Pt 1 (Perioperative) Flashcards
1
Q
What is the difference between an urgent and an emergent surgery
A
An emergency surgery must be done right away to save the patient’s life, whereas an urgent surgery is performed to prevent any additional problems like removing a gallbladder to prevent stones.
2
Q
What is an ablative surgery
A
Removing a body part (amputation)
3
Q
What is the difference between constructive and cosmetic surgery
A
Constructive is to restore function to a body part (repairing cleft palate), while cosmetic is to improve personal appearance
4
Q
Describe a patient classified as ASA I
A
They are a normal healthy patient (nonsmoking, no-minimal alcohol use, etc.)
5
Q
Describe a patient classified as ASA II
A
They have mild systemic disease (smoker, social alcohol drinker, pregnant, obese, controlled DM/HTN, mild lung disease)
6
Q
Describe a patient classified as ASA III
A
They have severe systemic disease (uncontrolled DM/HTN, COPD, morbidly obese, hepatitis, alcohol abuse, pacemaker, moderate reduction of cardiac ejection fraction).
7
Q
Describe a patient classified as ASA IV
A
They have severe systemic disease that is a constant threat to their life (Recent MI, CVA, TIA, ongoing cardiac ischemia or severe valve dysfunction, sepsis, disseminated intravascular coagulation, end-stage renal disease not having dialysis)
8
Q
What is a moribund patient
A
A patient who is not expected to survive without the surgery
9
Q
What does AORN stand for and what do they do
A
Association of periOperative Registered Nurses - they set standards and guidelines
10
Q
What type of allergies would I want to know about before surgery
A
Latex or penicillin
11
Q
If a patient is not sure if they are allergic to latex, what can you ask them
A
If they have a reaction when eating apples, avocados, bananas, celery, chestnuts, melons, papayas kiwis, raw potatoes/tomatoes? Or if they have a reaction when blowing up a balloon? If they have a reaction to the elastic in their underwear
12
Q
Is it our job to explain the surgical procedure to the patient
A
No - that’s the physician’s job
13
Q
What does ectomy stand for
A
Excision or removal of “appendectomy”
14
Q
What does lysis stand for
A
Destruction of “electrolysis”
15
Q
What does orrhaphy stand for
A
Repair or suture “Herniorrhaphy”
16
Q
What does oscopy stand for
A
Looking into “Endoscopy”
17
Q
What does ostomy stand for
A
Creation of opening into “Colostomy”
18
Q
What does plasty stand for
A
Repair or reconstruction of “mammoplasty”
19
Q
Besides allergies, what else do we want to screen for?
A
- Blood thinners
- Cultural (Jehovah witness)
- History of A-fib (can lead to blood clots)
20
Q
What is a big plus of ambulatory surgeries, where you are going home the same day
A
You do not have to stay overnight in the hospital, where you are at risk for hospital acquired infections
21
Q
Define local anesthesia
A
Usually given in your ambulatory setting, patient is healthy, they can tolerate the procedure, they’re not nervous, there is no sedation or loss of consciousness, they can go home the same day and eat and drink regularly.
22
Q
What is regional anesthesia
A
It “blocks” a central nerve (spinal) or a group of nerves (ex plexus). That body region becomes numb. Usually for orthopedic procedures. If a patient has comorbidities, they will also probably get something to put them to sleep, so their HR doesn’t spike during surgery. Also given for C-sections. (you are still conscious)
23
Q
What is a person at risk for when they receive a local anesthetic (from lidocaine)
A
Local anesthetic systemic toxicity (LAST)
24
Q
What are early symptoms of LAST 5
A
- Ringing or whoosing in ears
- Confusion
- Metallic taste
- Oral numbness
- Dizziness
25
If left untreated, what can LAST lead to
Seizures, coma and dysrhythmias
26
What is the difference between a spinal and epidural anesthesia
A spinal anesthesia is injected into the cerebrospinal fluid, while an epidural is injected into the epidural space and does not enter the cerebrospinal fluid (you can't feel anything, but you can still move (does not block motor, only blocks sensory) - versus spinal, where you can't move or feel anything)
27
Is intubation required for sedation
In mild to moderate, the patient is usually breathing on their own. For Deep sedation, they may need to be intubated.
