health and illness

cut or remove

for diagnosis, treatment, or cure

to go into the body, all surgeries are invasive

opening

repair

incision

repair

diagnostic/exploratory, ablative, constructive, reconstructive, palliative, transplant, aesthetic, preventative

confirming, ex: breast surgery

removal with lasers, ex: burning layers

buliding, ex: burned pt. reconstruct part

building, ex: repairing damage, not from scratch

rebuilding, ex: make your pt. comfortable, not curing them

to replace or restore function

repair; to make it look better

to prevent problems

• minor- very minimal
• major- high risk
• emergency- life or death

preoperative, intraoperative, postoperative

begins with the decision to have surgery and ends when pt. enters OR

48 hours

• o
• May need to have labs(1 week before), ekg, chest
• x-ray, pregnancy test,CBC, PT, artial blood gasses, type and cross match, creatine,
• fasting blood sugar, oxygen staturation,
• percentage of oxygen, advanced
• directives- do they want to be resuscitated , teaching, baseline, interventions, and nursing process

• ·
• begins when you enter the OR and ends when you enter
• recovery room

begins in recovery room, ends when you are completely recovered, can end when at hospital after surgery or when discharged

call Dr.

pt. and family, before surgery

infection, bleeding, cardiac problems, respiratory, renal problems

assess: temperature changes-hyperthermic/hypo, decreased O2, bleeding, output, airway

• ·
• pain management, respiratory function,
• ambulation, bowel sounds, confusion, skin,

pulmonary problem aftersurgery

hanging off side of bed right after surgery

• being Well hydrated, well nourished, more protein, vitamin
• C, being the ideal weight

infection, pulmonary and cardiac complications

cover with sterile dressing, and let doctor know

increase risk for shock, hypotension, thrombophlebitis, stroke,

• monitor vital signs, pulse, rate and rhythm, apical pulse, general conditions, any thing slightly wrong before surgery should be told to physician
• After surgery- skin color, chest pain, lung congestion, and peripheral edema (shows that pt. has CHF) , get them up and moving, do range of motion, deep breathing every 2 hours

• higher risk for respiratory issue, pneumonia, atolacksis(collapse
• of aveoli), bronchitis

• Do not smoke for 24 hours before, 3-4 weeks with
• chronic lung disease before a surgery·
• Monitor for respiratory complication, deep
• breath and cough, spirometery, etc.

underweight, liver issue, may need more anesthetic, risk for hemorrhaging, and wound healing

look for delirium tremors, monitor diet, assess for bleeding

must be cleared for surgery, risk for cardio complications, delayed wound healing/infection, pt. with diabetes type I have high risk for diabetic ketoacidosis (DKA), or hypoglycemia, may get dextrose 5% depending on fluids

anesthetics

subjective and objective data, medication history nursing diagnosis, goals, ask if they had any complications, assess emotional attitudes, reaction to surgery, demographic information (work and live), reason for surgery, important to know when they had last period, any hospitalizations, alcohol and smoking, family history, how they cope

• Observe pt. vitals signs, etc., claim or anxious, baseline assessment, subjective- ask about dentures or crowns, lose
• teeth, remove dentures before surgery, jaw or neck problems, medication history- for interactions with meds , doctor will write how to take meds before surgery, anticoagulant stopped/looked at, FBS on DB pt., steroids can not be stopped suddenly will get iv med, beta blockers block electrical pulses in heart cant stop suddenly either, recreational drugs- affects anesthesia, preoperative teaching

altered body image, anxiety, fear, knowledge deficit

doctor provides information on consent form, they talk about risk for surgery, and success of procedure, alternate procedures, pt has the right to refuse surgery, witnessed to signature only when signing consent

• ID band, hospital gown, remove jewelry, labs,
• vitals, H&P, signed consents, hearing aids/ glasses(write order if needed during surgery), contacts, orders, tin hoses, void before surgery

give meds when you get the call to give it

surgery, past history, age, client preference

transfer aid takes them to surgery

• OR team , nurse, assistant, wear head covers and
• shoe covers, masks on everybody, sterile equipment on at pt. tables, control temp. in room cold to keep bacteria down

