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How do anti coagulants affect anesthesia
they can can cause hemorrhage
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how do antidepressants affect anesthesia namely MAOI's
They can increase hypotensive effects of anesthesia
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How do anti hypertensives effect anesthesia
they increase hypotensive effects of anesthesia
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how do antibiotics effect anesthesia
may cause apnea and respiratory paralysis
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How do diuretics effect anesthesia
may lead to fluid and electrolyte imbalances producing altered cardiovascular response and respiratory depression
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How do herbal supplements affect anesthesia
may prolong effects of anesthesia, may increase bleeding or raise blood pressure
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how do immunosuppressants affect anesthesia
may increase risk of infection and hypothermia
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what test is done to determine clotting ability of blood prior to emergent surgery
PTT, PT, INR
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how soon should clot affecting drugs and herbals be stopped before surgery
2 weeks
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what drugs can be used to help prevent DVT's
low dose heparin or warfarin. Aspirin is NOT considered adequate protection
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Which patients should you not use inhalation agents for general anesthesia with
Patients with a history of malignant hyperthermia
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What is succinylcholine
A neuro musclular blocking drug
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characteristics of conscious sedation
patient can maintain open airway, use of opiods and sedatives, patient can respond to verbal and physical stimulants. RN must be on hand to administer reversal agent if necessary. Narcan
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Circulating nurse duties
assist with transferring, counts all sponges and instruments, prepares patients skin, ensures no break in aseptic technique occurs and plays DJ
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Scrub nurse
handles sutures, instruments, and other equipment
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Dorsal recumbent position (laying flat on back)
abdominal surgeries as well as thoracic surgeries such as open heart
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Semi sitting position (neck hyper extended)
thyroid and neck areas (can lead to venous pooling in legs)
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Prone position (stomach with buttocks propped up)
for spinal infusions and removal of hemorrhoids
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Lateral chest position (side lying with pillows between legs)
for some thoracic surgeries and hip replacements
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lithotomy position (flat on back with legs up in sling)
For gynecological procedures, perineal or rectal surgeries
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Jackknife position (prone with bends at hips and knees)
for removal of hemorrhoids and some spinal surgeries
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Trendelenberg (flat on back with head of bed slightly tilted downward)
- used for most surgeries (pros- good for emergency hypotension and cardiac return)
- (cons- puts pressure on diaphram and restricts ventilation)
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hearing aids
leave in place if patient cannot hear with out it and notify operating room nurse
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when does intraoperative phase begin
when patient enters operating room (75 Lemone) and end when patient is transferred to PACU
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what should post op out put be
30 ml an hour average with foley
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how often should nurse asses patient after surgery
every 15 mins for first hour and if patient is stable every 30 mins for next 2 hours then q4
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what causes shock
insufficient blood flow to vital organs
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Healing by primary intention
Clean incision, clean well approximated suture edges, minimal tissue loss,
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Secondary intention healing
large, gaping irregular wound (perhaps with blood clot) Tissue loss prevents would from approximating therefore granulation tissue fills wound, takes longer to heal and more prone to scar
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Healing by tertiary intention
Infection more likely to occur, edges are not approximated, tissue is regenerated by granulation process, and large amount of scar tissue forms
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What is protrusion of organ from a wound
Evisceration
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What is disruption of suture of a wound (split open)
Dehiscence
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Elective surgery
is by choice (can improve quality of life)
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Urgent surgery
needs to be done asap within 1-2 days (remember heart bypass surgery is urgent not emergent)
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emergent surgery
needs to be done now Bowel obstruction, tubal pregnancy life threatening
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Antidote to blood thinner is
protamine sulfate
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Antihypertensives and beta blockers may cause what condition when mixed with anesthesia
stroke
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What meds are allowed on morning of surgery
Blood pressure medications
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what can bradycardia and hypotension cause
can cause impaired circulation which can cause DVT and PE
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What are infants and elderly predisposed to
dehydration and hypothermia due to less sub-Q fat
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what can hypothermia associated with bleeding from surgical site lead to post surgical
increased cardiac ischemia which could lead to cardiac morbity
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what is atelectasis
lung collaspe
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what is rhinospasm
airway collapse during intubation
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pre op teaching is best when
a week before surgery
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what can cause hypovolemic shock
metabolic alkalosis
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what procedures do you need informed consent for
surgery, receiving blood, chemo therapy, anesthesia, invasive procedures and for PICC line
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when are antibiotics given before surgery
30 mins to an hour before in surgery holding area (preoperative)
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Skin markers are done by
surgeon in preoperative phase
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what do we shave with
clippers not blades
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who calls timeout
usually circulating nurse but any one can call it
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What do adjunct drugs do
assist with general anesthesia, such as NMBD (paralyzers), opiod analgesics, sedative hypnotics, and anticholenergics
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what is malignant hyperthermia
occurs during or after general anesthesia, temp spikes to 104 or higher, elevated CO2, condition is genetic, tachycardia, tachpnea and muscle rigidity are also signs. Can cause metabolic acidosis. relieved by DANTROLENE and cold IV fluids and ice
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type of general anesthetics
propofol
- (gases)
- isoflurane
- sevoflurane
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what reverses NMBD
anticholinergics
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what keeps stomach contents from coming up
chrochoid pressure
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what is aldrete scale
scale to determine if patient is stable enough for transfer out of PACU
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if patient is cold with low blood pressure what to avoid
applying warm blankets to quick, could cause vasodialation and make blood pressure drop lower
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what is convalescence
when patient goes to floor continue to monitor for things from PACU
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what would healing issue is common with diabetics
Dehiscence
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