28
What can a patient be intubated with under general anesthesia
Laryngeal mask airway (LMA) or a trachea tube.
29
Why would a person be put under general anesthesia
- Surgery may be long
- Need muscles to be relaxed
- May be uncomfortable positions
- Ventilation may need to be controlled
- Patient refused local or regional techniques
- Uncooperative
30
What is a fat embolism (risk during surgery)
Where subcutaneous fat can travel into the bloodstream and into your lungs
31
What are normal albumin levels
3.4-5.4
32
What can a deficiency in albumin indicate
- Liver or kidney disease.
| - Body is not absorbing enough protein.
33
What is our main goal in preop
- Provide baseline data
| - Identify risk factors
34
What other goals do we want to accomplish in preop
- Prepare patient for surgery
- Patient teaching
- Complete our checklist
- Interprofessional communication
35
What if the patient believes that they are going to die in the surgery
Notify the provider right away - the strong emotional state may put stress on the surgery (surgery might be delayed due to this)
36
If a patient has had juice or milk to drink before surgery, what should you do
Call anesthesia to inform them
37
What is the total surgical period called
Perioperative care
38
When assessing the respiratory system, what things should we ask
- If they have had a cold or fever recently (if they have had an upper respiratory infection - surgery will probably be delayed)
- If they have used their inhaler recently - have them bring it with them to take a few puffs the morning of to help open up the airways.
- STOP BANG - for patients with sleep apnea, have them bring in their CPAP to use in the recovery room.
- Want to know if they smoke, smoking should be stopped 6 weeks prior to surgery.
- If they have COPD
39
If a patient has COPD, what are they at high risk for after surgery
- Hypoxemia (low oxygen in blood)
| - Atelectasis (alveoli become deflated)
40
What do you want to assess for in the nervous system
- Check capillary refill
- Nevers - assess by touch and feel
- If they take gabapentin, take morning of surgery
41
What are we assessing for in the genitourinary system 8
- Is and Os
- If they look dehydrated
- Do they look emaciated
- How is their skin turgor
- Kidney disease
- Chronic UTIs
- Renal function test (labs)
- If a woman may be pregnant
42
Why is renal dysfunction scary for surgery
Renal dysfunction can lead to f&e imbalances, coagulopathies (blood doesn't clot), increased risk for infection and impaired wound healing.
43
When assessing the hepatic (liver) system, what are we looking for 8
We are checking for signs of liver disease
- Are they itchy
- Do they have an altered mental status
- Do we see jaundice
- Ask about alcohol and tylenol
- History of hepatitis
- Obese - can indicate liver dysfunction
- Enlarged abdomen
- Perform a liver function test
44
Impaired hepatic function can cause what risks
Clotting abnormalities and adverse responses to drugs
45
What do we want to assess for the integumentary system
- If they have any present cuts, document, in case they think we gave them the cut after surgery or they get an infection
- Note any skin breakdown
- History of pressure sores - may need more padding
46
What do we assess for in musculoskeletal
- Assess any numbness/tingling
- If they have a history of arthritis
- Test ROM/strength
- Patients will usually be on muscle relaxants
47
What is one major concern we have for the endocrine system
If the patient is diabetic
48
If the patient is diabetic, what are we doing
Don't have them take oral diabetic medication the morning of surgery, if they are on insulin - take half of the dose.
- Check their sugar before surgery and during.
49
What are we assessing for with fluid and electrolytes
If the patient has had any episodes that might impact F&E, like vomiting, diarrhea or completing a bowel prep.
- Check electrolyte levels before surgery
- Be careful with older adults, they are less adaptive and more prone to overhydration or dehydration
50
What if a patient has a BMI greater than 40
Notify the OR team so they can prep.
