adult I

wide variety of nursing functions associated with the patient's surgical procedure

wise variety of nursing functions associated with the patient's care before and after anesthesia

• begins when decision for surgical intervention is made
• ends with transfer of the patient to the operating room table

• assess level of understanding
• explain pre and post-operative procedures
• medications
• coughing and deep breathing exercises
• splinting of incision (putting a blanket/pillow over an abdominal incision when coughing)
• turning side-to-side
• leg exercises

OTC drugs - stop taking two weeks prior to surgery

all other prescribed meds are usually taken up until the day of surgery, unless otherwise stated

• nature and reason for surgery
• who will perform the surgery & others who will be present
• all available options and risks associated with each
• risks associated with surgical procedure and potential outcomes
• risks associated with anesthesia

diazepam (valium)

midazolam

morphine sulfate

• atropine sulfate
• glycopyrrolate

zantac, axid, tagamet

• begins when patient is admitted or transferred to the surery department
• ends when patient is admitted to the recovery area (post anesthesia/PACU)

• preoperative verification process
• marking with operative site
• "time out" immediately before starting the procedure

the point at which anesthesia is inititated just prior to the first incision cut

• controlled loss of consiousness
• protective reflexes lost
• sedation and analgesia
• muscle relaxation
• IV agents, inhalation agents, narcotics

• CNS: emergence delerium; delayed emergence
• CV: hypotension, dysrhythmias, MI
• hypothermia (temp less than 95)
• repiratory: laryngospasm
• malignant hyperthermia

• chain reaction of abnormalities
• pharmacogenetic disease of skeletal muscle (muscle breakdown = heat production)
• inherited disorder (single defective gene)
• laboratory tests: caffiene, halothane contracture test

• early signs: muscle rigidity, tachycardia and dysrhythmias
• cutatneous changes
• tachypnea
• pyrexia (hallmark of disease but late sign)

• discontinue anesthesia/surgery
• administer 100% oxygen
• administer Dantrolene ASAP (reconstitte with 60 mL PF sterile water) - ONLY drug that can treat MH
• patient cooling

• spinal
• epidural
• caudal
• peripheral nerve block
• intravenous (bier block)
• infiltration block
• field block
• topical
• local

• fewer complications
• decreased pain
• faster recovery

• used to determine level of block
• access level using a sharp, dull, or cold test item

• monitored anesthesia care
• administered by anesthesia provider
• pt maintains own airway
• all IV

• minimally depressed level of consciousness in which the patient retains the ability to maintain a patent airway independently and continuously and is able to respond appropriately to verbal commands
• administered by a non-anesthesia provider who has received speial training

• begins with the admission of the patient to the recovery area
• ends with a follow-up evaluation in the clinical setting or at home

monitoring patient for sings and symptoms of anesthesia and/or surgery/procedure complications

vital signs are the first item assessed -- RR is most important!

• seperation of the wond edges
• more likely wih vertical incisions
• may be caused by a bacterial infection or poor wont healing

• protrusion of loops of bowel accompanied by escape of pink, serous drainage
• more likely in patients who are older, obese, diabetic, or malnourished
• emergency situation - patient must be readmitted to OR
• prevention: splint incision

• urinary retention
• pulmonary problems: atelectasis, pneumonia, embolus
• thrombophlebitis
• decreased GI peristalsis (prevented by BG tube, encourage early ambulation)