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NRSG 327 > Week 1: Perioperative > Flashcards

Week 1: Perioperative Flashcards

1
Q

Cardiac Output

A

The amount of blood ejected from the heart in one minute

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2
Q

Stroke volume:

A

the amount of blood pumped by each ventricle with each heartbeat (mL/beat)

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3
Q

What are the 4 determinants of cardiac output?

A
  1. heart rate
  2. preload
  3. afterload
  4. contractility
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4
Q

Preload

A

the amount of blood entering the ventricles during diastole

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5
Q

ways to increase preload

A

IV fluids
stimulating the sns system

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6
Q

ways to decrease preload

A

diuretics
vasodilators

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7
Q

afterload

A

the pressure the ventricles must overcome to open valves and pump blood out go the heart (when the ventricles are contracting during SYSTOLE)

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8
Q

ways to increase afterload

A

vasoconstrictors

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9
Q

Ways to decrease afterload

A

diuretics
vasodilators

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10
Q

contractility

A

how hard the myocardium contracts for a given period

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11
Q

How to calculate CO

A

heart rate x stroke volume = CO

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12
Q

Explain the steps of the RAAS system

A
  1. the body blood pressure drops
  2. the kidneys (juxtaglomerular cells) release renin in response to low BP
  3. The renin stimulates the liver to release angiotensin 1
  4. ACE turns angiotensin 1 into angiotensin 2
  5. 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)
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13
Q

diagnosis

A

to determine the presence or extent of pathological abnormality (eg. lymph node biopsy)

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14
Q

Cure

A

to eliminate or repaire a pathological condition (eg. ruptured appendix)

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15
Q

Palliation

A

to alleviate symptoms without cure

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16
Q

Prevention

A

to reduce the risk of developing a condition

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17
Q

Cosmetic

A

to alter physical appearance

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18
Q

Exploration

A

to determine the nature or extent of a disease

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19
Q

Periopaerative

A

the total surgical episode

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20
Q

What is the first interaction a patient has with a surgical team?

A

the perioperative admission assessment done by the perianesthesia nurse

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21
Q

What happens in the perioperative admission assessment

A

physical assessment
admission data collection
consent form review
pre anaesthesia evaluation
patients weight/airway history
laboratory and diagnostic tests

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22
Q

What information should the perianesthia nurse provide patients during the perioperative admission assessment?

A

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

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23
Q

What must all patients have done by the physician

A

a physical assessment completed and documented

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24
Q

Day of surgery assessment the nurse does a focused assessment that includes:

A

review of existing information
reinforced teaching
review of discharge plans

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25
Q

-ectomy

A

exicision/removal

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26
Q

-oscopy

A

looking into

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27
Q

-ostomy

A

creating an opening into

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28
Q

-otomy

A

cutting into

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29
Q

-plasty

A

repair/reconstruction

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30
Q

Appendectomy

A

to remove appendix

GENERAL SURGERY

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31
Q

Gastroscopy

A

examining the upper digestive tract

GENERAL SURGERY

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32
Q

Colostomy

A

creating a stoma

GENERAL SURGERY

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33
Q

Tracheotomy

A

creating an opening in the trachea

GENERAL SURGERY

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34
Q

Mammoplasty

A

surgery to reduce breast size

GENERAL SURGERY

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35
Q

Disectomy

A

surgery to remove the damaged park of a disk in the spine

ORTHOPEDIC SURGERY

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36
Q

Knee arthroplasty

A

to resurface a knee damaged by arthritis

ORTHOPEDIC SURGERY

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37
Q

arthrotomy

A

requires the opening of a joint

ORTHOPEDIC SURGERY

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38
Q

total hip arthroplasty

A

replaces part of the hip joint with artificial implants

ORTHOPEDIC SURGERY

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39
Q

Nephrectomy

A

surgical removal of the kidney

UROLOGICAL SURGERY

40
Q

Cytoscopy

A

looking inside the bladder

UROLOGICAL SURGERY

41
Q

Ureterostomy

A

creates a new path for urine to leave the body out the abdominal wall

UROLOGICAL SURGERY

42
Q

Cystotomy

A

surgical incision into the gallbladder or urinary bladder

UROLOGICAL SURGERY

43
Q

Ureteroplasty

A

fixing the narrowing of the ureters

UROLOGICAL SURGERY

44
Q

Common fears patients have regarding surgery

A

fear of death
fear of pain
fear of medication/body alteration
fear of anesthesia
fear of life disruption

45
Q

What should be asked regarding health history of a patient

A

understanding of reason for surgery
previous surgeries, times, reactions
women’s obstetric and menstrual history
family health hx

46
Q

What conditions in a families history may predispose a patient to having similar reactions?

A

cardiac and endocrine disease
HTN
sudden cardiac death
MI
CAD
DM

47
Q

Malignant Hyperthermia

A

Rare metabolic disease triggered by specific anesthesia that results in hyperthermia, skeletal muscle rigidity and possible death (a genetic predisposition)

48
Q

What is important to note with ASA?

A

Stop 2 weeks before surgery

49
Q

What information needs to be collected regarding medications during the perioperative admission assessment?