51
What if a patient is underweight
They may need more padding then usual
52
What assessments do we want to do for nutritional status
- Get their height and weight
- If they have dentures or partials
- How is their skin over bony prominences
53
What patients are at risk for VTE 8
- History of thrombosis
- Blood-clotting disorders
- Cancer
- Varicosities (twisted, large veins)
- Obesity
- Tobacco use
- Heart failure
- COPD
54
How can I help reduce fears
Use common language and avoid medical jargon
55
How can I help relieve anxiety
Give them information about what to expect
56
What if the patient has a fear of anesthesia
Notify the ACP, so they can talk to the patient
57
What does ACP stand for
Anesthesia care provider
58
Overall what things should be completed when prepping a patient 8
- Medical history
- Current medications
- ROS, PA (review of systems, psychological assessment)
- Obtain/review lab results
- Psychosocial assessment
- Teaching
- Document findings
- Assist ACP to rate patient for ASA class
59
What teaching should always be provided
Deep breathing, coughing and early ambulation.
60
Should antibiotics ever be started in preop
No it is always on-call in the operating room.
61
What can trigger malignant hyperthermia
Anesthesia
- Can be from a combination of succinylcholine and inhaled anesthetics
- Usually during general anesthesia
- Also can be from trauma, stress and heat
62
In regards to malignant hyperthermia, what should be asked
It is genetic, so you should ask if someone in their family has had it.
63
Is a rise in body temperature an early symptom of malignant hyperthermia
No, it is not an early sign.
64
What is an early symptom of malignant hyperthermia 7
- Blowing off a lot of CO2
- Muscle rigidity
- tachypnea (rapid breathing)
- Tachycardia
- Heart arrhythmias
- Hyperkalemia
- Hypercarbia (increase in CO2 in blood)
65
What is given for malignant hyperthermia
Dantrolene
66
In regards to recreational drug use and alcohol, what is important to remember
If they have used drugs and/or alcohol intake - it may take more medication to put them to sleep
67
What are some drugs that we really want to pay attention to when getting a history from our patient 7
- Anticoagulatns (warfarin)
- Aspirin
- Corticosteroids
- Cardiac meds
- Diabetic meds
- Anxiolytics/sedatives
- Opioids
68
Why can corticosteroids be dangerous
They can thin out the blood
69
What labs tests are we performing prior to surgery 11
- CBC (red blood cells)
- BMP (basic metabolic panel)
- CBG (sugar)
- LFT (liver function test)
- BUN/Creatinine
- PT/INR (how fast blood is clotting)
- T & CM (type and cross match (for blood donor))
- hCG (pregnancy test)
- ECG
- CXR (chest x-ray)
- Pulmonary function test (for heart and lungs)
70
What are the adequate levels of sodium
135-145
71
What are the adequate levels of potassium
3.5-5.0
72
What are the adequate levels of cratinine
0.6-1.2
73
What are the adequate levels of BUN
7-20
74
What are the adequate levels of PT (prothrombin time)
10-12 seconds
75
What is the adequate level of international normalized ration (INR)
Greater than 1
76
What is an adequate WBC count
4500-11,000
77
What are good CBG levels (glucose)
70-110
78
What are adequate albumin levels
3.5-5.5
79
What is an adequate PLT (platelet count)
F 12-16
| M 13-18
80
What are adequate ALT levels
7-56
81
What are adequate AST levels
5-40
82
What can we put on a patient to prevent a DVT or PE
SCDs (sequential compression devices)
83
Are all patients at risk for a DVT or PE
Yes
84
If a patient has a history of a CV condition, what is likely to happen
They will have a cardiologist consult and be placed on telemetry leads
85
Before a nonemergency surgery, what must take place
The patient needs to give informed consent in the presence of a witness (nurse)
86
In order for informed consent to be valid, what must be met
- Adequate disclosure of the procedure (PARQ - procedure, alternatives, risks and questions)
- Patient must show that they understand the information that they are receiving
- Consent must be given voluntarily
87
Who is ultimately responsible for obtaining consent
The surgeon
88
What if consent cannot be obtained and it is an emergency
The surgeon will proceed and you will fill out an unusual occurrence
89
What required legal forms should be in the patient's chart (4)
1. Informed consent
2. Blood transfusions
3. Advance directives
4. Power of attorney
90
Is there a separate consent for anesthesia
Yes - the ACP is responsible for obtaining consent (you may witness the signature)
91
Who should mark the surgical site
The surgeon
92
Can consent be withdrawn at any time
Yes
93
What antibiotic is usually given to prevent a surgical site infection (SSI)
Cefazolin (Ancef)
