suspected latex allergies with
wristband

risk: tropical fruits/spinal Bifida/ alot of surgeries in life

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18
Q

General Anesthesia:

A

vUse of inhalation and skeletal muscle relaxation
vGiven IV and/or inhalation
vPatient has loss of sensation/pain, consciousness, and reflexes
vRequires advanced airway
management
vUsed for “major surgeries”

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19
Q

Anesthetic given IV and inhalation:

Sedative Hypnotics- IV
( BAM)

A

Nonbarbiturate hypnotic: Propofol (Diprivan)

a.Barbiturates: pentothal, brevital

b.Benzodiazepines:
-midazolam (Versed)
-diazepam (Valium)
-lorazepam (Ativan)

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20
Q

Narcotics:

Anticholinergics:

Muscle relaxants:

A

Narcotics: (opioids -provide analgesia, induce and maintain
anesthesia) morphine, fentanyl, dilaudid
Anticholinergics: (depress gastric secretions and motility) robinul,
atropine
ADD: Antiemetics (prevents nausea/vomiting): zofran, reglan
Muscle relaxants: (cause skeletal muscle relaxation, allowing for
easier intubation) succinylcholine

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21
Q

IV Induction Agents

A

Induction- administration of anesthetic agent for placement of
endotracheal tube (ET) or laryngeal masked airway (LMA)
vGiven IV- smooth and rapid induction with short duration of action.
Barbiturates: sodium pentothal
Others: propofol, succinylcholine, etomidate, ketamine

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22
Q

Inhalation Agents:

A

Administered through mask or ET tube while on mechanical
ventilation
ET tube permits control of ventilation,
from aspiration
protects the airway
n
nExamples:
nVolatile liquid: isoflurane, desflurane, sevoflurane, (halothane)
nGaseous agent: nitrous oxide

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23
Q

(relax)
(paralyze)

A

nSuccinlcholine, anectine- depolarizing agent (relax)

nPavulon, curare- non-depolarizing agent (paralyze)

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24
Q

Undesirable Effects
of General Anesthesia

A

Decr ciliary-HRF infection (pneumonia)/ HRF ineffective airway
clearance RT increased secretions
Loss of gag reflex- HRF aspiration
Snoring- HRF ineffective airway clearance
Atelectasis- HRF ineffective gas exchange
Hypotension- HRF ¯ cardiac output, increased HR
Decr peristalsis- HRF constipation/altered bowel

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25
Q

Diagnostic surgery

A

going in the patient looking

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26
Q

Palliative Surgery

A

providing relief

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27
Q

ablative surgery think “ ectomy”

A

the removal or destruction of a body part or tissue or its function.

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28
Q

reconstructive

A

one to correct facial and body abnormalities caused by birth defects, injury, disease, or aging

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29
Q

Pre Induction-
Induction-
Maintenance –
Emergence –

A

pre-anesthesia evaluation
and sedation to reduce pt anxiety

administration of anesthetic with
endotracheal intubation

positioning pt, prepping skin,
surgical procedure, anesthesia maintained

surgery complete, anesthetics
are decreased, pt begins to waken, airway
removed

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30
Q

Post Op Pulmonary Complications: Atelectasis (cont.)
Assessment:

A

I- poor chest expansion; poor cough
P- uneven expansion; decreased excursion; absent or decreased
“99” where no air is moving
P- consolidation=dullness on percussion
A- crackles, decreased breath sounds,

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31
Q

Hypostatic pneumonia –
.

A

due to ̄ mobilization of secretions/stasis –
RT poor C&DB, ­ secretions, lying in bed, poor resp effort

32
Q

Aspiration pneumonia –

A

mechanical / chemical reaction in the lungs

33
Q

Pleurisy

A

symptomatic unless pneumonia

34
Q

Hemorrhage
Internal –
Refer to Shock Content for assessment and treatment guidelines

External-
Wound – must assess the dressing frequently postoperatively.

