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Definition
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Definition
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Definition
| formation of plastic repair |
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Term
| physiological responses to stress |
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Definition
n
↑blood flow to brain & vital organs
n
↓ motility & blood flow to GI tract
n
↑gastric acid production
n
↑blood glucose
nPupils dilate |
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Term
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Definition
delay wound healing
anti-inflammatory
aid in stress response |
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Definition
| potentiate barbituates and narcotics |
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Term
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Definition
inhibit platelet aggregation
prolong bleeding time
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Definition
inhibit platelet aggregation
interfere with coagulation factors
- Aspirin (ASA)
- heparin
- coumadin (warfarin)
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Term
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Definition
cause electrolyte imbalances
- hypokalemia K+ -- dysryhthmias
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Term
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Definition
can interfere with vascular compensatory responses
- predisoposes to shock
- if patient bleeding and needs vasoconstriction, but has taken an antihypertensive drug they are at an increased risk for hemorrage due to it's effects on vascular relaxation
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Term
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Definition
It is important to do a complete review of systems
•so that we can determine their condition before surgery so that we have a basis of comparison
•So that we can notify the doctor so that decisions can be made about things that can be treated before surgery.
General: chills • fever • night sweats • lethargy • fatigue •
Skin/Hair/Nail: rashes • pruritis • jaundice • bruising • non healing sores
HEENT: H/A • dizziness • syncope • visual field changes • blurring • diplopia • glasses • tinnitis • dentures
Neck: pain • discomfort • lumps/swelling • difficulty swallowing or moving neck.
Respiratory: wheezing • dyspnea • coughing • hemoptysis • asthma • TB • bronchitis • pneumonia • emphysema • SOB • PE
Cardiac: chest pain • dizziness • orthopnea • edema • palpitations • weakness on exertion • HTN • known heart murmurs
GI: abdominal pain • hepatitis • heartburn • nausea • vomiting • melena • hematochezia • ulcers
GU: burning or pain upon urination • nocturia • hematuria
Endo: polydipsia • polyuria • polyphagia • temperature intolerance • hormone therapy • energy levels
Neuro: vertigo • neurological deficit • seizure • tremors
M/S: redness • swelling • warmth • pain • discomfort • numbness • tingling
Heme: anemia • bleeding tendency • easy bruising • blood disorders •
Psych: depression • anxiety • drug or alcohol abuse
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Term
| factors increasing surgical risk |
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Definition
elderly
poor nutrition
fluid and electrolyte imbalances
obesity
radiation/chemotherapy
comorbidities:
- cardiovascular
- pulmonary
- renal
- hepatic
- diabetes
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Term
| physiological changes of aging |
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Definition
Cardiovascular -
Decreased - elasticity of blood vessels , cardiac output, peripheral circulation causes less circulation to vital organs
Complication - shock, P.E. wound healing, confusion etc
Respiratory -
Decreased elasticity of lungs & chest wall, forced expiratory volume, ciliary action causing decreased vital capacity, gas exchange, cough reflex
Potential - atelectasis, pneumonia, confusion
Neurological - decrease in metabolic rate, decrease in response time, reduced short term memory, sensory deficit, cerebral atherosclerosis, benign hypothermia
Effect – mobility and cognitive process
Potential – confusion, stroke
Urinary -
Decreased glomerular filtration rate, bladder tone, weakened perineal muscle Effects - decreased kidney function & loss of urinary control
Complications - prolonged response to anesthesia & drugs, hyperkalemia, UTI, incontinence.
GI -
Decreased intestinal motility and absorption.
Complication - ileus, constipation, fecal impaction
Decreased WBC especially T cells which leads to decreased response to foreign antigens
Effect - lower immune response
Complications - wound infections, dehiscence, pneumonia, UTI
Musculoskeletal -
Decrease - muscle strength, limitation of motion.
Effect - decrease activity
Complications - atelectasis, pneumonia, thrombophlebitis,constipation etc.
