perioperative

  1. perioperative phase
    starts when the descision for surgery is made and ends when pt goes to OR
  2. intraoperative phase
    when pt is on OR and ends when pt is in PACU
  3. postoperative phase
    when pt gets to PACU and ends at recovery
  4. ablative
    removal of disease tissue, organ or extremity
  5. urgent is considered in___
    Emergent is___
    • 24-48 hours
    • no delay
  6. ambulatory surgery setting
    • ER
    • dr office
    • clinic
    • out pt
  7. pre op pt assessment includes
    • psycosocial
    • health hx
    • meds
    • allergies
    • review of systems
  8. pshycosocial assesment
    • anxiety
    • fears
    • hope
  9. health hx assesment
    • med problems
    • hospitilazations and surgeries
    • obgyn
    • family hx
    • family hx of adverse reactions
  10. medication assesment
    • routine scripts
    • otc drugs
    • herbs
    • vitamins
    • etoh and drugs
  11. types of routine scripts
    • anticoagulants
    • dieuretics
    • antihtn
    • abx
  12. allergy assesmnt
    • food
    • chemicals
    • pollen
  13. 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
  14. if you smoke you should quit
    6 weeks before surgery
  15. urinary system review
    because many drugs are metabolized and excreted through the kidneys
  16. the pt with hepatic dysfunction may have
    problems with glucose control, clotting abnormalitites, and adverse response to drugs
  17. frequently, post op pain is due to
    chronic musculoskeletal pain and positioning during surgery rather than acute pain of the surgery
  18. endocrine system review
    the diabetic pt is at risk for the development of hypo/hyperglycemia, cardio alterations, delayed wound healing and infection
  19. fluid and electrolyte status
    • vomiting
    • diarrhea
    • swallowing
  20. JAHCO requires what to be in chart and done by who
    • H&P
    • surgeon
  21. CBC with Diff
    • anemia
    • immune status
    • infection
  22. ABGs and pulse ox
    • pulmonary
    • metabolic
  23. PT/PTT(INR)
    bleeding tendincies
  24. SGOT/SGPT, albumin
    liver function
  25. type and cross
    blood available for replacement
  26. EKG
    • cardiac disease
    • electrolyte abnormalitites
  27. pre op teaching
    • turn cough and deep breath
    • IS
    • leg, ankle and foot
    • turning
  28. breath and cough excersise
    • -sitting position
    • -inhale nose, exhale pursed lip
    • -hold breath 3 seconds then cough
    • -cough and deep breath q2hr while awake
  29. ankle pump
    -5-10 min
  30. quad setting
    • -press knee against bed and relax
    • -10x in 10 min
  31. foot circles
    • -5x in each direction
    • -3-4x/day
  32. straight leg raise
    • -tighten thigh
    • -lift leg
    • -hold 5-10sec
    • -repeat several times
    • -NOT FOR ABD OR BACK SURGERY/PROBS
  33. pre op

