Surgery Flashcards
when should abx be given and when stopped
1 hr before and after procedure unless IV abx which is 48hrs before and after
abx given for prophylaxis
vancomycin, levoquin IV 2 hrs prior
blood glucose rate should be under what value?
200 mg/dL
how does high bg put the pt at risk
increased infection
less likely to get renal failure and receive ventilation support
when should urinary catheters be removed by
within 48hours
how does hypothermia put pt at risk
below 36 (97F)
risk for infection, impairs healing, affects drug metabolism, adverse cardiac events
why is beta blockers given during pre-op
to regulate heart rate and decrease mortality
VTE prophylaxis and post sx
how long before and after
what is done
24 hrs before and after
compression hose or SCD
lovenox, coumadin given
what lab tests are done for pre-op
pregnancy test
glucose
electrolytes
CBC
BUN/creatinine/eGFR/urinalysis
Coags PT/PTT/INR
CXR/ECG
why is atropine sulfate given pre-op
to decrease resp secretions
what is the purpose of anticholinergics
blocks acetylcholine which prevents muscle spasms
relieve cramps or spasms of the stomach, intestines, and bladder
S/S of malignant hypothermia
tachycardia
muscle stiffness
unstable or increased BP
increased temp
hypercalcemia
met/resp acidosis
increased CK
treatment for malignant hyperthermia
dantrolene (dantrium)
sodium bicarbonate for met. acidosis
iced saline inj
d/c triggering agent
transfer to ICU 24hrs
when is orientation given when a pt arrives in PACU
first arrival as their hearing is returned first
D/C criteria for O2 saturation
90-92%
what is UOP
intraoperative urine output given to PACU
what is assessed first when arriving to PACU
ABCs
response to reversal of anesthesia
spinal block
RR range for PACU and what to do
12-30 max
give O2 cannula regardless of O2 saturation help to get rid of anesthesia gases
how often are VS done in PACU
q15mins for an hour
when are narcotics given in PACU and range
48hrs of narcotics and then NSAIDS
what meds are given for antiemetics
zofran, reglan
what is the most common cause of hypoxia during anesthesia recovery
atelectasis
Criteria for systemic inflammatory response syndrome
temp: <36 or >38 (97-100 good)
HR: >90
RR: >20 with PaCO2 <32mmHg
WBC: <4,000 or >12,000
D/C criterias
No IV narcotics last 30mins
can ambulate
minimum N&V
who gives report to PACU nurse
anaesthesiologist verbal report
what is emergence delirium
pt can wake up agitated
typically due to hypoxemia
what is considered hypoxemia
PaO2 <60mmHg
position of unconscious vs conscious pts
on the lateral side - unconscious
supine with head elevated - conscious
how often should DB&T and IS be used
DB 10 times/hour while awake. turn q1-2hrs
IS used 10-15 times and cough, q2-3hrs while awake
cause of cardiovascular issues post-surg
sympathetic nerve stimulation from pain, anxiety, bladder distension, or resp compromise
when is anaesthesiologist or surgeon notified for BP & HR
systolic below 90 or above 160
HR less than 60 or above 120
residual vasodilating effects of anesthesia vs/ impending hypovolemic shock
OK - hypotension, normal pulse, warm and dry pink skin
hypov shock - hypotension, tachycardia, cold & clammy skin
how often should pts flex and extend all joints
10-12 times every 1-2 hrs while awake
nursing assessment for neuro in PACU
PERRLA pupils
sensory & motor status
what is used to check motor block as the effects of spinal anesthesia is resolving
ice packs
fever in PACU
mild elevation up to 38 first 48 hrs - stress response
higher than 38 - respiratory congestion or atelectasis
after 48hrs - infection
response to fever in PACU
CXR, wound culture, urine, blood
large intestine vs small intestine response post-op
large intestines slow for 3-5 days
small intestine should return within 24hrs
hiccups cause
irritation of phrenic nerve which innervates diaphragm
why is NG tube used post-op
decompress stomach to prevent N&V, abdominal distension
how to prevent abdominal distension
frequent ambulation
what drug is used to encourage flatus, feces, and colonic peristalsis
bisacodyl (Dulcolax)
when should catherization be considered in PACU
after 8-12 hours of not voiding
expected drainage from wound
go from sanguineous to serosanguineous to serous (clear yellow)
sign of wound dehiscence
separation of wound edges with sudden discharge of brown, pink, or clear drainage