94
If a patient is allergic to penicillin, can they have cefazolin
No - they are usually given clindamycin instead
95
What is given to decrease oral secretions
Atropine
96
What is given to increase gastric emptying
Metoclopramide
97
What drugs are usually given to decrease anxiety, induce sedation and add amnesic effects (loss of memory)
- Midazolam (versed)
- Lorazepam (ativan)
- Diazepam (valium)
98
What drug is given to decrease gastric acid
Famotidine (pepcid)
99
What drugs are given for pain relief and sedation
Morphine and Fentanyl
100
When you are under anesthesia, will you have the urge to urinate
No
101
What eye medications are given for eye surgery
- Mydriacyl (dilates the pupils)
- Tetracaine (numbs the surface of the eye)
- Pilocarpine (acute angle closure glaucoma)
102
What medication is given for someone having nasal surgery
Afrin - it constricts the blood vessels in the nose
103
When administering ear drops to adults, how do you pull back the ear
Back and upwards
104
When administering ear drops to pediatrics, how do you pull the ear back
Back and downwards
105
What is given if a patient has a history of sea sickness
Scopolamine patch behind the ear
106
Do we want more surgeries to be performed in the hospital or ambulatory
Ambulatory (healthier patients and shorter procedures)
107
What is in the unrestricted zone
- Personnel in street clothes
- Holding area
- Locker room
- Information areas
108
Can you wear street clothes in the unrestricted zone
No - you should have your surgical srubs on, jacket, shoe covers, head cover, mask and other PPE
109
What is taking place in the holding area in the unrestricted zone
- Patients are waiting
- Final identification and assessment
- Friends/family allowed
- Surgical care improvement project (SCIP) (includes patient warming, antibiotic administration, applying sequential compression devices)
110
When should patients d/c st johns wart
A week prior to surgery
111
Where will the anesthesiologist greet the patient
In the holding area
112
What is it important to do with a diabetic before surgery
Warm them (every patient should be warmed up, but it is especially important for diabetics)
113
When should the on-call antibiotics be given
30-60 minutes before incision
114
Before putting the patient to sleep, what should happen in regards to the SCDs
They must be on and working prior to the patient being put to sleep
115
When a patient is given an epidural/spinal, what are they always at risk for
Hypotension (they might feel like they're going to pass out)
116
What if a patient complains of a headache and they received a spinal
They may be having a cerebral spinal leak - call the anesthesiologist
117
What can ketamine cause
Hallucinations
118
Why do we want to keep the room quiet when a patient is waking up from anesthesia
If the room is loud, it can cause emergence delirium (especially for pediatrics)
119
Where is it best to have the OR located
Next to the PACU and ICU
120
How is the OR set up to prevent the transmission of infection 5
- Filters and controlled airflow in the ventilating systems provide dust control
- Positive air pressure prevents outside air from entering
- Narrow range in temperature and humidity
- UV lights
- Strict cleaning protocols
121
Who makes up the nursing team in the OR
- Circulator
| - Scrub RN (this can also be an LPN or surgical tech (ST))
122
Who is supervised by the RN
The LPN or surgical tech
123
What is anesthesia responsible for
Administering anesthetic and managing vital life functions (breathing, BP, etc.)
124
What are the 3 improvement projects by the Surgical Care Improvement Project that focus on improving surgical outcomes
1. Administering a prophylactic antibiotic within 30-60 minutes before surgery
2. Applying a warming blanket
3. Applying intermittent pneumatic compression devices
125
What are the surgical sentinel events (never events)
Wrong surgical procedure, wrong body part or wrong patient
126
When are the surgical timeouts
- Right before the patient is given anesthesia
| - Right before the surgery is going to start
127
What are they identifying in a surgical timeout 7
1. Right patient
2. Patient history
3. Signed consent forms
4. Assessments
5. Results of diagnostic studies
6. Correct site marked (this should be done before the patient is put to sleep)
7. Fire risk assessment
128
What is a clean wound
Operative wound NOT entering the resp. GI or GU tracts (ie vascular, neuro, eye, orthopedic)
129
What is a clean-contaminated wound
Operative wound entering the thoracic, GI or GU tract (ie GYN procedures, GU, appendectomy)
130
What is a contaminated wound
Accidental injury or operative wound with gross contamination, spillage, foreign bodies.
