Week 1: Perioperative Flashcards
Cardiac Output
The amount of blood ejected from the heart in one minute
Stroke volume:
the amount of blood pumped by each ventricle with each heartbeat (mL/beat)
What are the 4 determinants of cardiac output?
- heart rate
- preload
- afterload
- contractility
Preload
the amount of blood entering the ventricles during diastole
ways to increase preload
IV fluids
stimulating the sns system
ways to decrease preload
diuretics
vasodilators
afterload
the pressure the ventricles must overcome to open valves and pump blood out go the heart (when the ventricles are contracting during SYSTOLE)
ways to increase afterload
vasoconstrictors
Ways to decrease afterload
diuretics
vasodilators
contractility
how hard the myocardium contracts for a given period
How to calculate CO
heart rate x stroke volume = CO
Explain the steps of the RAAS system
- the body blood pressure drops
- the kidneys (juxtaglomerular cells) release renin in response to low BP
- The renin stimulates the liver to release angiotensin 1
- ACE turns angiotensin 1 into angiotensin 2
- angiotensin 2 causes vasoconstriction, aldosterone release (keep sodium and water in kidneys and no pee) and the release of ADH (stimulates thirst, keep water to increase blood volume)
diagnosis
to determine the presence or extent of pathological abnormality (eg. lymph node biopsy)
Cure
to eliminate or repaire a pathological condition (eg. ruptured appendix)
Palliation
to alleviate symptoms without cure
Prevention
to reduce the risk of developing a condition
Cosmetic
to alter physical appearance
Exploration
to determine the nature or extent of a disease
Periopaerative
the total surgical episode
What is the first interaction a patient has with a surgical team?
the perioperative admission assessment done by the perianesthesia nurse
What happens in the perioperative admission assessment
physical assessment
admission data collection
consent form review
pre anaesthesia evaluation
patients weight/airway history
laboratory and diagnostic tests
What information should the perianesthia nurse provide patients during the perioperative admission assessment?
policy for taking medications routinely
which medications/vitamins to stop prior to surgery/when to stop them
NPO instructions
pain management options
infection prevention and wound care
instructions for postoperative exercises
postoperative discharge and care
What must all patients have done by the physician
a physical assessment completed and documented
Day of surgery assessment the nurse does a focused assessment that includes:
review of existing information
reinforced teaching
review of discharge plans
-ectomy
exicision/removal
-oscopy
looking into
-ostomy
creating an opening into
-otomy
cutting into
-plasty
repair/reconstruction
Appendectomy
to remove appendix
GENERAL SURGERY
Gastroscopy
examining the upper digestive tract
GENERAL SURGERY
Colostomy
creating a stoma
GENERAL SURGERY
Tracheotomy
creating an opening in the trachea
GENERAL SURGERY
Mammoplasty
surgery to reduce breast size
GENERAL SURGERY
Disectomy
surgery to remove the damaged park of a disk in the spine
ORTHOPEDIC SURGERY
Knee arthroplasty
to resurface a knee damaged by arthritis
ORTHOPEDIC SURGERY
arthrotomy
requires the opening of a joint
ORTHOPEDIC SURGERY
total hip arthroplasty
replaces part of the hip joint with artificial implants
ORTHOPEDIC SURGERY
Nephrectomy
surgical removal of the kidney
UROLOGICAL SURGERY
Cytoscopy
looking inside the bladder
UROLOGICAL SURGERY
Ureterostomy
creates a new path for urine to leave the body out the abdominal wall
UROLOGICAL SURGERY
Cystotomy
surgical incision into the gallbladder or urinary bladder
UROLOGICAL SURGERY
Ureteroplasty
fixing the narrowing of the ureters
UROLOGICAL SURGERY
Common fears patients have regarding surgery
fear of death
fear of pain
fear of medication/body alteration
fear of anesthesia
fear of life disruption
What should be asked regarding health history of a patient
understanding of reason for surgery
previous surgeries, times, reactions
women’s obstetric and menstrual history
family health hx
What conditions in a families history may predispose a patient to having similar reactions?
cardiac and endocrine disease
HTN
sudden cardiac death
MI
CAD
DM
Malignant Hyperthermia
Rare metabolic disease triggered by specific anesthesia that results in hyperthermia, skeletal muscle rigidity and possible death (a genetic predisposition)
What is important to note with ASA?
Stop 2 weeks before surgery
What information needs to be collected regarding medications during the perioperative admission assessment?
current medications (including OTC and herbal)
drug/substance use (tobacco, alcohol, opioids, weed, cocaine, amphetamines)
When should smoking be stopped in preparation for surgery?
