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TERM 4 N2261 KNLG 3 > SURGICAL CLIENT & ERAS > Flashcards

SURGICAL CLIENT & ERAS Flashcards

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1
Q

Name the components of the ABCSDEF prioritization framework

A

Airway
Breathing
Circulation
Safety
Discomfort
Education
Feelings

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2
Q

Name the 5 levels of Maslow’s hierarchy of needs

A
  1. Physiological
  2. Safety
  3. Love, belonging
  4. Self esteem
  5. Self actualization
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3
Q

What are 4 examples of pieces of information to ensure to get during report to determine the patient’s acuity level?

A
  1. Preoperative health status
  2. Comorbidities
  3. Emerg vs elective surgery
  4. Length and type of surgery
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4
Q

What are 5 examples of ways surgery could affect the patient’s airway?

A
  1. Intubation/extubation
  2. Anaphylaxis
  3. Inflammation
  4. Sedation
  5. Surgery of the neck/face
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5
Q

What are 4 examples of ways surgery could affect the patient’s breathing?

A
  1. Aspiration
  2. Medication (esp. opioids)
  3. Pain or decreased LOC
  4. Fluid overload > pulmonary edema
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6
Q

What are 3 examples of ways surgery could affect the patient’s circulation?

A
  1. Blood loss
  2. Fluid overload > hypertension
  3. Thrombosis
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7
Q

When should hyperthermia postoperatively be a concern?

A

After 48 hours postop, especially if >38 deg

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8
Q

What are 2 causes of postop ileus?

A

Anesthesia
Manipulation

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9
Q

What are 2 signs of postop ileus?

A

Firm abdomen
Vomiting bile

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10
Q

What are 2 interventions for postop ileus?

A

NG insertion and encourage mobilization until pt passes gas

(Bowel protocol may be contraindicated until pt passes gas, depends on policy)

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11
Q

What rate of urine output is desireable postop?

A

~30 ml/h

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12
Q

What are 4 main components of clinical pathways?

A
  1. Timeline
  2. Categories of care
  3. Outcome criteria
  4. Variance record
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13
Q

What are 5 advantages of clinical pathways?

A
  1. Collaborative practice
  2. Tracking
  3. Reduce unecessary variations
  4. Decision support
  5. Evidence-informed best practice
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14
Q

What are 6 core principles of ERAS (enhanced recovery after surgery)?

A
  1. Patient and family engagement
  2. Nutrition management
  3. Fluid/hydration management
  4. Multi-modal opioid sparing analgesia
  5. Perioperative best practices (e.g. SSI, HAP, CAUTI, VTE)
  6. Mobilization
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15
Q

The stress response causes changes in which 6 physiological areas?

A
  1. Oxygen consumption
  2. Metabolic
  3. Fluid shifting/retention
  4. Immunity
  5. Coagulability
  6. GI motility
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16
Q

What are 3 guidelines for preoperative fasting under ERAS?

A
  1. Clear liquids up to 2 hrs before surgery
  2. Light meal/milk up to 6 hrs before surgery
  3. Additional fasting time after eating fried/fatty foods or meat
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17
Q

Under ERAS, how soon preop should carbohydrate rich drinks be ingested?

A

Up to 2 hours

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18
Q

What are 3 advantages of preoperative carbo loading?

A
  1. Avoids catabolic state
  2. Increases insulin sensitivity
  3. Decreases risk of post-op hyperglycemia
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19
Q

What are 3 advantages to early oral intake postoperatively?

A
  1. Sooner discontinuation of IV fluids
  2. Stimulates GI motility
  3. Lower incidence of SSI
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20
Q

What are 2 guidelines to progressing the patient’s diet postoperatively?

A
  1. Sips of clear fluid 2 hrs post-op
  2. Offer regular diet POD1
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21
Q

What is the general CBG target for all postoperative patients?

A

<10 mmol/l

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22
Q

What are 3 reasons hypervolemia be avoided postoperatively?

A
  1. Cardiopulmonary complications
  2. Bowel complications (e.g. anastomotic leak, impaired GI motility)
  3. Tissue hypoperfusion (poor wound healing, SSI)
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23
Q

Which IV fluid should be avoided in postoperative patients?

A

Normal saline

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24
Q

Which assessment value should not be the sole basis for ordering an IV bolus?

A

Urine output

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25
Q

Name the components of the I-COUGH acronym

A

I: Incentive spirometry (10x/hr)
C: Cough and deep breathe
O: Oral care (2x/day)
U: Understanding (patient education)
G: Get out of bed
H: Head of bed elevated

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26
Q

Foley catheters should generally be removed when postoperatively?

A

POD1 in am

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27
Q

If the nurse decides not to remove the Foley in the first 24 hrs, what needs to be provided?

A

Rationale

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28
Q

What is the guideline for mobilization preoperatively?

A

Dangle at the bedside or get up to the chair for 2 hrs

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29
Q

What are 2 guidelines for mobilization postoperatively?

A
  1. Up in chair for all meals
  2. Ambulate/get out of bed for at least 6 hr/day
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30
Q

What are 2 principles to prevent surgical site infection?

A
  1. Early removal of drains/tubes
  2. Follow physician’s orders for dressing changes
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31
Q

According to WHO, what are 5 precautions to take pre and post-op to prevent infection?

A
  1. Bathe/shower
  2. Do not shave
  3. Use antibiotics sparingly
  4. Use chlorhexidine skin prep
  5. Wound care/monitoring
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32
Q

What are 4 reasons postoperative nausea/vomiting should be prevented?

A
  1. Airway compromise
  2. Aspiration pneumonia
  3. Fluid/electrolyte imbalance
  4. Stress on incision
33
Q

Besides pain, infection, or drug side effects, what are 6 possible underlying causes for postoperative nausea/vomiting?

