Preop Flashcards
-centesis
puncture of a cavity
-cholangio
bile vessel
-chole
bile or gall
cyst-, -cyst
urinary bladder or a cyst
ecto-
outside
ectomy-
removal
endo-
within
entero-
intestines
gaster-, gastro-
stomach or ventral
hepat-, hepato-
liver
ileo-
area of the abdomen from the lowest rib to the pubes. Prefex meaning ileum
-itis
inflammation
laparo-
flank or abdominal wall
lith-, litho
stone or calculus
-lysis
reduction or relief of
-oma
tumor
-plasty
surgical repair
post-
behind, after, posterir
pre-
infront of, before
retro-
backward, back, behind
-rrhage, -rrhagia
rupture, profuse fluid discharge
-rrhaphy
suture, surgical repair
-scopy
examination with a device or tool
sub-
under, beneath, in small quantity, <normal
stoma
small opening
super-, pura-
above, beyond, superior
-tomy
cutting, incision
Anesthesia
reflex loss, not arousable, no reaction to painful stimuli, they loose the ability to maintain ventilatory function & require assistance in maintaining a patent airway
How are anesthesia agents inhaled or given?
Inhaled or IV
Inhaled anesthesia pros
important in situations where there is a lack of venous access & anticipated airway difficulty, easy to administer, inexpensive, & reliable
Local Anesthesia
used to block nerves in the peripheral and CNS. It blocks the transmission of pain sensation. Degree of blockage depends on both drug concentration & volume
Sinal, epidural, peripheral nerve blocks are examples of what?
Regional Anesthesia
Local anesthesia route?
topical or local infiltration
How is a Reginal Anesthesia administered
anesthesia agent is injected around the nerves
Morphine, Fentanyl, sufentanil, alfentanil are examples of what?
Opiod Analgesics
Rocuronium (Zemuron) & Vecuronium (Norcuron) are examples of what?
Nondepolarizing muscle relaxers
Etomidate (Amidate), Diazepam (Valium), Midazolma (Versed), & Propofol (Diprivan) are examples of what?
Intravenous Anesthetics
Where is the local anesthetic introduced during a Spinal Anesthesia?
into the subarachnoid space
Which type of anesthesia is a local anesthetic introduced into the subarachnoid space at the lumbar level?
Spinal Anesthesia
An after-effect of spinal anesthesia
Headache
How is Epidural anesthesia achieved?
by injecting a local anesthetic into the epidural space
Advantages to peripheral nerve blocks (PNB)
- )reduces physiological stress compared to having a spinal or epidural
- ) avoids any potential complications with intubation & side effects of anesthesia
Moderate sedation (conscious sedation) involve what?
IV administration of sedatives and/or analgesics
Clues you may need more sedation or alnalgesia include:
- Hypertenstion
- Tachycardia
- Patients report of pain
- Distressed facial expression
For moderate sedation the patient should not have eaten for how many hours?
4-6 hrs
How do you prevent hypoventalation?
Ask the patient to take deep breaths at least every 5 mins
Retained CO2 is a sign of what?
hypoventilation
What is the goal of moderate sedation?
to depress a patient’s LOC to a moderate level while ensuring the patient’s comfort
Moderate Sedation allows the patient to maintain what?
a patent airway, protective reflexes, respond to verbal & physical stimuli and recover more rapidly post procedure, may be drowsy
Hypothermia is indicated if temp falls below:
36.6 C or 98 F
Muscle disorder that is chemically induced by anesthetic agents
Malignant hyperthermia
Outpatient
admitted & discharged on the same day - from hospital, clinic, office
Admitted the day before major surgery, alternative is an AM admission with a post op stay
Inpatient
important rule when getting Informed consent
Dr. MUST talk to patient about the risks not the nurse
Factors affecting adaptation for surgery
Age, Neuroendocrine stress response, surgical procedure, previous hospitalization, spiritual beliefs, type of admission for surgery
Preadmission requirements
obtain history & preform physical, establish baseline data, review results of any tests, prioritize nursing care, listen to verbal /nonverbal messages
Preadmission interventions
Pre-op teaching, physical prep (meds), infor for family, teaching about day surgery, teaching about post-op care & operative permit
responsibilites of circulating nurse
keeps track of everything in room, makes sure sterile procedures are done
Surgical scrub should last for how many mins?
5-10mins
unrestrictive surgical attire
street clothes, hospital attire
semi-restrictive surgical attire
scrubs, shoe covers, cap/hood
restrictive surgical attire
masks, sterile gown, gloves
Which kind of soap do you use for a surgical scrub
antimicrobial soap
Steps of the universal protocol
Preopertive verification process, marking the operative site, “Time Out” immediately before starting the procedure
Why are the tools & spounges counted before and after a surgical procedure?
