perioperative

starts when the descision for surgery is made and ends when pt goes to OR

when pt is on OR and ends when pt is in PACU

when pt gets to PACU and ends at recovery

removal of disease tissue, organ or extremity

• 24-48 hours
• no delay

• ER
• dr office
• clinic
• out pt

• psycosocial
• health hx
• meds
• allergies
• review of systems

• anxiety
• fears
• hope

• med problems
• hospitilazations and surgeries
• obgyn
• family hx
• family hx of adverse reactions

• routine scripts
• otc drugs
• herbs
• vitamins
• etoh and drugs

• anticoagulants
• dieuretics
• antihtn
• abx

• food
• chemicals
• pollen

• hcp
• multiple surgeries
• rubber industry workers
• hay fever or asthma
• avocado, guava, banana, water chesnut, hazelnut, tomato, potato, peach, grape, apricot

6 weeks before surgery

because many drugs are metabolized and excreted through the kidneys

problems with glucose control, clotting abnormalitites, and adverse response to drugs

chronic musculoskeletal pain and positioning during surgery rather than acute pain of the surgery

the diabetic pt is at risk for the development of hypo/hyperglycemia, cardio alterations, delayed wound healing and infection

• vomiting
• diarrhea
• swallowing

• H&P
• surgeon

• anemia
• immune status
• infection

• pulmonary
• metabolic

bleeding tendincies

liver function

blood available for replacement

• cardiac disease
• electrolyte abnormalitites

• turn cough and deep breath
• IS
• leg, ankle and foot
• turning

• -sitting position
• -inhale nose, exhale pursed lip
• -hold breath 3 seconds then cough
• -cough and deep breath q2hr while awake

-5-10 min

• -press knee against bed and relax
• -10x in 10 min

• -5x in each direction
• -3-4x/day

• -tighten thigh
• -lift leg
• -hold 5-10sec
• -repeat several times
• -NOT FOR ABD OR BACK SURGERY/PROBS

• 2 hr
• 4 hr
• 6 hr
• 6 hr
• 8 hr

• versed
• valium
• ativan

• reduce anxiety
• sedation
• induce amnesia

• morphine
• Demerol
• fentynal

relieve discomfort

• Tagamet
• zantac
• pepcid

• increase gastric ph
• decrease acid secretion

sodium citrate

increase gastric ph

• reglan
• zofran

• decrease n/v
• increase GI emptying

• atropine
• scopolamine

• -dcrease oral and resp secretions
• -prevent bradycardia

• -admit
• assess
• monitor

• activity
• resperations
• circulation(BP)
• LOC
• o2 sat >92 on room air

genitourinary

• -type of surgery
• -unsual events
• -orders
• -pt status
• -VS, LOC, PA data
• -I&O left to count
• -dressing/drains
• -tubes/foleys

bed flat in high position with covers back

inadequate o2 concentration in arterial blood

• -restless
• -dyspnea
• -hypertension
• -tachy
• -diaphoresis
• -cyanosis

blood clot from deep veins, fat or tumor particle travels through the blood stream to pulmonary arteries

• -dyspnea/SOB
• -pleuritic chest pain
• -diaphoresis
• -anxiety, restless
• -rapid rr w/ crackles
• -low grade fever
• -hemoptysis/cyanosis

• -d dimer
• vent-perfusion scan
• abgs
• pulmonary angiography
• cxr

blood test that measures a substance in the blood that is released when a clot breaks up

• -may indicate clot
• -PE not likely
• -don't have PE
• - doesn't mean they have PE but follow up with vent perfusion scan

radioactive material to see how well air and blood are flowing to all areas of the lung

• -fowlers or high fowlers
• -lower extremities dependent
• -max lung expansion, reduce venous return to right side of heart
• -o2
• -heparin iv and Coumadin
• -vs and pulse ox q15
• -analgesics but non that depress respiration

incomplete expansion or collapse of lung tissue with inadequate ventilation and retention of secretions

• -fever >100.4 24/48 hrs post op
• -dyspnea
• -diminished breath sounds
• -crackles and cyanosis
• -anxiety, restlessness

• -HOB up
• -turn, cough deep breath
• -ambulate
• -iv or po fluid 2500-3k mls/day
• -analgesics
• -rt

• -fever >100 3rd day post op
• -chills
• -rapid pulse and rr
• -productive cough
• -chest pain

• redness or edema
• temp elevation over the vein
• positive hoffmans sign if clot is in calf

• -have pt bend the knee and dorsi flex foot
• -palpate calf and it will hurt if DVT is present

• -elevate
• -no ambulate
• -no massage
• -heat
• -bilateral circumference qshift

• -dark red and oozes quickly
• -bright red and spurts with pulsation

• -gradual lower of BP
• -increase pulse
• -rr unchanges
• -skin cool and moist
• -thirst and decreased urine output
• -decreased cap refill

• -q1 hr x4
• -q4 hr

• q15 x4
• q30 x4
• q4
• prn

• -H&H
• -platelet
• -PT/PTT/INR

• -loss of >1000ml blood/plasma
• -sufficient blood flow
• -sbp 80, rapid thread pulse
• -cyanotic
• -confused
• -urine output <30ml/hr x 2h anuria

failure to pass stool w/in 48 hrs after restart solid diet

• q1 hr
• q4 hr

3-6 days post op

volatile gaseous inhalation anesthetics and succinylcholine

during general anesthesia or up to 4 hours post op

iv dantolene/dantrium