A
35
Q

nPhlebitis:

A
36
Q

nVenous Thrombosis:
n SVT (Superficial Vein Thrombus):
n DVT (Deep Vein Thrombosis):
nVenous Thromboembolism (VTE): includes DVT and PE (pulmonary
emboli)

A
37
Q

SVT and/or DVT caused by:

A
  1. Venous stasis
  2. Injury to vessel wall
  3. Increased blood coagulability
38
Q

Patients at highest risk for DVT or SVT:

A

nDehydrated, fluid volume deficit
nStroke pts – 75% in affected side
nSpecific surgeries – Gyn – esp vaginal / abdominal hysterectomy,
prostate, bladder, orthopedic
nDrugs – hormonal replacements, birth control
nFamily history of DVT
nBedrest, occupations with prolonged sitting/standing
nVaricosities, obesity, elderly, smokers

39
Q

SVT:
s/s and treatment

A

Symptoms: palpable, cordlike vein. Surrounding area may be itchy,
tender, reddened and warm.

Treatment: arm/leg exercises, TEDS, ambulation, ASA, NO
massage/rubbing to area, (anticoagulant therapy is not usuallyneeded for superficial vein thrombus)

40
Q

Deep Vein Thrombus
S/S:

A

nTenderness on palpation
nPain, severe cramping, or heaviness
nEdema; discoloration
nPositive Homan’s sign (if leg vein)
nMalaise, fever

Location: axillary or subclavian veins of arms; femoral or iliac veins of legs

41
Q

DVT
Diagnosis:

A

nBloodwork: H & H; aPTT; INR; bleeding time; platelet level; D-
dimers

nDoppler ultrasound
nVenogram : CT and/or MRI

42
Q

DVT PREVENTION

A

nPrimary Goal for all surgical patients = Prevention of DVT formation

nEarly ambulation or T & P Q2hr minimum if on bedrest
nHip and knee flexion exercises if not contraindicated
nPneumatic Compression Devices: Flowtrons, Foot Pumps; DVT
cuffs, etc.
nCompression stockings - TEDS, JOBST, ace bandages

43
Q

nProphylactic anticoagulants:

A

nUH: Heparin
n Vitamin K Antagonists: warfarin (Coumadin)
nLMWH: Lovenox, Fragmin
nDirect Thrombin Inhibitors: Arixtra

44
Q

DVT TREATMENT

nSurgical :

A

nUH, LMWH, or Factor Xa Inhibitor and warfarin
nMonitor appropriate labwork
- watch out for shaving
nUH, LMWH, or Factor Xa Inhibitor and warfarin
nMonitor appropriate labwork
nBleeding precautions
nThrombolytic agent
nMonitor for & prevent PE
nSurgical :
nVenous thrombectomy
nGreenfield Filter

45
Q

Pulmonary Embolism-
PE: Blood clot/ mass of cells lodged in pulmonary artery

Diagnosis: ______scan;

A

PE: Blood clot/ mass of cells lodged in pulmonary artery

nPartial or total occlusion resulting in loss of blood flow to 1 or more
lobes of lung
nEmbolism may be bone, fat, air, blood, foreign object, amniotic fluid
Life threatening!!!
Diagnosis: V/Q scan; ABG; Chest x-ray; CT

46
Q

Pulmonary Embolus

A

Pulmonary Embolus
S/S: Vary on size of embolus
n Chest Pain ( head of the bed with oxygen)
n Tachycardia,
n tachypnea,
n Dyspnea,

n Skin changes-
n LOC changes- hypoxia

n Hemoptysis- blood in sputum
n Cough, crackles, wheezes, cyanosis

47
Q

Anticoagulation Therapy
For DVT prophylaxis: (subcutaneous)

A

nUH (Heparin SC) and LMWH (Low molecular weight heparin)

nWhen given as prophylaxis – given in low doses that and routes that do not change lab values significantly or need monitoring

48
Q

nIV Heparin –

A

given according to WEIGHT BASED at first then adjusted to aPTT
time q6h ® qd to prevent further thrombus

49
Q

naPTT values:

A

n Normal also referred to as control; varies according to type of
reagent/test used by lab

nControl/Normal aPTT value = 30 – 40 seconds

50
Q

nFor treatment of DVT need anti-coagulated values which is an aPTT

A

nFor treatment of DVT need anti-coagulated values which is an aPTT
at 1.5 – 2.5 times control (also called therapeutic level)

51
Q

nAntidote for heparin = NEED TO KNOW!

