unit 2 Flashcards
assess pt duting conscious sedation
monitor airway, LOC, O2 sat, capnography, ECG, and vital signs q 15min
malignant hypothermia
- stop all inhalation anesthetic
- intubate
- vent at 100% at highest rate
- give dantolene
- terminate surgery is possible
- check ABGs and treat
- cool pt/ monitor temp
RN interventions during general anestheia
stage 1- close OR door, dim lights, control OR traffic, position pt, keep voices low
stage 2- avoid auditory and physical stimulus, protect extremities, assist w suctioning, stay w pt
stage 3- assist w intubation, place in operative position, prep skin
stage 4- prepare/assist w cardiopulmonary arrest, document occurance
7 meds for conscious sedation
etomidate-amidate diazepam-valium midazolam-versed fentanyl-sublimaze alfentanil-alfenta propofol-diprivan morphine
insufflation
the practice of injecting gas or air into a cavity before surgery
DVT assessment
obese, over 40, cancer, decreased mobility, Hx of VTE, DVT, varicose veins, edema, oral contraceptives, smoke, decreased cardiac output, hip or knee surgery
-sudden swelling in 1 leg, dull ache in calf that worsens w mobility
application of pneumatic pressure device
measure legs for proper size, place boots on legs and check compression pressure (35-55), apply preop
deep breathing
gentle in and out, hold for 5
post coughing
every 1-2 hrs post surgery, expel secrestion, keep lungs clear,allow full aeration, prevent pneumonia and atelactesis
day of surgery meds
sedatives, hypnotics, anxiolytics, opoid analgesics, anticholinergic, antibiotic w/n 60 min of surgery
informed consent w nonenglish speaker
requires qualified translator and witness
lab assessment preop
urinalysis, CBC or HH, clotting studies, electrolytes, BUN and Cr, pregnancy
hypokalemia
increased risk for digoxin toxicity, slows recovery from anesthia, increased cardiac irritability
hyperkalemia
increased risk for dysrhythmias w anestheia
assessment priorities post op
phase 1- airway, vitals, indicators of recovery every 15 min
phase 2- presurgery LOC returned, O2 sat at baseline, vitals stable
phase 3- vitals stable, surgical site bleeding
post op hand off report
type and extent of proceedure, anestheia details, allergies, health problems, vitals, fluids, blood loss, complications, communication issues, special requests, resp function, location/type incisions/dressings/drains, I&O
time out
verify correct pt, proceedure, position
RN informed consent
provide detailed info about proceedure, clarify facts and myths, verify signitures, serve as witness
age related changes to consider pre op
chronic illness, malnutrition, more allergies, increased impaired self care, inadequate support system, decrease ability to handle stress of surgery/anestheia, increased risk for cardiac, change in mental status, increased fall risk
10 SCIP measures
- antibiotic wn 60 min
- proper antibiotic selection
- antibiotic d/c wn 24 hrs post op
- cardiac pts w controlled 0600 post op blood glucose
- hair removal
- urinary cath removal 1-2 days post op
- temp management
- beta-blockers
- VTE prophylactics ordered
- VTE pro recieved 24 hrs pre and post surgery
diagnostic surgery
determine origin and cause of disorder
curative surgery
resolve health problem by repair or removal of cause
restorative surgery
improve functionable ability
palliative surgery
relieve symptoms of dx processbut not cure
elective surgery
correction of nonacute problem
urgent surgery
requires prompt intervention, life threatening in 24-48 hrs
emergent surgery
immediate intervention due to life threatening consequences
subcutaneous infusion indications
- pain and insulin drug infusions
- palliative care can’t take oral meds, IM to painful, or vascular access not available
- hypodermoclysis- short-term fluid replacement
assess post intraosseous device placement
no longer than 24 hrs, check for fluid accumulation, any signs of decreased circulation in limb
3 potential systemic complications of IV therapy
- circulatory overload
- speed shock
- catheter embolism
assessing peripheral IV site
begin w insertion site and work up, swelling, redness, hardness, drainage, lightly palpate, integrity of dressing, tubing
choosing correct IV site
superfiscial veins of forearm (bascilic, cephalic, and median), no hands on older pts, avoid arm w mastectomies, stroke, fistulas
IV fluid orders
type, rate, specific dose to be added to solution
IV drug orders
name, dose, route, frequency, time of administration, length of infusion time, purpose
cholinergic agonists side effects
stimulate bladder and GI tone, constrict pupils, increase neuromuscular transmission, decrease HR and BP, increase saliva, GI, and bronchial glandular secretions
antichoinergic effects
decrease GI motility, saliva, bladder contraction, rigidity and tremmors, dilation of pupils, increase pulse
evisceration
get help, cover w warm sterile solution dressing, keep dressings moist, assess for shock, supine w knees bent and head raised 15-20 degrees, vitals, emergent surgery
dehiscence
apply sterile dressing, avoid cough, alert surgeon
assess post op wounds
dr first dressing change, tissue integrity, type and amt of drainage
assess pt w spinal or epidural
cardiac depression, restlessness, excitement, incoherent speech, headache, blurred vision, metalic taste, nausea, tremors, seizures, incresed pulse, RR, BP
discharge from PACU
9-10 rating on recovery scale, stable vitals, no overt bleeding, return gag/swallow, can take liquids, urine output
post op ed for home discharge
prevention of infection, care and assessment of surgical site, mgt of drains and catheters, nutrition, pain and drug mgt, progressive increase in activity
pH and osmolarity w IV site
central line needed w pH 5-9 and osmolarity more than 600
IV infiltration
stop infusion and remove catheter, apply sterile dressing, elevate extremity, warm/cold compress, insert new line in opposite extremity, rate infiltration and document
central line bundle to reduce infection
use checklist, hand hygiene, maximal barrier precautions, sterile technique, min traffic in room, chlorhexide for skin disinfection, use preferred sites, post-placement care, remove ASAP
nonpharmacological pain mgt
positioning, massage, relaxation techniques, diversion, ice
actions post PICC placement
meticulous dressing changes, hang bags w sterile technique, vigorous scrub of catherter hub, chest xray
