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perioperative phase
starts when the descision for surgery is made and ends when pt goes to OR
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intraoperative phase
when pt is on OR and ends when pt is in PACU
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postoperative phase
when pt gets to PACU and ends at recovery
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ablative
removal of disease tissue, organ or extremity
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urgent is considered in___
Emergent is___
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ambulatory surgery setting
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pre op pt assessment includes
- psycosocial
- health hx
- meds
- allergies
- review of systems
-
-
health hx assesment
- med problems
- hospitilazations and surgeries
- obgyn
- family hx
- family hx of adverse reactions
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medication assesment
- routine scripts
- otc drugs
- herbs
- vitamins
- etoh and drugs
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types of routine scripts
- anticoagulants
- dieuretics
- antihtn
- abx
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people at risk for latex allergy
- hcp
- multiple surgeries
- rubber industry workers
- hay fever or asthma
- avocado, guava, banana, water chesnut, hazelnut, tomato, potato, peach, grape, apricot
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if you smoke you should quit
6 weeks before surgery
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urinary system review
because many drugs are metabolized and excreted through the kidneys
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the pt with hepatic dysfunction may have
problems with glucose control, clotting abnormalitites, and adverse response to drugs
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frequently, post op pain is due to
chronic musculoskeletal pain and positioning during surgery rather than acute pain of the surgery
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endocrine system review
the diabetic pt is at risk for the development of hypo/hyperglycemia, cardio alterations, delayed wound healing and infection
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fluid and electrolyte status
- vomiting
- diarrhea
- swallowing
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JAHCO requires what to be in chart and done by who
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CBC with Diff
- anemia
- immune status
- infection
-
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PT/PTT(INR)
bleeding tendincies
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SGOT/SGPT, albumin
liver function
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type and cross
blood available for replacement
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EKG
- cardiac disease
- electrolyte abnormalitites
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pre op teaching
- turn cough and deep breath
- IS
- leg, ankle and foot
- turning
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breath and cough excersise
- -sitting position
- -inhale nose, exhale pursed lip
- -hold breath 3 seconds then cough
- -cough and deep breath q2hr while awake
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quad setting
- -press knee against bed and relax
- -10x in 10 min
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foot circles
- -5x in each direction
- -3-4x/day
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straight leg raise
- -tighten thigh
- -lift leg
- -hold 5-10sec
- -repeat several times
- -NOT FOR ABD OR BACK SURGERY/PROBS
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pre op
-clear
-breast milk
-infant milk
-light meal
-heavy meal
-
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benzo mode of action
- reduce anxiety
- sedation
- induce amnesia
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narcotic mode of action
relieve discomfort
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gastric acid blocker drugs
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gastric acid blocker mode of action
- increase gastric ph
- decrease acid secretion
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antacid drugs
sodium citrate
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antacid mode of action
increase gastric ph
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antiemetics mode of action
- decrease n/v
- increase GI emptying
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anticholenergenic mode of action
- -dcrease oral and resp secretions
- -prevent bradycardia
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aldrete scoring for pt to leave PACU
- activity
- resperations
- circulation(BP)
- LOC
- o2 sat >92 on room air
-
which type of surgery has the highest return rate
genitourinary
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when PACU rn calls report
- -type of surgery
- -unsual events
- -orders
- -pt status
- -VS, LOC, PA data
- -I&O left to count
- -dressing/drains
- -tubes/foleys
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post op room prep
bed flat in high position with covers back
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what is hypoxia
inadequate o2 concentration in arterial blood
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hypoxia s/s
- -restless
- -dyspnea
- -hypertension
- -tachy
- -diaphoresis
- -cyanosis
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what is PE
blood clot from deep veins, fat or tumor particle travels through the blood stream to pulmonary arteries
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PE s/s
- -dyspnea/SOB
- -pleuritic chest pain
- -diaphoresis
- -anxiety, restless
- -rapid rr w/ crackles
- -low grade fever
- -hemoptysis/cyanosis
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tests for PE
- -d dimer
- vent-perfusion scan
- abgs
- pulmonary angiography
- cxr
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D-Dimer
blood test that measures a substance in the blood that is released when a clot breaks up
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D-Dimer
high levels
normal levels
negative
positive
- -may indicate clot
- -PE not likely
- -don't have PE
- - doesn't mean they have PE but follow up with vent perfusion scan
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vent perfusion scan
radioactive material to see how well air and blood are flowing to all areas of the lung
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PE intervention
- -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
-
atelectasis
incomplete expansion or collapse of lung tissue with inadequate ventilation and retention of secretions
-
atelectasis s/s
- -fever >100.4 24/48 hrs post op
- -dyspnea
- -diminished breath sounds
- -crackles and cyanosis
- -anxiety, restlessness
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atelectasis interventions
- -HOB up
- -turn, cough deep breath
- -ambulate
- -iv or po fluid 2500-3k mls/day
- -analgesics
- -rt
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pneumonia s/s
- -fever >100 3rd day post op
- -chills
- -rapid pulse and rr
- -productive cough
- -chest pain
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DVT s/s
- redness or edema
- temp elevation over the vein
- positive hoffmans sign if clot is in calf
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positive hoffmans
- -have pt bend the knee and dorsi flex foot
- -palpate calf and it will hurt if DVT is present
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DVT intervention
- -elevate
- -no ambulate
- -no massage
- -heat
- -bilateral circumference qshift
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venous flow is____
arterial flow is ____
- -dark red and oozes quickly
- -bright red and spurts with pulsation
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s/s of hemmorage
- -gradual lower of BP
- -increase pulse
- -rr unchanges
- -skin cool and moist
- -thirst and decreased urine output
- -decreased cap refill
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hemmorage intervention:
dressings
-
hemmorage intervention:
VS
-
hemmorage intervention:
monitor
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hypovolemic shock
- -loss of >1000ml blood/plasma
- -sufficient blood flow
- -sbp 80, rapid thread pulse
- -cyanotic
- -confused
- -urine output <30ml/hr x 2h anuria
-
constipation
failure to pass stool w/in 48 hrs after restart solid diet
-
-
wound infection usually occurs
3-6 days post op
-
malignant hyperthermia is triggered by
volatile gaseous inhalation anesthetics and succinylcholine
-
malignant hyperthermia can occur
during general anesthesia or up to 4 hours post op
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malignant hyperthermia treatment
iv dantolene/dantrium
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