• Holding area the nurse double checks
• everything

start 10-20 mins or 24 hours later after meds start, all OR have hyperthermia kits,muscle disease can trigger it, epinephrine, atropine, digitalisis,theopolein, alters calcium functions in body, s/s- increase metabolism, muscles rigid, tachycardia, tacypnea, HBP, cardiac disrrythmias, hyperkalima, metalbolic and respiratory acidosis,

skeletal muscle relaxant, reverses muscle rigidness; metabolic acidosis- sodium bicarbonate treatment, for mal. hyperthermia

grab crash cart, give 100% O2, cooling blanket, stop surgery, cold IV fluid, start meds immediately

15 min.

intravascular, not enough volume, effect cardiac, biggest cause is hemorrhaging, N/V, diarrhea, burns, diuaresis, lose 10% to show signs of shock, lab will not change until they lost the 10%; hypotension is a late symptom and shows when they last 30% of fluids, find cause and treat underline cause, give O2 in acute phase, look for acidosis, O2 sat. should be over 95%, panic at 89%, IV with large bore needle, replace blood loss, report any changes immediately

• heart is failing, the left side is failing, reduce blood flow, B/P will falls below 90, fast pulse, temp falls, urine output, normal output is 30ml per hour, and it dereases, confused, tx: implament order, pain meds, 100% O2 by face mask,
• morphine common pain meds, slows breathing down
• , meds digoxin to increase contractions of heart

excessive dilation of blood vessels- anaphylactic, septic, neurogenic;

hyper sensitivity of allergic reaction, swollen, temp. goes up, emergency, a lot of causes, large amount of histamine released affects airway, mast cells , itching, rashes, and hives, strider breathing sound, give epinephrine, B/P goes up, steroids given, give )2

• bacteria infection, most common gram negative or strep, damage of cell, vasodilatation, flush and warm, drop in blood pressure, restless, tachycardia, thirst, temp is
• high, increased WBC, C&S lab culture, Tx: increase circulating volume, antibiotic, O2, ICU or ventilator

• Neurogenic shock- alteration in vascular smooth
• muscle cells, loss of sympathetic nervous sytem , spinal, brain and injury, from drugs or injury, decrease cardiac output, work with them quickly, B/p drops fast

airway, assess pt. , get help don’t leave pt., maintain blood flow to the brain, LOC, “glasscocoma scale”, pt. NPO initially, elevate legs except if in congestive heart failure, bleeding from head, or spinal injury, keep pt. flat, cover with blanket

epinephrine constricts blood vessels and relaxes smooth muscle

• Surface or topical, local, nerve block, epidural block, spinal
• anesthesia, conscious sedation(Regital), lidocaine with epiphernie causes heart
• to race some

admission, assessment, airway, LOC, bleeding, V/S, pain management, O2, monitor for complications, car planning starts right away

• shock, hemorrhage(circle it), DVT(blood clot),
• pulmonary Embolus, pneumonia, atelectasis, urinary retention,
• bowel sounds, elimination

Wound complications- hematoma, infection, dehiscence, evisceration-“guts” come out, place pt. in low flowers position, moist sterile dressing, get them back in surgery,watch for shock (drop in B/P). poor wound healing uses wound vac.

organs failing, have inadequate tissue perfusion, life threating

Drop in b/p decreased heart rate classic signs

• body takes over, tries to maintain, blood volume
• starts to falls, picked up by the aortic and carotid barrier receptors, sympathetic system shoots every thing up,
• stimulate release of adrenaline, heart rate goes up, Vasoconstriction to help give blood to the brain and heart; brain can died in 4-6 min., kidney is extremely sensitive, urine output decreased, watch output,

S/S-irritable, restless, orthostatic hypotension,pulse bounding over a 100,respiration over 20 , cool pale skin, elevation blood glucose, respiratory alkliosis- to much sodium bicarbonate

when compensatory stage starts to fail it starts, sodium collects inside the cells,potassium is leaking outside anaerobic metabolism is forming getting respiratory acidosis, getting vasoconstriction and blood gets trapped in capillaries, and increases hyperstatic pressure, fluid leakage into surrounding tissue, blood gets thicker, concentrated, moves very slowly

S/S- no energy, confused, B/P falls, weak thread pulse, body temp drops, skin cold clammy pale,thristy, dry mouth, muscles weak

• vital organs fail, pt. will die, cant reverse
• the shock

S/S-unconscious, B/P continue to drop, diastolic will drop almost to 0, slow irregular pulse, scant urine output, cyanotic , cold

includes outpatient, same-day, or short-stay surgery that does not require an overnight hospital stay

period of time that begins with transfer of the patient to the operating room table and continues until the patient is admitted to the post anesthesia care unit