To make sure nothing is left in the patient
Deep sedation
may sleep but can be aroused without difficulty, minimal depression of protective reflexes
Trendelenburgh position
laying supine upsidedown slanted downward with head towards floor
Intraop complications
hemmorrhage, cardiac dyshythmias, diminished circulation, respiratory depression, lack of response to pain
clinical manifestations of malignant hyperthermia
hyperpyrexia, tachycardia, cardiac dysrhythmias, unstable BP, muscle stiffness, cyanosis, respiratory & metabolic acidosis, hyperkalemia
What do you do if malignant hyperthermia occurs?
stop surgery ASAP, administer 100% oxygen, Administer Dantrolene Na (Dantrium) IV, Cool-iced IV solutions/NG lavages, treat acidosis/hyperkalemia, monitor temp/output
Dantrolene Na (Dantrium)
Administered IV for Malignant Hyperthermia
Benefits of Cyberknife surgery
Painless, no sedation, no incisions, no blood loss, no recovery time (patient goes home same day), lower risk of fewer complications than open surgery
Inhalation anesthetics and muscle relaxants can trigger the symptoms of what?
Malignant Hyperthermia
What causes hyperthermia and damage to CNS?
sustained muscle contractions in patients with Malignant Hyperthermia
Pathophysiology of Malignant Hyperthermia
is related to a hypermetabolic condition in skeletal muscle cells that involves altered mechanisms of calcium function at the cellular level. The disruption of calcium causes clinical symptoms of hypermetabolism, which in turn increases muscle contraction (rididity)
Postanesthesia care phase I (phase I PACU) is the..
immediate recovery phase, intensive nursing care is provided
In the Postanesthesia care phase II (phase II PACU) the patient is..
prepared for self-care or care in the hospital, an extended care setting, or discharge. Recliners rather than stretchers or beds are standard in phase II
Primary Hemmorrhage occurs
at the time of surgery
Intermediary hemmorrhage occurs
during the first few hours after surgery when the rise of BP to its normal level dislodges insecure clots from untied vessels
Secondary Hemmorrhage may occur
some time after surgery if a suture slips b/c of a blood vessel was not securely tied, became infected or was eroded by a drainage tube
First-intention healing
grannulation tissue is not visible & scar formation is minimal
Second-intention healing
granulation occurs, skin grows over scar
Third-intention healing
used for deep wounds. Late suturing with wide scar
Goals of postop
1.) Promote healing & recovery 2.) Prevent complications
OR -> _____ -> ______ -> Home
OR -> PACU -> Nursing Unit -> Home
Considerations in Post-op Care- What did we do to the patient during surgery?
- )Because tissue is removed during surgery - need to be concerned about fluid/blood loss
- )The patient will be immoble - need to be concerned about blood stasis - clotting
When does Post-op care begin?
when patient transfers from OR to PACU
PACU stands for
post anesthesia care unit
What gets reported to the PACU nurse?
Diagnosis & surgery preformed, Age &general condition, type of anesthesia, meds given, problems, malignancy & if family knows, I&O, any drains, who to notify c problems
During Post-op what should be assessed?
Airway, resp effort, cardio function, LOC, movement & sedation, pain, surgical site, N/V
What hould be assessed q15m post op?
Vital signs: resp effort, cardio effort, LOC
What is the main cause of airway obstruction post-op?
the tongue
Causes of compromised airway
tongue & secretions
What do you do when assessing airway post-op?
LOC - awake enough to maintain airway? Able to clear airway/cough?
signs of compromised airway post op
snoring, choking, irregular respirations, SPO2 decreasing, cyanosis
Interventions for compromised airway post op
- ) Maintain airway 2.) position on side 3.) cough
4. )supply O2 5.)insert oral airway 6.) suction 7.) Call anesthesiologist
What are you doing when assessing respiratory effort post-op
patient airway, resp, O2 stat (>93) & lung sounds
post op Cardiac assessment in order
rate & rhythem then check perfusion then check BP
When checking perfusion post op what are you assessing?
skin color, capillary refill, urine out put, mentation
Why is checking mentation post op important?
Because mental status gives a good indicattion of O2 perfusion of the brain
What does it mean when a patient has orthostatic hypotension post op?
There is an imbalance of fluid somewhere
Serous fluid
Blood plasma. Clear. Ex fluid in blister
Sanguinous fluid
Bloody. Bleeding out
Serosanguineous
Blood plasma + blood. Ex if yup start an Iv and they bleed
Fibrinous
Yellow thick sticky. Eye infection
CMS stands for
color, movement, sensation
Potential respiratory complications post op
Pneumonia, atelectasis
Potential cardiovascular complications post op
Shock, DVT, pulmonary embolism