131
When are counts performed
Before, during and after surgery
132
When are sterile gown and gloves put on
After you scrub in, and you're in the OR
133
Who lets us know when we can begin positioning
The ACP (it is after the patient has been put to sleep)
134
What are your five responsibilities when assisting the ACP 5
- Understand anesthetic administration and the effects
- Know where emergency equipment and drugs are located in the OR
- May place leads on patients
- Remain at patient's side to ensure safety
- Assist in difficult intubations
135
When positioning the patient, what do we want to think about 7
- Is the operative site accessible
- Is there airway going to be ok
- Is this a correct skeletal alignment
- Is this putting pressure on nerves, skin, boney prominences or eyes
- Adequate thoracic excursion
- Are we preventing occlusion of arteries and veins
- Are we providing modesty
136
How do you clean the surgical site
In a circular motion from clean to dirty
137
What are the 4 types of local enesthesia
1. Topical
2. Ophthalmic
3. Nebulized
4. Injectable
138
What are the advantages of local and regional anesthesia
- Rapid recovery
| - Little residual "hangover"
139
What are the disadvantages of local and regional anesthesia
- Discomfort
- Hypotension
- Seizures
- Technical difficulties
140
When a patient is given a spinal or epidural anesthesia, what should you watch for
Signs of autonomic nervous system blockade
- Bradycardia
- Hypotension
- N & V
141
Who administers drugs under conscious sedation
A nurse can under the direct supervision of a physician
142
What are advantages of conscious sedation 8
- The patient is responsive
- They can breath on their own
- Reduced fear and anxiety
- Amnesia
- Relief of pain
- Patient cooperation
- Stable vital signs
- Rapid recovery
143
What is conscious sedation used for
Routine, short-term surgical, diagnostic and therapeutic procedures
144
What are the 3 phases of general anesthesia
1. Induction
2. Maintenance
3. Emergence
145
When is emergence anesthesia given (reversal agents)
In the OR
146
What are complications from general anesthesia 9
- Aspiration
- Cardiac irregularities
- Hypotension
- Hypothermia
- Hypoxemia
- Laryngospasm
- Malignant hyperthermia
- Nephrotoxicity
- Respiratory depression
147
What are late sings of malignant hyperthermia
- Elevated temperature
- Myoglobinuria (excess myoglobin in urine)
- Multiple organ failure
148
What is happening in malignant hyperthermia 7
- High carbon dioxide levels
- Respiratory and metabolic acidosis
- Increased oxygen consumption
- Production of heat
- Activation of the sympathetic nervous system
- High potassium levels
- Organs stop working
149
How can general anesthesia be given
- IV
| - Inhalation
150
What does TIVA stand for
Total intravenous anesthesia
151
What is a negative side effect of inhalation agents
They can irritate the respiratory tract
152
What is the typical process of general anesthesia
They will receive an IV with an induction agent, which will put them to sleep for a couple of minutes. Then an LMA or ET tube can be inserted. Then inhalation and IV agents can be given.