• period of time that constitutes the surgical
• experience; includes the preoperative, intraoper-ative, and postoperative
• phases of nursing care

period of time that begins with theadmission of the patient to the postanesthesia care unitand ends after follow-up evaluation in the clinical settingor home

period of time from when thedecision for surgical intervention is made to when thepatient is transferred to the operating room table

may be diagnostic (eg, biopsy, exploratory laparo-tomy), curative (eg, excision of a tumor or an inflamed ap-pendix), or reparative (eg, multiple wound repair), may be reconstructive or cosmetic (eg, mammoplasty or a facelift) or palliative (eg, to relieve pain or correct a problem—for in-stance, a gastrostomy tube may be inserted to compensate for the inability to swallow food). Surgery may also be classified according to the degree of urgency involved: emergent, ur-gent, required, elective, and optional.

Patient requires immediate attention; disorder may be life-threateningII. Without delay; Severe bleedingBladder or intestinal obstructionFractured skullGunshot or stab wounds Extensive burns

Patient requires prompt attention Within 24–30 hours; Acute gallbladder infection Kidney or ureteral stones

• Patient needs to have surgery Plan within a few weeks or months; Prostatic hyperplasia without bladder obstruction
• Thyroid disorders Cataracts

Patient should have surgery Failure to have surgery not catastrophic; Repair of scarsSimple herniaVaginal repair

Decision rests with patient Personal preference; Cosmetic surgery

including the following: Malignant hyperthermia, Central core disease (CCD), Duchenne muscular dystrophy, Hyperkalemic periodic paralysis, King-Denborough syndrome

• Obtain a thorough assessment of personal and family history, inquiringabout prior problems with surgery or anesthesia with specific attention to complications such as fever, rigidity, dark urine, and unexpected reactions. •Inquire about any history of musculoskeletal complaints, history of heat
• intolerance, fevers of unknown origin, or unusual drug reaction.•Assess for family history of any sudden or unexplained death, especially during participation in athletic events.

• •Assess for subclinical muscle weakness.
• •Assess for other physical features suggestive of an under-lying genetic condition, such as contractures, kyphoscoliosis, and pterygium with progressive weakness. Management Issues Specific to Genetics
• •Inquire whether DNA mutation or other genetic testing has been performed on an affected family member.
• •If indicated, refer for further genetic counseling and evaluation so that family members can discuss inheritance, risk to other family members, availability of diagnostic/genetic testing.
• •Offer appropriate genetics information and resources.
• •Assess patient’s understanding of genetics information.
• •Provide support to families with newly diagnosed malignant hyperthermia.
• •Participate in management and coordination of care of patients with genetic conditions and individuals predisposed to develop or pass on a genetic condition.

To allow collagen deposition and wound healing to occur; Collagen deposition leading to impaired/delayed wound healing Decreased skin and wound strength Increased wound infection rates

To provide necessary substrate for collagen synthesis and nitric oxide (crucial for woundhealing) at wound siteTo increase wound strength and collagen depositionTo stimulate T-cell responseAssociated with a variety of essential reactions of intermediary metabolism; Impaired wound healing

• Primary source of energy in the body and consequently in the wound healing process To meet the demand for increased essential fatty acids needed for cellular function after an injury To spare protein To restore normal weight;
• Signs and symptoms of protein deficiency due to use of protein to meet energy requirements Extensive weight loss

• To replace fluid lost through vomiting, hemorrhage, exudates, fever, drainage, dieresis To maintain homeostasis; Signs, symptoms, and complications of dehydration, such as poor skin turgor, dry mucous membranes, oliguria, anuria,
• weight loss, increased pulse rate, decreased central venous pressure

Important for capillary formation, tissue synthesis, and wound healing through collagen formation Needed for antibody formation; Impaired/delayed wound healing related to impaired collagen formation and increased capillary fragility and permeability Increased risk for infection related to decreased antibodies

• Indirect role in wound healing through their influence on host
• resistance; Decreased enzymes available for energy metabolism

Increases inflammatory response in wounds, reduces anti-inflammatory effects of corticosteroids on wound healing; Impaired/delayed wound healing related to decreased collagen synthesis; impaired immune function Increased risk for infection

Important for normal blood clotting Impaired intestinal synthesis associated with the use of antibiotics; Prolonged prothrombin time Hematomas contributing to impaired healing and predisposition to wound infections

Essential cofactor for many enzymes that are involved in the process of protein synthesis and wound repair; Impaired/delayed wound healing (impaired collagen production)

Required cofactor in the development of connective tissue; Impaired wound healing

Involved in DNA synthesis, protein synthesis, cellular proliferation needed for wound healing Essential to immune function; Impaired immune response

biotransformation of anes-thetic compounds.