A
  1. Hypovolemia
  2. Hypotension
  3. Hypoxia
  4. Hyper or hypothermia
  5. Hunger
  6. Oral hygiene
34
Q

What are 5 characteristics of concerning pain?

A
  1. Increasing
  2. New onset
  3. Change in character
  4. Change in location
  5. Not getting batter
35
Q

Surgical trauma may cause what state in the patient, which may be the root cause for chronic pain syndrome?

A

Neuroplasticity/spinal sensitization

36
Q

What are 3 advantages to using multi-modal opioid sparing analgesia?

A
  1. Max analgesia
  2. Lower doses
  3. Lower risk of side effects
37
Q

Which route is not recommended for postoperative pain management?

A

Intramuscular

38
Q

What are 2 contraindications to using NSAIDs?

A
  1. Certain comorbidities
  2. GI anastomosis
39
Q

What are 2 examples of weak opioids, and what kind of pain are they used to treat?

A

Codeine and tramadol; mild to moderate pain

40
Q

What are 7 criteria for discharge?

A
  1. Mobilizing well
  2. Adequate oral intake
  3. Normal urinary function
  4. Pain control
  5. Afebrile
  6. Patient comfortable with discharge
  7. Patient teaching complete
41
Q

What is the term for local anesthetic injected into the CSF in the subarachnoid space below L2?

A

Spinal anesthesia

42
Q

What level of blockade is achieved with spinal anesthesia?

A

Autonomic, sensory, and motor

43
Q

Autonomic blockade results in what outcome in the patient?

A

Vasodilation, hypotension

44
Q

What kind of procedures typically use spinal anesthesia?

A

Abdominal, lower extremities, back

45
Q

What is the term for local anesthesia injected into the epidural space that binds to the nerve roots?

A

Epidural anesthesia

46
Q

What level of blockade is achieved with epidural anesthesia?

A

Sensory and motor (amount controlled by anesthesiologist)

47
Q

What kind of procedures typically use epidural anesthesia?

A

Maternity, knee/hip replacements

48
Q

Between spinal and epidural anesthesia, which mode has a faster onset of action?

A

Spinal anesthesia

49
Q

Between spinal and epidural anesthesia, which mode has a higher risk of post-anesthesia headache?

A

Spinal anesthesia

50
Q

What is the term for sedatives administered intravenously with or without analgesia, resulting in the client being conscious but with reduced anxiety?

A

Procedural sedation

51
Q

For patients who have received procedural sedation, what must be assessed immediately upon arrival back to the unit?

A

ABCs and LOC

52
Q

What are 5 examples of procedures that may use procedural sedation?

A
  1. IR
  2. Endo
  3. Wound debridement
  4. CVC or chest tube insertion
  5. Dental
53
Q

What is the mechanism of action of ondansetron?

A

5-HT3 receptor antagonist

54
Q

How is ondansetron administered?

A

IV intermittent or push

55
Q

What are 2 adverse effects of ondansetron?

A

Drowsiness, heart dysrhythmias

56
Q

What is the mechanism of action of ibuprofen?

A

Prevents synthesis of prostaglandins by inhibiting COX-1 and COX-2

57
Q

How does acetaminophen work as an antipyretic?

A

Works on hypothalamus

58
Q

What is the mechanism of action of gabapentin when used to treat pain?

A

Binds to gabapentin receptors in the brain

59
Q

How is gabapentin usually administered?

A

Oral

60
Q

What is another example of a gabapentinoid?

A

Pregabalin

61
Q

Why is pulse oximetry not a first line indicator of opioid induced respiratory depression?

A
  1. Resp depression may be masked by O2 administration
  2. SpO2 readings may remain normal for minutes after patient stops breathing
62
Q

What should be avoided when assessing a client’s LOC?

A

Patient stimulation

63
Q

What are 3 ways opioids cause respiratory depression?

A
  1. Depress respiratory effort/rate
  2. Relax pharyngeal tone
  3. Depress response to hypoxia/hypercarbia
64
Q

What is the mechanism of action of hydromorphone?

A

Mu-receptor agonist; blocks ascending pain pathways

65
Q

How is hydromorphone administered?

A

All routes; however IM not recommended

66
Q

What patient comorbidity should be considered when administering hydromorphone?

A

Renal dysfunction

67
Q

What is the mechanism of action of morphine?

A

Agonist-analgesic of opiate receptors; blocks ascending pain pathways

68
Q

How is morphine administered?

A

All routes except IM

69
Q

Which 2 adjuvant drugs act as non-competitive NMDA receptor antagonists?

A

Ketamine, magnesium

70
Q

Which adjuvant drug is an alpha-2 adrenergic agonist?

A

Clonidine

71
Q

Which non-pharmacological treatment is used to treat postoperative nausea and vomiting?

A

P6 acupoint (below wrist in between 2 tendons)

72
Q

What airway complication is a concern for patients who were intubated in the OR?

A

Laryngospasm/laryngeal edema

73
Q

What is generally the desired systolic BP for postoperative patients?

A

90-160

74
Q

What is generally the desired heartrate for postoperative patients?

A

60-120

75
Q

When considering pulse pressure (difference between systolic and diastolic BP readings) what finding would be a cause for concern?

A

Narrow pulse pressure

76
Q

During the first 48hrs post-op, what is an expected temperature finding?

A

Mild elevation (<38)

77
Q

What temperature reading would be concerning more than 48 hrs post-op?

A

> 37.7

78
Q

When is postoperative ileus considered as paralytic ileus?

A

2-3 days post-op

TERM 4 N2261 KNLG 3 (9 decks)

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