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How many days should aspirin be stopped before surgery
how about anticoagulants?
aspirins should be stopped 7-10 days before
anticoagulants 7-14 days before
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Name a corticosteroid and how it affects surgery
- Dexamethasone
- CVS collapse with anesthesia
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Name a phenothiazine and how it affects surgery
chlorpromazine hydrochloride
can cause hypotension risk
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How to give diazepam
- diazepam can cause anxiety if withdrawn suddenly
- it cant be diluted
- give it 100% out of the vial
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Nurses job in consent
- Consent is the docs responsibility
- nurses witness and can answer questions after
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Who does the site markings
operating physician not the RN
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Circulating nurse jobs
- verifies consent
- preps the room ( temp, light)
- monitors asepsis and the pt
- documents
- ensures time out happens ( right pt, side)
- - surgical counts
- - not sterile
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Scrub nurse job
- -RN, LPN
- -sets up the sterile table
- -counts instruments ( 1x at the beginning, 2x at the end)
- -sterile
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3 OR zones
- unrestricted: street clothes
- semi restricted: scrub clothes and caps
- restricted: scrub, shoe cover, cap, mask
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Surgical asepsis
- sterile gown : chest is sterile field
- sleeves 2" above elbow
drape from front to back, only the top is sterile
at least 1ft from the sterile field is maintained
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General anesthesia
- Noises exaggerated
- excitement( restrained)
- no reflexes
-
Inhaled (volatile)anesthesia
non explosive less nausea
Succinylcholine: K+ leaves = muscle tremor
Propofol: white, long term causes high cholest not for egg allergy
- Midazolam: benzodiazapine
- reversed with flumazodile
-
regional anesthesia
epidural : no spinal headache
- spinal: position left side, knee to chest
- spinal headache
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Signs of malignant hyperthermia and what to do
- 1) tachycardia
- 2) hypotension
- 3) rigid muscle
late: temp goes up
Give dantrolene
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Signs of hypovolemic shock
- 1) hr goes up ( weak and thready)
- 2) bp goes down
- pallor , cool skin, cyanosis
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When to remove the airway
dont remove until the gag reflex is back
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Aldrete score when to be discharged
7-10= discharge from the PACU
areas: activities, circ, 02, resp, conscious
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Who changes the 1st post op dressing
MD
ABD pad, xeroform
100_ml/h= excessive wound drainage
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