• excreting anesthetic med-ications and their metabolites; therefore, surgery is con-traindicated if a patient has acute
• nephritis, acute renal in-sufficiency with oliguria or anuria, or other acute renalproblems . Exceptions include surgeriesperformed as lifesaving measures or those necessary to im-prove urinary function (ie, obstructive uropathy).

develop during anesthesia or postoperatively from in-adequate carbohydrates or excessive administration of in-sulin. Hyperglycemia, which can increase the risk for surgi-cal wound infection, may result from the stress of surgery,which can trigger increased levels of catecholamine.

Prednisone (Deltasone) Cardiovascular collapse can occur if discontinued suddenly. Therefore, a bolus of corticosteroid may be administered intravenously immediately before and after surgery.

Hydrochlorothiazide (HydroDIURIL) During anesthesia, may cause excessive respiratory depression resulting from an associated electrolyte imbalance

Chlorpromazine (Thorazine) May increase the hypotensive action of anesthetics

Diazepam (Valium) May cause anxiety, tension, and even seizures if withdrawn suddenly

Interaction between anesthetics and insulin must be considered when a patient with diabetes is undergoing surgery. Intravenous insulin may need to be administered to keep the blood glucose within the normal range.

Erythromycin (Ery-Tab) When combined with a curariform muscle relaxant, nerve transmission is interrupted and apneafrom respiratory paralysis may result.

Warfarin (Coumadin) Can increase the risk of bleeding during the intraoperative and postoperative periods; should bediscontinued in anticipation of elective surgery. The surgeon will determine how long before theelective surgery the patient should stop taking an anticoagulant, depending on the type ofplanned procedure and the medical condition of the patient.

Intravenous administration of medication may be needed to keep the patient seizure-free in theintraoperative and postoperative periods.

Levothyroxine sodium (Levothroid) Intravenous administration may be needed during the postoperative period to maintain thyroid levels.

Long-term use of opioids for chronic pain (6 mo or greater) in the preoperative period may alter the patient’s response to analgesic agents.

The patient is transferred to the holding area or presurgical suite in a bed or on a stretcher about 30 to 60 minutes be-fore the anesthetic is to be given.

a rare life-threatening conditiontriggered by exposure to most anesthetic agents induc-ing a drastic and uncontrolled increase in skeletal muscle oxidative metabolism that can overwhelm the body’scapacity to supply oxygen, remove carbon dioxide, andregulate body temperature, eventually leading to circula-tory collapse and death if untreated. Malignanthyperthermia is often inherited as an autosomaldominant disorder

previously referred to as conscioussedation, involves use of sedation to depress the levelof consciousness without altering the patient’s ability tomaintain a patent airway and to respond to physicalstimuli and verbal commands

• moderate sedation adminis-tered by an anesthesiologist or
• anesthetist

• an anesthetic agent is injected aroundnerves so that the area
• supplied by these nerves is anes-thetized

area in the operating room where scrubattire and surgical masks are required; includes operat-ing room and sterile core areas

registered nurse, licensed practical nurse, orsurgical technologist who scrubs and dons sterile surgi-cal attire, prepares instruments and supplies, and handsinstruments to the surgeon during the procedure

area in the operating room wherescrub attire is required; may include areas where surgi-cal instruments are processed

• achieved when a local anesthetic agentis introduced into the
• subarachnoid space of the spinalcord

absence of microorganisms in the surgi-cal environment to reduce the risk for infection

area in the operating room thatinterfaces with other departments; includes patient re-ception area and holding area

a state of narcosis, analgesia, relaxation, andloss of reflexes

physician trained to deliver anesthesiaand to monitor the patient’s condition during surgery

the substance, such as a chemical orgas, used to induce anesthesia

health care professional, such as a nurseanesthetist, who is trained to deliver anesthesia and tomonitor the patient’s condition during surgery

• registered nurse who co-ordinates and documents patient
• care in the operatingroom

• state of narcosis, analgesia, relaxation,and loss of reflexes
• achieved by injecting an anestheticagent into the epidural space of the spinal cord

• state of narcosis, analgesia,relaxation, and loss of reflexes
• produced by pharmaco-logic agents