6 weeks
What is important to note with cannabis use?
recent cannabis use has been shown to need increased doses of postoperative analgesia
What may increase a patients risk to latex allergy?
history of contact dermatitis and atopic immunological reactions
allergies to nuts, bananas, avocados, kiwi, chestnuts, papayas, pitted fruits
frequent exposure (HCP)
What risks are people with diabetes subject to when it comes to surgery?
hypoglycemia
hyperglycaemia
ketosis
cardiovascular alterations
delayed wound healing
infection
what risks are people with thyroid dysfunction subject to when it comes to surgery?
hyperthyroidism
hypothyroidism
Neurological patient assessment
orientation to time, place and person
identify presence of confusion, disorderly thinking, inability to follow commands
history of strokes, TIAs or disease of the CNS
history of headaches/issues with vision/hearing
Cardiovascular patient assessment
acute or chronic conditions (presence of angina, HTN, HF, MI)
palpate radial pulse for characteristics
inspect for edema
baseline BP
medication that may affect blood clotting
lab and diagnostic test review for cardio function
Respiratory System patient assessment
acute or chronic conditions
history of smoking
baseline resp rate/rhythm, pattern, O2
cough, dyspnea, accessory muscles cyanosis
Urinary system assessment
ability to void
renal function lab tests
Hepatic system assessment
history of substance misuse
liver lab tests
Endocrine system assessment
pre existing complications with bleeding or endocrine disorders
Integumentary system assessment
mucous membranes, skin starts
rashes boils, ulcers
skin moisture/temperature
skin turgor
wound healing problems
Musculoskeletal assessment
pressure point
limitations in joint pain, range of motion an muscle weakness
mobility, gait, balance
GI system assessment
GI disorders or complications with elimination
food and fluid intake patterns and recent weight loss
weigh patient
dentures or bridges (may be dislodged during intubation)
What is the ASA system
to classify patients to a physical status regarding the administration of anesthesia
When are preoperative laboratory and diagnostic tests completed?
on the basis of patients health history in order to identify risk and decrease the rates of unnecessary testing
what happens if it is a life or limb situation but there is no consent yet?
physician does what is necessary with the known information regarding wishes then obtains consent as soon as possible
who can consent
anyone who has the capacity and maturity to consent (Quebec is the exception where they must be 14 or older)
Benzodiazepines
reduce anxiety used for sedative and amnesic properties
Anticholinergics
reduce respiratory and oral secretions
Opioids
given to decrease intro operative anesthesia requirements and to decrease pain
Antacids
decrease gastric volume and increase gastric pH
when should oral medications be given?
60-90 minutes before
When should subcut injections be given
30-60 minutes before
when should IV medications be given
in the preoperative holding area or the OR
How does the anesthesiologist determine what anaesthetic technique will be used?
Based on:
- physical and mental status
- age
- family history
- allergies
- pain
- length of surgery
- operative procedure
- discharge plans
how is anaesthesia classified?
based on the effect it has on the patients CNS and pain perception
General anesthesia
altered physiological state characterized by reversible loss of consciousness, skeletal muscle relaxation, amnesia and analgesia
Local anesthesia
the loss of sensation without the loss of consciousness and can be induced topically vis intracutaenous or subcutaneous infiltration
Regional anesthesia
causes the reversible loss of sensation to a region of the body by blocking nerve fibres with the administration of an anesthetic
moderate sedation
mild depression of consciousness that is from IV sedatives, analgesias or both (can still maintain airway control)
When is general anesthesia indicated?
when it is lengthy surgical procedure that requires the patient to be in uncomfortable positions for the duration, when a patient has anxiety, those who refuse or contraindications to local or regional anesthetic
What reverses benzodiazepine induced respiratory depression?
flumazenil (benzodiazepine antagonist)
Administration routes for local anesthesia
topical
local
regional
IV regional block
spinal anesthesia
epidural anesthesia
What anesthetic commonly is the cause of malignant hyperthermia
succinylcholine
What are the types of opioids used during general anesthesia?
fentanyl
Morphine sulphate
sufentanil
alfentanil
Opioids use during surgery
induce ad maintain anesthesia, reduce stimuli from sensory nerve endings, provide analgesia during surgery
Types of benzodiazepines used during general anesthesia
midazolam
diazepam
lorazepam
Benzodiazepines use during surgery
induce and maintain anesthesia
What does signed consent require to complete the process?
a secondary witness signature, a nurse can do this
Signs of blood loss
increased HR
hypotension
Anaphylaxis S&S?
hypotension, tachycardia, bronchospasm, pulmonary edema
What is an advanced directive
a capable written instruction that gives or refuses consent to health care in the event the adult later becomes incapable of giving the instruction at the time the health care is required
When should a patient be intubated?
Less than 8 intubate or RR <4
Every post operative patient is at risk for:
Infection
Post op pneumonia
DVT
Normothermia
decreased ability to amount a fever response
What is the treatment for malignant hyperthermia?
dantrolene (slows metabolism, reduces muscle contraction, and mediates the catabolic processes associated with MH)