    -clear
    -breast milk
    -infant milk
    -light meal
    -heavy meal
    • 2 hr
    • 4 hr
    • 6 hr
    • 6 hr
    • 8 hr
  34. benzo drugs
    • versed
    • valium
    • ativan
  35. benzo mode of action
    • reduce anxiety
    • sedation
    • induce amnesia
  36. narcotics drugs
    • morphine
    • Demerol
    • fentynal
  37. narcotic mode of action
    relieve discomfort
  38. gastric acid blocker drugs
    • Tagamet
    • zantac
    • pepcid
  39. gastric acid blocker mode of action
    • increase gastric ph
    • decrease acid secretion
  40. antacid drugs
    sodium citrate
  41. antacid mode of action
    increase gastric ph
  42. antiemetics drugs
    • reglan
    • zofran
  43. antiemetics mode of action
    • decrease n/v
    • increase GI emptying
  44. anticholenergenic drugs
    • atropine
    • scopolamine
  45. anticholenergenic mode of action
    • -dcrease oral and resp secretions
    • -prevent bradycardia
  46. PACU task
    • -admit
    • assess
    • monitor
  47. aldrete scoring for pt to leave PACU
    • activity
    • resperations
    • circulation(BP)
    • LOC
    • o2 sat >92 on room air
  48. which type of surgery has the highest return rate
    genitourinary
  49. 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
  50. post op room prep
    bed flat in high position with covers back
  51. what is hypoxia
    inadequate o2 concentration in arterial blood
  52. hypoxia s/s
    • -restless
    • -dyspnea
    • -hypertension
    • -tachy
    • -diaphoresis
    • -cyanosis
  53. what is PE
    blood clot from deep veins, fat or tumor particle travels through the blood stream to pulmonary arteries
  54. PE s/s
    • -dyspnea/SOB
    • -pleuritic chest pain
    • -diaphoresis
    • -anxiety, restless
    • -rapid rr w/ crackles
    • -low grade fever
    • -hemoptysis/cyanosis
  55. tests for PE
    • -d dimer
    • vent-perfusion scan
    • abgs
    • pulmonary angiography
    • cxr
  56. D-Dimer
    blood test that measures a substance in the blood that is released when a clot breaks up
  57. 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
  58. vent perfusion scan
    radioactive material to see how well air and blood are flowing to all areas of the lung
  59. 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
  60. atelectasis
    incomplete expansion or collapse of lung tissue with inadequate ventilation and retention of secretions
  61. atelectasis s/s
    • -fever >100.4 24/48 hrs post op
    • -dyspnea
    • -diminished breath sounds
    • -crackles and cyanosis
    • -anxiety, restlessness
  62. atelectasis interventions
    • -HOB up
    • -turn, cough deep breath
    • -ambulate
    • -iv or po fluid 2500-3k mls/day
    • -analgesics
    • -rt
  63. pneumonia s/s
    • -fever >100 3rd day post op
    • -chills
    • -rapid pulse and rr
    • -productive cough
    • -chest pain
  64. DVT s/s
    • redness or edema
    • temp elevation over the vein
    • positive hoffmans sign if clot is in calf
  65. positive hoffmans
    • -have pt bend the knee and dorsi flex foot
    • -palpate calf and it will hurt if DVT is present
  66. DVT intervention
    • -elevate
    • -no ambulate
    • -no massage
    • -heat
    • -bilateral circumference qshift
  67. venous flow is____
    arterial flow is ____
    • -dark red and oozes quickly
    • -bright red and spurts with pulsation
  68. s/s of hemmorage
    • -gradual lower of BP
    • -increase pulse
    • -rr unchanges
    • -skin cool and moist
    • -thirst and decreased urine output
    • -decreased cap refill
  69. hemmorage intervention:

    dressings
    • -q1 hr x4
    • -q4 hr
  70. hemmorage intervention:

    VS
    • q15 x4
    • q30 x4
    • q4
    • prn
  71. hemmorage intervention:

    monitor
    • -H&H
    • -platelet
    • -PT/PTT/INR
  72. hypovolemic shock
    • -loss of >1000ml blood/plasma
    • -sufficient blood flow
    • -sbp 80, rapid thread pulse
    • -cyanotic
    • -confused
    • -urine output <30ml/hr x 2h anuria
  73. constipation
    failure to pass stool w/in 48 hrs after restart solid diet
  74. dressing assesment
    • q1 hr
    • q4 hr
  75. wound infection usually occurs
    3-6 days post op
  76. malignant hyperthermia is triggered by
    volatile gaseous inhalation anesthetics and succinylcholine
  77. malignant hyperthermia can occur
    during general anesthesia or up to 4 hours post op
  78. malignant hyperthermia treatment
    iv dantolene/dantrium
Author
ChelseaL
ID
339946
Card Set
perioperative
Description
perioperative
Updated