• injection of a solution containing theanesthetic agent into the
• tissues at the planned incisionsite

• standard OR ventilation pro-vides 15 air exchanges per hour, at least three of which are fresh air (Phillips, 2007). A room temperature of 20C to24C (68F to 73F),
• humidity between 30% and 60%, and positive pressure relative to adjacent areas are maintained. Staff members shed skin scales, resulting in about 1000bacteria-carrying particles (or colony-forming units[CFUs]) per cubic foot
• per minute. With the standard air exchanges, air counts of bacteria are reduced to 50 to 150CFUs per cubic foot per minute. Systems with high-efficiency particulate air (HEPA) filters are needed to remove particles larger than 0.3 µm

As the patient breathes in the anesthetic mixture, warmth, dizziness, and a feeling of detachment may be experienced. The patient may have a ringing, roaring, or buzzing in the ears and, although still conscious, may sense an inability to move the extremities easily. During this stage, noises are exaggerated; even low voices or minor sounds seem loud and unreal. For this reason, unnecessary noises and motions are avoided when anesthesia begins.

• characterized variously by struggling, shouting, talking, singing, laughing, or crying, is often avoided if the anesthetic agent is administered smoothly and quickly. The pupils dilate, but they contract if exposed to light; the pulse rate is rapid, and respirations may be irregular. Because of the possibility of uncontrolled movements of the patient during this stage, the anesthesiologist or anesthetist must always be
• assisted by someone ready to help restrain the patient. Manipulation increases circulation to the operative site and thereby increases the potential for bleeding

• reached by continued administration of the anesthetic vapor or gas. The patient is unconscious and lies quietly on the table. The pupils are small but contract when exposed to
• light. Respirations are regular, the pulse rate and volume are normal, and the skin is pink or slightly flushed. With proper administration of the anesthetic agent, this stage may be aintained for hours in one of several planes, ranging from light (1) to deep (4), de-pending on the depth of anesthesia needed.

• This stage is reached if too much anesthesia has been
• administered. Respirations become shallow, the pulse is weak and thready, and the pupils become widely dilated and no longer contract when exposed to light. Cyanosis develops and, without prompt intervention, death rapidly follows. If
• this stage develops, the anesthetic agent is discontinued mmediately and respiratory and circulatory sup-port is nitiated to prevent death. Stimulants, although rarely used, may be administered; narcotic antagonists can be used if the over dosage is due to opioids.

Glu-cose metabolism is reduced, and, as a result, metabolic aci-dosis may develop. This condition is called hypothermiaand is indicated by a core body temperature that is lower than normal

• is a rare inherited muscle dis-order that is chemically induced by anesthetic agents(Rothrock, 2007). MH can be triggered by myopathies, emo-tional stress, heatstroke, neuroleptic malignant syndrome,strenuous exercise exertion, and
• trauma. Susceptible people include those with strongand bulky muscles, a history of muscle cramps or muscle weak-ness and unexplained temperature elevation, and an unex-plained death of a family member during surgery that was ac-companied by a febrile response

hypermetabolism,which in turn increases muscle contraction (rigidity) andcauses hyperthermia and subsequent damage to the centralnervous system.

Anxiety related to surgical or environmental concerns•Risk of latex allergy response due to possible exposureto latex in OR environment

partial or complete separation of wound edges

protrusion of organs through the surgical incision

method of healing in which woundedges are surgically approximated and integumentarycontinuity is restored without granulation

area designated for care of surgical patientsimmediately after surgery and for patients whose condi-tion warrants close monitoring

area designated for care of surgicalpatients who have been transferred from a phase IPACU because their condition no longer requires theclose monitoring provided in a phase I PACU

• setting in which the patient is cared for inthe immediate
• postoperative period and then preparedfor discharge from the facility

• area where postopera-tive patients are monitored as they
• recover from anes-thesia; formerly referred to as the recovery room orpostanesthesia recovery room

method of healing in whichwound edges are not surgically approximated andintegumentary continuity is restored by the processknown as granulation

method of healing in which surgi-cal approximation of wound edges is delayed andintegumentary continuity is restored by apposing areasof granulation

• phase I PACU,used during the immediaterecovery phase, intensive nursing care is provided.
• In thephase II PACU,the patient is prepared for self-care orcare in the hospital or an extended care setting.
• In phaseIII PACU,the patient is prepared for discharge.