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Term
| Risk factors for post-op complications |
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Definition
Smoking – irritates the bronchial passages. Quitting even a couple of weeks before surgery actually prevents complications. Teaching is important.
•
Chronic lung disease – decreased ciliary action to get rid of secretions, but also air is trapped in lungs (a problem with anesthesia), and there is poor oxygenation. Increases risk for pneumonia
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Respiratory infections: if the patient has a cold or pneumonia, surgery will be postponed if possible to get the lungs in the best shape possible
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Upper abdominal or thoracic surgery – they can’t expand their lungs as well. If the thorax is entered, the lungs must be re-expanded.
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Obesity – don’t breath as deeply related to pressure of abdomen on lungs
•Inhalant anesthesia – is irritating to the lungs. People react differently. It is the quickest form of anesthesia, and can be controlled the best. As soon as it is turned off, and the patient breathes out, anesthesia is stopped.
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Term
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Definition
n
Increased demands of the heart
n
Decreased resistance to infection
n
Decreased healing
n
Increased risk for dehiscence
n
Decrease mobility (risk for DVT)
n
Hypoventilation – (atelectasis)
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Term
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Definition
•
Patient advocate – does the patient understand what is being done
•
Are they alert and willing to have the procedure done
•
We verify consent with our signature
•Any questions by the patient trigger a call to the surgeon
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Term
| purpose of pre-op medications |
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Definition
nReduce anxiety & provide sedation
n
↓secretions of saliva & gastric juices
n
Relieve pain & discomfort
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Decrease anesthetic requirements
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Facilitate induction
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Prevent autonomic reflex response
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Prevent nausea and vomiting
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Term
| Types of pre-op medications |
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Definition
sedatives/barbituates
antianxiety/benzodiasepines
anticholinergics
narcotics
H2 antagonist or proton pump inhibitor
antiemetics/sedatives hypnotics
antibiotics |
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Term
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Definition
n
Ordered for pm before surgery to help patient get needed sleep, calm and sedate
nNembutal, Seconal, Dalmane |
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Term
| antianxiety/ benzodiazepines |
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Definition
nDecrease anxiety, sedate, amnesia
nVersed, Ativan, Valium
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Term
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Definition
n
To decrease oral & respiratory secretions
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Atropine - raises the pulse rate,
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Robinul - less effect on rate and lasts longer
n
Toxic effect: tachycardia (rebound)
nRemember contraindicated for people with glaucoma
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Term
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Definition
n
Can lead to respiratory depression, decrease BP, N&V, increases risk for aspiration
nDemerol, MSO4, Stadol, Numorphan, Nubain |
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Term
H2 Antagonist or Proton Pump inhibitor |
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Definition
n
Decrease gastric acid and volume
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Lessens chance of aspiration pneumonia
nPepcid, Zantac, Protonix, Nexium, Prilosec |
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Term
Antiemetics / Sedative Hypnotics |
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Definition
n
n
Can be used antiemetic combine with opioid analgesic
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Administer z-track
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Sedation, treatment or prevention of nausea & vomiting
Vistaril, Phenergan, Zofran |
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Term
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Definition
n
Evidence-based practice to administer ATB prior to incision time
nPrevent infection |
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Term
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Definition
| patients who receive general anesthesia |
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Term
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Definition
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Patients who received local, regional, or conscious sedation
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Discharged home PACU
–Usually ambulatory surgery patients |
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Term
| assessment immediately post-op |
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Definition
[image]Priority
–Monitor and manage: respiratory, circulatory, pain, temp, and surgical site
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Term
| respiratory assessment post-op |
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Definition
[image]Airway patency
[image]Rate
[image]Quality
[image]Auscultate breath sounds throughout all lung fields
[image]Aids – oxygen, ventilator
[image]Pulse oximetry
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Term
| post-op respiratory complications |
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Definition
airway obstruction
hypoxemia
hypoventilation
laryngospasm
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Term
| post-op circulatory complications |
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Definition
hypotension r/t fluid loss
hypovolemia/shock
cardiac arrhythmias
hypertension
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Term
| post-op neurological complications |