153
How are inhalation agents given
Through the endotracheal tube or LMA
154
What does the term adjuncts refer to
Other drugs added to the inhalation (we rarely use just one drug)
155
What drug is given as a dissociative anesthesia
Ketamine
156
What is given with Ketamine to help reduce the hallucinations
Midazolam (versed)
157
What is important to remember if a patient is given ketamine
They need a quiet, unhurried environment to wake up in
158
Because older adults can have changes in how they absorb, distribute or metabolize drugs, what should happen to the drugs that they are given
They should be carefully titrated
159
What is a common complication with older adults
Emergence delirium
160
Besides emergence delirium, what are other complications regarding older adults
- May have trouble with communication (hearing and seeing)
- Skin may be at risk from tape, electrodes, warming/cooling blankets
- Positioning may be difficult if they have osteoporosis or arthritis
- They are at risk for perioperative hypothermia
161
What is an issue with anaphylactic reactions and the OR
Anaphylactic reactions may be masked by anesthesia
162
What can recent use of tobacco lead to
- Blood clots
- Myocardial infarction
- Death
- Slow wound healing
- Risk for infection
163
Why is it important to establish a baseline of motor skills and mental status before surgery
So you can compare their mental status and motor skills after surgery
164
What are indications of a DVT
- Pain
- Redness
- Swelling
- Warm to the touch
165
What are indications of a pulmonary embolism
(When a clot caused by a DVT breaks off and travels to the lungs)
- Chest pain
- Dyspnea (Difficulty breathing)
- Tachycardia
- Hypoxia
166
How does anesthesia increase the risk for atelectasis
Anesthesia decreases the function of the surfactant in the lungs, which leads to the collapse of alveoli
167
What are the signs of a surgical site infection (SSI)
- Redness
- Swelling
- Pain
- Purulent (milky) or foul-smelling drainage
168
Who is at risk for poor wound healing and infections 6
- If you are a diabetic
- Have chronic health problems
- Poor diet
- Obese
- Older
- Using corticosteroids
169
What is dehisence
A separation of the wound or incisional edges (most common after abdominal surgery)
170
Define evisceration
A complication of dehiscence, where organs begin to slip out
171
Why do we fast before surgery
During surgery, stomach contents can move up to the mouth and into the trachea or lungs (aspiration)
172
If a patient is having surgery on their hand, and the anesthesia delivered will provide them a with a temporary loss of feeling in their arm, what type of anesthesia is this?
Regional
173
After surgery, when should a patient be repositioned
Once every hour
174
Who is involved in a patient's admission to the PACU
- Anesthesia care provider
- OR nurse
- PACU nurse
175
Can patient's bypass phase I?
Yes they can go straight into phase II (these are usually our ambulatory surgeries)
176
What system do we use to determine if a patient can transition to the next phase?
The modified aldrete scoring system
177
When receiving a patient from the OR, what is your number one priority
ABC
178
If the patient received a general anesthetic, what should they be receiving
Oxygen through a face mask at 10L
179
When a patient is being discharged after a general anesthetic, what are the typical rules
- Want someone with them for the next 24-48 hours
- Don't want them to drive
- Don't want them to eat a big meal (motility is slowed from the anesthetic, so they are at risk for vomiting)
180
How many categories are there in the aldrete scoring system
5 categories
181
A score of what, in the aldrete scoring system indicates that the patient is ready to transfer to the next phase of recovery
Score of 9 or 10
182
What is rapid PACU progression (RRP)
Where a patient is rapidly progressed through phase I to phase II or inpatient care
183
What is fast tracking
Where you admit ambulatory surgery patients directly to phase II care
184
When receiving a patient in PACU, what information do we want to receive from the transfer team
- Patient name
- Age
- Surgeon
- Surgical procedure
- Why they had the surgery
- Medical history
- Current medications
- Allergies
- Blood loss
- What anesthetics were used
- Fluid replacement
- Urine output
- Unexpected events or reactions
- Vital signs and trends
- Lab results
185
What is the difference between MAC and general
Both are causing sedation, but general is also receiving a paralytic. With this paralytic, the patient cannot keep their airway open, so they are given a breathing tube. With MAC, the patient is not paralyzed and can still breath on their own.
186
For airways, what are we checking
Patency
187
For breathing, what are we checking 4
- RR and quality
- Breath sounds
- Supplemental oxygen
- Continuous pulse ox
188
For circulation, what are we checking 5
- ECG monitoring
- Vital signs
- Peripheral pulses
- Capillary refill
- Skin color and temperature
189
For neurologic, what are we checking 4
- LOC
- Orientation
- Sensory and motor status
- Pupil size and reaction
190
For genitourinary, what are we checking for 3
- Intake
- Output
- Estimated blood loss (EBL)
191
When checking an NG tube, what are we looking for
That the tube is in place, what kind of secretions are coming out of it (red=bad).