• Based on the assessment data, major nursing diagnoses mayinclude the following:
• •Risk for ineffective airway clearance related to de-pressed
• respiratory function, pain, and bed rest
• •Acute pain related to surgical incision
• •Decreased cardiac output related to shock or hemorrhage •Risk for activity intolerance related to generalizedweakness secondary to surgery
• •Impaired skin integrity related to surgical incision
• and drains
• •Ineffective thermoregulation related to surgical envi-ronment and anesthetic agents
• •Risk for imbalanced nutrition, less than body require-ments related to decreased intake and increased needfor nutrients secondary to surgery
• •Risk for constipation related to effects of medications,surgery, dietary change, and immobility
• •Risk for urinary retention related to anesthetic agents
• •Risk for injury related to surgical procedure/positioningor anesthetic agents
• •Anxiety related to surgical procedure•Risk for ineffective management of therapeutic regi-men related to wound care, dietary restrictions, activ-ity recommendations, medications, follow-up care, orsigns and symptoms of complications
• Collaborative Problems or Potential Complications Based
• on the assessment data, potential complications mayinclude the following:
• •Pulmonary infection/hypoxia
• •Deep vein thrombosis (DVT)
• •Hematoma or hemorrhage
• •Infection
• •Pulmonary embolism
• •Wound dehiscence or evisceration

circulatory shock state resulting froma severe allergic reaction producing an overwhelmingsystemic vasodilation and relative hypovolemia

messenger substances that maybe released by a cell to create an action at that site orbe carried by the bloodstream to a distant site beforebeing activated; also called cytokines

shock state resulting from impairmentor failure of the myocardium

shock state resulting fromdisplacement of blood volume creating a relative hypov-olemia and inadequate delivery of oxygen to the cells;also called distributive shock

intravenous solutions that contain molecules thatare too large to pass through capillary membranes

intravenous electrolyte solutions that movefreely between the intravascular compartment and interstitial spaces

shock state resulting from decreasedintravascular volume due to fluid loss

presence ofaltered function of two or more organs in an acutely illpatient such that interventions are necessary to supportcontinued organ function

shock state resulting from loss of sym-pathetic tone causing relative hypovolemia

circulatory shock state resulting fromoverwhelming infection causing relative hypovolemia

physiologic state in which there is inadequate blood flow to tissues and cells of the body

overwhelming inflammatory response in the absence of infectioncausing relative hypovolemia and decreased tissue perfusion

• •Support of the respiratory system with supplementaloxygen and/or mechanical ventilation to provide optimal oxygenation •Fluid replacement to restore intravascular volume •Vasoactive medications to restore vasomotor tone and improve cardiac function
• •Nutritional support to address the metabolic requirements that are often dramatically increased in shock

When vasoactive medications are administered, vitalsigns must be monitored frequently (at least every 15 minutes until stable, or more often if indicated). Vasoactive medications should be administered through a central venous line, because infiltration and extravasation of some asoactive medications can cause tissue necrosis and sloughing. An IV pump or controller should be used to ensure that the medications are delivered safely and accurately

• is initiated to assess the patient’sresponse to treatment. In many
• institutions, this is per-formed in the intensive care unit (ICU), where an arterialline can be inserted.

dobutamine, nitroglycerin, and dopamine.

produces in otropic effects by stimulating myocardial beta-receptors, increasing the strength of myocardial activity and improving cardiac out-put.

IV nitroglycerin in low doses acts as a venousvasodilator and therefore reduces preload. At higher doses,nitroglycerin causes arterial vasodilation and therefore re-duces afterload as well.

is a sympathomimetic agent that hasvarying vasoactive effects depending on the dosage. It may be used with dobutamine and nitroglycerin to improve tissue perfusion.

norepinephrine, epinephrine, milrinone, vasopressin, and phenylephrine.

• Drotrecogin alfa(Xigris)- acts as an antithrombotic, anti-inflammatory, andprofibrinolytic agent.
• Drotrecogin alfa- acts as an anti-inflammatory cytokine, it stimulates
• fibrinolysis- restoring bal-ance in the coagulation–anticoagulation homeostatic processof the body’s inflammatory response to injury and infection.
• Drotrecogin alfa- has provided a significant breakthroughin the successful pharmacologic treatment of patients with sepsis.

It is important to elevate and maintain the head of the bed at least 30 degrees to prevent neurogenic shock when a patient receives spinal or epidural anesthesia.

halothane, enflurane