A

protamine sulfate***

52
Q

Warfarin (Coumadin) Therapy:

nNormal/Control/ value PT -
n PT Therapeutic levels -
nINR therapeutic levels-

(normal = )
nAntidote for Coumadin =

A

Warfarin (Coumadin) Therapy:
nUsually started within 24 hrs of heparin initiation
nOral dosage
nAdjusted daily according to Prothrombin time (PT) and International
Normalized Ratio (INR)
nPT normal
nNormal also referred to as control; varies according to type of
reagent/test used by lab
nNormal/Control/ value PT - 11 – 12.5 seconds
n PT Therapeutic levels - 1.5 – 2 X control value
nINR therapeutic levels- 2 – 3

(normal = 0.75-1.25)
nAntidote for Coumadin = Vitamin K

53
Q

Adjusted daily according to Prothrombin time (PT) and International
Normalized Ratio (INR)

A

Tells you how long it takes for your blood to clot

54
Q

NEED TO KNOW*
DVT prophylaxis

Orthopedic surgery

DVT Treatment

Pulmonary embolism

A

Preferred INR
1.5-2.0
2.0-3.0
2.0-3.0
3.0-4.0

55
Q

BLEEDING PRECAUTIONS:

A

nNo razor (electric ok)
nIM very cautiously with pressure after
n­ pressure on bleeding areas
nSoft toothbrush
nAvoid trauma- risk of internal bleeding
nOn coumadin – Health teaching patients to keep Vit. K foods
consistent (Dark green veggies) Don’t change amount daily.

56
Q

nAntidotes on unit AAT –

A

nHeparin –protamine sulfate (aPTT)
nCoumadin –Vitamin K (PT/INR)

57
Q

nDo not give anticoagulants if :

A

nAny existing bleeding – vaginal, rectal, urinary, open wounds,
aneurysm

nAlcoholism

57
Q

Heparin-
Coumadin-

A

Heparin- aPTT
Coumadin- PT/INR

58
Q

Post Op GI Complications-

A

Causes-
1. Anesthesia

  1. Pain
  2. Manipulation of internal organs
  3. Pain
  4. Manipulation of internal organs
59
Q

Treatment-GI

A

v NPO, progressing to clear to full liq to regular diet

nOften order written as “Advance as tolerated”
v Antiemetic meds
v Pain meds
v N/G tube prn
v Prevent injury to suture line

60
Q

FUNCTIONAL BOWEL
(s/s)/ upper vs lower

A

A.Paralytic Ileus –

define : Peristalsis does not return to parts of the bowel within 3-5 days post op

Signs and symptoms –
ØUpper intestine- discomfort, mild distention, nausea / vomiting

ØLower intestine –Colicky pain, distention evident, tympany on
percussion, vomiting- may look like fecal matter (but usually pt has
been NPO and bowel emptied before OR)

61
Q

GI Complication: Paralytic Ileus
Diagnosis

A

Diagnosis:
nX-ray - Flat plate abdomen
nEndoscopy
nGI series
nIAPP

62
Q

Paralytic Ileus-
Treatment
(lay on WHAT SIDE)

A

ØOOB and AMBULATE!!!
ØNPO until + bowel sounds – listen carefully
ØNG tube in or unclamped
ØGive metoclopramide (Reglan) if ordered –GI stimulant
ØAvoid meperidine (Demerol) – slows smooth muscle.
Ø Pt should lie on RIGHT side when in bed

63
Q

Post op GI Complication: Bowel Obstruction mechanical
Causes:

A

vIntussusception

vTumors

vStrictures / hernias

vAdhesions from previous surgeries (scar tissue that grows in
peritoneum between and around organs)

vAbscesses

64
Q

Bowel Obstruction – mechanical
(Signs and symptoms:)

A

v Pain – crampy, wavelike, colicky

vAbdominal distention

vLeakage or passing blood or mucus rectally

vNo stool, No flatus

vVomiting intestinal contents

vS/S dehydration-?? 3rd spacing

65
Q

“Third Spacing” =

A

fluid shifts to an area not contributing to
equilibrium

66
Q

3rd spacing

causes/s/s / rx

A

nSurgical trauma- esp. bowel surgery of bowel obstruction, burns,
peritonitis, bleed into joints causes inflammatory process.

