Surgical Patient Flashcards

Question

malignant hyperthermia

Answer 1

rapid rise in temperature, 105 F degrees, or 40.5 C Usually happens intra-operatively but CAN HAPPEN IN POST-OP Susceptibility (a) rare (b) Genetic components (c) Stress, trauma, heat S&S (a) Hyperthermia (NOT the 1st sign) (b) Muscle rigidity Causes (a) Altered control of Ca++  increased metabolism of skeletal muscle (contractures)  elevated temperature  hypoxemia  lactic acidosis  hemodynamic/cardiac alterations  death Trigger (a) Succinylcholine (b) Inhalation Agents Treatment (a) Early detection is critical (b) ICE! (c) IV dantrolene (Dantrium) - Slows metabolism and reduces muscle contractions Prevention - Obtain family history

Answer 2

IV dantrolene (Dantrium) Slows metabolism and reduces muscle contractions

Answer 3

Airway obstruction – Especially if intubated Hypoxemia (i) Atelectasis (ii) Pulmonary edema (iii) Aspiration (iv) Bronchospasm (v) Pulmonary embolus Hypoventilation due to decreased drive, decreased effort, restriction, pain Pneumonia

Answer 4

atelectasis, not infection. What can we instruct the patient on to prevent atelectasis? Cough and Deep Breathe

Answer 5

First 48 hours, less than 100.4 F=inflammatory response, surgical stress. Greater than 100.4 F=atelectasis, dehydration Greater than 48 hours, greater than 100.4 F=infection (wound, respiratory, urinary).

Answer 6

(a) Know pre-op respiratory function, frequent assessment (b) Position appropriately – prevents stasis of lung secretions (c) Stimulation – helps clear anesthetic effect (d) Anesthetic reversal (e) Hydration – prevents mucus plugging (f) Cough, deep breathe, turn, IS – the key to preventing complications (g) Intraoperative SCDs, (h) prophylactic anticoagulation (Heparin) (i) Suction and emergency airway equipment readily available (j) Pain management (k) Monitoring

Answer 7

Hypotension, Hypertension, Dysrhythmias, and Myocardial Infarction key is monitoring pt and know the pre-op status!

Answer 8

Abrupt hypotension indicates hemorrhage or cardiac dysfunction (consider pain meds) The most common cause is third spacing Treatment 1. Lower head of bed to a neutral position 2. NS given as IV bolus a. Replace fluid (preload) that has shifted from the vascular space into the void left by surgical excision. b. Maintain perfusion of tissues and organs – especially the kidneys. 3. Notify provider Treatment 1. Vasoconstrictors (afterload): Dopamine, Neo-synephrine, Norepinephrine 2. NS – increases volume

Answer 9

Check body systems first – pain, anxiety levels, full bladder Pharmacologic therapy a. Vasodilators – Decrease afterload b. Beta blockers-effect HR too c. Calcium channel blockers- can effect HR d. ACE inhibitors e. Nitrates

Answer 10

Maintain electrolytes WNL Atrial a. Bradycardia: Atropine, Epinephrine b. Tachycardia: Beta blockers, Calcium channel blockers, Digitalis, Adenosine c. Atrial flutter/fibrillation: i. If new, cardioversion. ii. If of questionable duration, control heart rate with Beta blockers, calcium channel blocker, or digitalis until the presence of atrial clots confirmed or denied, then either anti-coagulation or cardioversion. Ventricular a. Slow/escape rhythms: Atropine b. Dysrhythmias (PVCs, VT): Amiodarone, Lidocaine, Procainamide c. Ventricular fibrillation and VT (unconscious): Defibrillation followed by Amiodarone, Lidocaine, or Procainamide as needed. Epinephrine as needed

Answer 11

Monitor urine output low perfusion to the kidney due to the MI = low urinary output Monitor vital signs and treat as needed Postoperative cardiac evaluation including enzymes Evaluate EKG-ST changes Complaining of chest pain, pressure, radiates to jaw/arm

Answer 12

Delayed emergence Check liver and kidney function Delirium causes include anesthesia, medications, *respiratory* Hypothermia how can we warm the patient? Warm blankets or Bear hugger Prevention and Treatment (a) Know at risk groups -- Elderly – lower immune system, comorbidities (b) Create safe environment (c) Careful patient and family history Was the pt previously confused? – GET a baseline! (d) Ongoing observation (e) Reversal agents (i) Narcan – opioids (ii) Romazicon – versed (antianxiety) (iii) Fresh frozen plasma - warfin (f) Careful use of pain medication-sedation, confusion (g) Medications to manage withdrawal symptoms - Adivan (h) Think about electrolytes – Low Na+  cerebral edema (i) Keep patient warm

Answer 13

N/V, paralytic ileum, hiccups

Answer 14

Common after anesthesia GI rest until BS resume, nausea subsides Treatment (i) Zofran to prevent N/V (ii) Promethazine (Phenergan), chlorpromazine (Thorazine), Prochlorperazine (Compazine), hydroxyzine (Vistaril) to treat - Watch sedation levels, watch bp What if they start vomiting, how do you protect their airway? 1. Turn on side 2. suction

Answer 15

Monitor bowel sounds 1. if they have an NG-turn off LIWS (low intermittent with suction) temporarily to auscultate bowel sounds 2. have Suction equipment at bedside Consider alternative pain meds (Tylenol) Fluids when gag reflex is present if low risk AMBULATE! Right sided position - Helps follow GI track and gets it moving!

Answer 16

Causes include: Gastric distension, intestinal obstruction, intraabdominal bleeding, subphrenic abscess, acid-base imbalance, electrolyte imbalance, hot or cold liquids. Give Hiccup meds - anticholinergics Usually lasts a short time

Answer 17

Infection, Retention, Low urinary output Prevention and Treatment (a) Monitor I & O (b) Cautious use of pain meds in high risk (c) Avoid catheter if possible (d) Males- stand to void (e) Fluid challenge

Answer 18

- minimal accept urinary output 0.5 ml/kg/hr or 30 mL - First 24 hours, 800 ml to 1500 ml of urinary output is expected. - Most void 6 to 8 hours after surgery. What do you do if there is a low urinary output? Bladder scanner 1. Yes to bladder full -> straight catheter 2. No to bladder full -> fluid bolus, check creatinine Common causes of low uop is third spacing (edema), low volume, sepsis, heart failure, obstruction, and medication harm. Treatment: 1. NS fluid bolus X 2-if low on volume/fluid-usually the first intervention 2. Diuretic-will pull fluid from third spacing/edema and back into the vascular space 3. Dialysis

Answer 19

Hemorrhage, Infection, Dehiscence, Evisceration Care (a) Check drains, adjacent tissue, dressings (b) Watch BP, trend H&H-bleeding (c) Clean technique with dressing change-infection control! (d) Wound support in stress areas such as Pillow for cough and deep breathing (e) Prophylactic antibiotics Discharge Instructions (a) Activities (i) What can pt do/not do? (like heavy lifting) (b) Diet (high protein for wound healing) (c) Wound/Incisional Care (d) Meds- new, old, when to resume (e) When to call, and when not to (i) What to worry about (S/S infection) (ii) What not to worry about (f) Who to call (g) When, where to return for follow up (h) Other information as needed

Answer 20

Dehiscence – splitting/bursting of a wound Evisceration – protrusion of the internal organs (usually abdominal) through an incision Evisceration tx – sterile gauze w/NS or sterile water over organ & notify HCP; check vitals