A

current medications (including OTC and herbal)
drug/substance use (tobacco, alcohol, opioids, weed, cocaine, amphetamines)

50
Q

When should smoking be stopped in preparation for surgery?

A

6 weeks

51
Q

What is important to note with cannabis use?

A

recent cannabis use has been shown to need increased doses of postoperative analgesia

52
Q

What may increase a patients risk to latex allergy?

A

history of contact dermatitis and atopic immunological reactions
allergies to nuts, bananas, avocados, kiwi, chestnuts, papayas, pitted fruits
frequent exposure (HCP)

53
Q

What risks are people with diabetes subject to when it comes to surgery?

A

hypoglycemia
hyperglycaemia
ketosis
cardiovascular alterations
delayed wound healing
infection

54
Q

what risks are people with thyroid dysfunction subject to when it comes to surgery?

A

hyperthyroidism
hypothyroidism

55
Q

Neurological patient assessment

A

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

56
Q

Cardiovascular patient assessment

A

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

57
Q

Respiratory System patient assessment

A

acute or chronic conditions
history of smoking
baseline resp rate/rhythm, pattern, O2
cough, dyspnea, accessory muscles cyanosis

58
Q

Urinary system assessment

A

ability to void
renal function lab tests

59
Q

Hepatic system assessment

A

history of substance misuse
liver lab tests

60
Q

Endocrine system assessment

A

pre existing complications with bleeding or endocrine disorders

61
Q

Integumentary system assessment

A

mucous membranes, skin starts
rashes boils, ulcers
skin moisture/temperature
skin turgor
wound healing problems

62
Q

Musculoskeletal assessment

A

pressure point
limitations in joint pain, range of motion an muscle weakness
mobility, gait, balance

63
Q

GI system assessment

A

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)

64
Q

What is the ASA system

A

to classify patients to a physical status regarding the administration of anesthesia

65
Q

When are preoperative laboratory and diagnostic tests completed?

A

on the basis of patients health history in order to identify risk and decrease the rates of unnecessary testing

66
Q

what happens if it is a life or limb situation but there is no consent yet?

A

physician does what is necessary with the known information regarding wishes then obtains consent as soon as possible

67
Q

who can consent

A

anyone who has the capacity and maturity to consent (Quebec is the exception where they must be 14 or older)

68
Q

Benzodiazepines

A

reduce anxiety used for sedative and amnesic properties

69
Q

Anticholinergics

A

reduce respiratory and oral secretions

70
Q

Opioids

A

given to decrease intro operative anesthesia requirements and to decrease pain

71
Q

Antacids

A

decrease gastric volume and increase gastric pH

72
Q

when should oral medications be given?

A

60-90 minutes before

73
Q

When should subcut injections be given

A

30-60 minutes before

74
Q

when should IV medications be given

A

in the preoperative holding area or the OR

75
Q

How does the anesthesiologist determine what anaesthetic technique will be used?

A

Based on:
- physical and mental status
- age
- family history
- allergies
- pain
- length of surgery
- operative procedure
- discharge plans

76
Q

how is anaesthesia classified?

A

based on the effect it has on the patients CNS and pain perception

77
Q

General anesthesia

A

altered physiological state characterized by reversible loss of consciousness, skeletal muscle relaxation, amnesia and analgesia

78
Q

Local anesthesia

A

the loss of sensation without the loss of consciousness and can be induced topically vis intracutaenous or subcutaneous infiltration

79
Q

Regional anesthesia

A

causes the reversible loss of sensation to a region of the body by blocking nerve fibres with the administration of an anesthetic

80
Q

moderate sedation

A

mild depression of consciousness that is from IV sedatives, analgesias or both (can still maintain airway control)

81
Q

When is general anesthesia indicated?

A

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

82
Q

What reverses benzodiazepine induced respiratory depression?

A

flumazenil (benzodiazepine antagonist)

83
Q

Administration routes for local anesthesia

A

topical
local
regional
IV regional block
spinal anesthesia
epidural anesthesia

84
Q

What anesthetic commonly is the cause of malignant hyperthermia

A

succinylcholine

85
Q

What are the types of opioids used during general anesthesia?

A

fentanyl
Morphine sulphate
sufentanil
alfentanil

86
Q

Opioids use during surgery

A

induce ad maintain anesthesia, reduce stimuli from sensory nerve endings, provide analgesia during surgery

87
Q

Types of benzodiazepines used during general anesthesia

A

midazolam
diazepam
lorazepam

88
Q

Benzodiazepines use during surgery

A

induce and maintain anesthesia

89
Q

What does signed consent require to complete the process?

A

a secondary witness signature, a nurse can do this

90
Q

Signs of blood loss

A

increased HR
hypotension

91
Q

Anaphylaxis S&S?

A

hypotension, tachycardia, bronchospasm, pulmonary edema

92
Q

What is an advanced directive

A

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

92
Q

When should a patient be intubated?

A

Less than 8 intubate or RR <4

93
Q

Every post operative patient is at risk for:

A

Infection
Post op pneumonia
DVT

94
Q

Normothermia

A

decreased ability to amount a fever response

95
Q

What is the treatment for malignant hyperthermia?

A

dantrolene (slows metabolism, reduces muscle contraction, and mediates the catabolic processes associated with MH)

NRSG 327 (4 decks)

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