nS/S - imbalance of fluid – more in than out

nOliguria, look of dehydration, poor VS but lots of IV fluid in.

nBowel can sequester (hold) up to 12 Liters
nWeight gain – each Liter of fluid retained =1kg = 2.2 lbs.

nRx – hypertonic IV to draw fluid from cells to intravascular spaces

67
Q

Bowel Obstruction – mechanical
Diagnosis –

A

Abdominal x-ray, CBC, Chemistries

Treatment – NPO, monitor VS esp Temp., minimal pain meds until Dx
made.

vNG tube (Salem sump), Miller-Abbott tube

vEndoscopy

vExploratory laparoscopy/laparotomy

68
Q

Nasogastric (NG) Tube

A

Used to decompress stomach & upper GI tract, rest GI system,
decompression for obstruction
Levin- single lumen
Salem Sump- double lumen with air vent
Pt NPO

Assess-
nPlacement, drainage, patency, tape/pin

nSuction (intermittent or low continuous)
nI/O, Fluid &Electrolyte balance, Labs
nOral care, nasal care, HOB ­, T&P q2h
nAssess bowel sounds (turn off suction first)

69
Q

NG Complications

A

nDehydration
nFluid &Electrolyte imbalance
nHyponatremia – low sodium (Na+)
nHypokalemia –low potassium (K+)
nMetabolic alkalosis
nHunger-irritable- assess depression
nGood oral care

70
Q

Electrolyte imbalances

A

nSodium (Na+) imbalance – fluid & electrolyte shifts. ̄ Na+ = less
water retained
­ Na+ = fluid volume excess
nPotassium (K+) imbalance – muscle contractility affected – esp
heart muscle
̄K+ OR ­ K+ -both need attention and medical collaboration -
meds

71
Q

RULES for KCl use IV
(potassium chloride)

A

nCheck lab values of K+ and Na+ often
nEKG done if ordered
nMust have urine output >30cc/hr- KCL is excreted by kidneys

nEKG done if ordered
nMust have urine output >30cc/hr- KCL is excreted by kidneys
nNever more than 80 mEq / liter of IV flds -40 mEq/L preferred amt
nIVPB – NEVER IV PUSH
nRate of infusion

72
Q

Post Op Wound Care
Wound Drains:
1.

2.

3.

A

Wound Drains: Reduce edema, drainage
1. Penrose

  1. Jackson Pratt drain- works by suction, must be compressed

.
3. Hemovac- must be compressed
Must empty drains every shift and prn

73
Q

Responsibilities with drains

A

nAssess q time of vitals and more often prn

nMaintain compression of JP drains and Hemovac

nExpect large amount of drainage on drsg. with penrose drains

nDon’t expect much drainage on drsg with JP & Hemovac drains if
working.

nBe careful when moving pt.- drains are not always sutured in!!

74
Q

Wound Separations
nDehiscence –
S/S –

nEvisceration –
S/S –

pt.
TREATMENT –

A

Wound Separations
nDehiscence – wound edges open and disintegration of underlying
layers
S/S – open incision. Serous oozing. Wound pain
nEvisceration – contents of body cavity protrude through dehiscence
S/S – organs through skin, gush of fluid

nEvisceration – contents of body cavity protrude through dehiscence
S/S – organs through skin, gush of fluid
pt. Feels something pop! Or let go!
TREATMENT –
NS soaked STERILE Drsg- must keep moist
CALL surgeon STAT

75
Q

Wound Healing
primary
secondary
tertiary

A

refers to when doctors close a wound using staples, stitches, glues, or other forms of wound-closing processes.

Secondary wound healing, or secondary intention wound healing, occurs when a wound that cannot be stitched causes a large amount of tissue los

delayed primary closure, occurs when there is a need to delay the wound-closing process.

76
Q

VQ scan

A

measures the airflow (ventilation) and blood flow (perfusion) in your lungs. You breathe in and are injected with radioactive material while a provider takes pictures of your lungs

nur 112 (23 decks)

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