192
For gastrointestinal, what are we looking for 2
- Bowel sounds
| - n&v
193
What is a JP drain used for (closed drain)
Standard drainage
194
What is a penrose drain used for (open)
Abscesses (used to clear out infection)
195
Are hiccups good after a surgery
No, they may indicate that vomiting is coming soon
196
What are signs of poor oxygenation from the cardiovascular system 5
- BPs are out of wack (high or low)
- HRs are out of wack (high or low)
- Poor capillary refill
- Decreased pulses
- Decreased O2
197
What are signs of poor oxygenation from the CNS 6
- Restlessness
- Agitation
- Confusion
- Muscle twitching
- Seizures
- Coma
198
What are signs of poor oxygenation from the integumentary system
- Flushed, cool or moist skin
| - Cyanosis
199
What are signs from the renal system of poor oxygenation
- Urine output is less than 0.5ml/kg/hr
200
What is the most common airway obstruction
The tongue
201
Is snoring an obstruction
Yes
202
What is hypoxemia
Low amount of oxygen in your blood
203
What are common causes of hypoxemia (3)
- Atelectasis
- Aspiration
- Bronchospasm
204
Can atelectasis happen right after surgery
Yes - it can be from an increase in secretions, decrease in respiratory excursion or from general anesthesia.
205
How is a person at risk for aspiration after surgery
Because the anesthesia depresses the respiratory protective airway reflex
206
What is a sign of bronchospasm
Wheezing
207
What type of patients do we most often see bronchospasm occur in
- Smokers
- Asthma
- COPD
208
Besides chest pain, what are other signs of a pulmonary embolism 5
- Acute tachypnea (rapid breathing)
- Dyspnea (difficulty breathing)
- Tachycardia
- Hypotension
- O2 drops
209
Why are patients on O2 after surgery
- Helps to eliminate anesthetic gases
| - Meets the increase demand for O2 due to decreased blood volume or increased metabolism
210
Once the patient is awake, what am I having them do
Deep breathing, coughing and using the IS
211
Why is coughing and deep breathing important
It helps to mobilize the built up secretions
212
Should a patient still cough if they had abdominal surgery
Yes, but use a pillow to splint over the incision
213
If a patient is vomiting, how would we want to move them
Move them to their side
214
How should an unconscious patient be positioned in recovery
In the lateral "recovery" position
215
What position should the patient be in once they are awake in recovery
Supine position
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When would we use a nasopharyngeal airway
When the patient is having trouble breathing and they are semi-obstructing. They are usually semi-conscious
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When would we use a oropharyngeal airway
When the tongue is completing obstructing, this may be evidenced by snoring
218
What is good to do for patient who have just had abdominal surgery
Elevate their legs (this takes the weight off the abdominal incision)
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What are the signs of atelectasis
- Breath sounds are decreased
| - O2 has dropped
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What are interventions for atelectasis
- Oxygen therapy
- Deep breathing
- IS
- Early mobilization
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What can hypoventilation be from
- Respiratory depression (from the anesthetics)
- Mechanical (tight dressing)
- Pain from surgery
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How often should a patient be repositioned to prevent respiratory complications
1-2 hours
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What are common post op cardiovascular complications 5
- Hypotension
- Hypertension
- Dysrhythmias
- VTE
- Syncope (loss of consciousness due to drop in BP)
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What can hypotension cause
Hypoperfusion (low blood output) to vital organs
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What are signs of hypotension 5
- Disorientation
- Loss of consciousness
- Chest pain
- Hypoxemia
- Loss of physiologic compensation
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What is the most common cause of hypotension after surgery
Fluid and blood loss (So give fluid!)
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What is a contributing factor to cardio problems
Fluid and electrolyte imbalances from surgery
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Why are patients at a higher VTE risk after surgery
The stress response from surgery can increase the clotting tendencies by increasing platelet production
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What can cause hypertension after surgery 4
- Pain
- Anxiety
- Bladder distention
- Respiratory distress
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What is syncope
Fainting (BP drops so you faint)
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What can cause syncope
- Decreased cardiac output
- Fluid deficits
- Defects in cerebral perfusion (blood flow to the brain)
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How often should you be obtaining vitals signs in phase I
At least every 15 mintues
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What is the treatment for hypotension
- Give O2
| - Give IV fluid boluses
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What are treatments for hypertension
- Giving pain meds
- Helping them go to the bathroom
- Warming them up
- Correcting any respiratory problems
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What are 4 nursing interventions to prevent F&E and cardiovascular complications
- Frequent vital signs monitoring
- Continuous ECG monitoring
- Adequate fluid replacement
- Assess surgical site for bleeding
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Should you get someone up to walk right away after surgery
No - they still may have anesthesia in their body
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When ambulating someone after surgery, what are you watching for
Orthostatic BP
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When and to whom is low molecular heparin given
To our bariatric patients, because they are at risk for a blood clot (heparin is a blood thinner)
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What should you first suspect for emergence delirium
Hypoxia (give O2)
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What does POCD stand for
Postoperative cognitive dysfunction
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What is POCD and who does it primarily effect
POCD is a decline in the patient's cognitive function weeks or months after surgery. It typically effects older patients.
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What is the reversal agent for benzodiazepine
Flumazenil
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What is the reversal agent for an opioid
Naloxone
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What are symptoms of alcohol withdrawal delirium 5
- Restlessness
- Insomnia
- Nightmares
- Irritability
- Auditory or visual hallucinations
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What temperature and below is considered hypothermia
96.8
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What are the signs and symptoms of septicemia
- Intermittent high fever
| - Shaking chills
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When would we see a fever from an infection
3 days after the surgery
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If the patient has a normal temperature, how often should we take their temperature in the PACU
Every hour
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If the patient is hypothermic in the PACU, how often should we take their temperature
Every 15 minutes
250
How should we treat shivering
- Give O2 (they are using more O2 due to the shivering)
| - Give opioids to help calm down the shivering
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How are we going to treat MH
- Give dantrolene (Dantrium)
- Cool the patient with ice packs
- Correct the acid-base imbalances
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What makes a patient more likely to have n&v after surgery 6
- Under 50
- Being a female
- History of motion sickness
- Nonsmoker
- The anesthetic or opioid used
- The duration of the surgery
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What type of drug are we giving for n&v
Antiemetic drugs
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When should a patient void after a surgery
6-8 hours
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What if evisceration happens
Cover with sterile gauze soaked in normal saline. Try to have the patient put their knees up. Call the physician.
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What is the discharge criteria for phase I 9
- Patent airway
- Patient is awake
- Vitals are at baseline
- No excessive bleeding or drainage
- No respiratory depress
- O2 is above 90
- Pain is managed
- N&V controlled
- Report given
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If you are having an ambulatory surgery done, what type of post care are you receiving
Phase II and/or extended observation postoperative care
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What is the discharge criteria for ambulatory surgery 7
- Must be mobile and alert
- Cannot drive (responsible adult present)
- No IV opioids in the past 30 minutes
- Minimal n&v
- Voided if appropriate to surgical procedure or orders
- Understands discharge instructions (has a copy)
- May use post anesthesia scoring system to determine readiness
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What are some good discharge teachings after ambulatory surgery
- What symptoms to report
- Where and when to return for follow-up care
- Reasons to seek help after discharge
- Answers to questions
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What is MAC used for and where
Diagnostic or therapeutic procedures inside or outside the OR (used for lumps and bumps)
261
Who must administer MAC
An ACP
262
If a bowel falls out of a patient, should you try to put it back in
NO
263
Who will place the the dressing on the patient when surgery is finished
The surgeon or the scrub RN
264
How should a diet progress after surgery
Clear to full to soft to regular
265
What area is sterile if you scrubbed in
Mid chest to abdomen
266
What is emergent
Life or death
267
What is urgent
Getting close to life or death
268
What type of airway is used with general anesthetic
ET used with a paralytic
269
Who is most at risk for fluid differences
The young and old
270
Who is at risk for fluid and electrolyte imbalances
Anyone that loses blood
271
How long should a patient remain NPO before surgery
6 hours with solid food and 2 hours with clear liquid