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Definition
emergence delirium
delayed awakening |
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Term
| post-op thermoregulation complications |
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Definition
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Term
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Definition
nausea and vomiting
hiccoughs
distention |
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Term
| post-op renal complications |
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Definition
urinary retention
electrolyte imbalance
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Term
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Definition
POD# 1-3
decreased breath sounds
crackles
Interventions:
Breathing tx, C&DB, IS, ambulation
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Term
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Definition
POD #5
increased temp
productive cough
Interventions: IV antibiotics, breathing tx |
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Term
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Definition
POD# 7-14
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Chest pain
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Anxiety
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Tachycardia
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Diaphoresis
Interventions: IV heparin, Coumadin |
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Term
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Definition
POD# 7-14
[image]Most common in pelvic surgery
–Causes:
[image]Dehydration, immobility, obesity
–S/S:
[image]Pain & local tenderness in calf
[image]Swelling
[image]Redness
Interventions:
Bedrest, IV heparin, Lovenox
[image]No SCD’s (after it occurs)
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Term
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Definition
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Can be internal or external
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Causes: slip ligature, poor cauterization
–S/S:
[image]Hypovolemic shock
[image]Increased heart rate
[image]Decreased BP
[image]Irritability
[image]May or may not see bleeding
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Interventions:
NPO
[image]Vital signs
[image]IV rate increase
[image]Prepare for return to surgery
[image]Pressure on site (if external)
[image]Call the surgeon STAT
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Term
| fluid and electrolyte imbalances |
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Definition
[image]Na+ and K+ imbalances - r/t stress of surgery, N & V, ileus, NG output, wound drains
q
Aldosterone stimulates retention of Na+ and water and excretion of K+
q
ADH stimulates retention of Na+ & water
[image]Hydration: negates the effect of ADH & Aldosterone effect
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IV - common D5 ½NS, D5LR (hypertonic) or LR, NS (isotonic)
[image]Administer potassium but make sure renal function is
>30 ml/ hour
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Term
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Definition
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Occurs 1st six hours post-op
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Causes: swallowing air during surgery, decreased peristalsis, secondary to anesthetic agent, anticholinergics
–Intervention:
[image]Anti-emetics
[image]NG insertion
[image]Mouth care
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Term
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Definition
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Causes: pre-op anticholingeric: Robinul, loss of body fluids
–Interventions: mouth care, cold swabs, chapstick, swish and spit |
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Term
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Definition
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Collection of large amount of fluid in a body compartment
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Shift of fluid from vascular spaces to an area of body where it is unavailable for functional use
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Assess cause: I & O, total protein and albumin levels
–Treatment: IV’s and albumin
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Term
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Definition
Intravascular fluid volume loss
IVF replacement (bolus)
–May need dopamine
–Supportive care
[image]Supplemental 02
[image]Position supine with legs elevated
–Minimize energy expenditure
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Term
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Definition
–Fistula drainage
–Diuresis |
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Term
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Definition
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Fluid volume moves out of the vascular space into extravascular space (third spacing)
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Peritonitis
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Ascites
–Internal bleeding
–Massive vasodilation (sepsis)
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Term
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Definition
POD #1
[image]Causes:
–Depressed reflexes secondary to anesthetic anticholingeric, stress, pain
[image]
S/S:
–I>O, inability to void, frequent small voids, bladder distension, suprapubic pain, restlessness
[image]
Intervention:
–Monitor I&O
–Interventions to facilitate voiding
–PRN straight catheterization
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Term
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Definition
[image]Causes:
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Poor asepsis, already had infection before surgery, dehydration, catheterization
[image]S/S:
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Frequency, burning, urgency, cloudy urine, malodorous, suprapubic pain
[image]Interventions:
–2500 ml of fluid/day
–Early ambulation
–Aseptic technique when cath
–Good perineal hygiene
–ATB’s when ordered
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Term
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Definition
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Irritation of phrenic nerve
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Causes: Gastric distention, drsgs, tubes, surgery intestinal obstruction, anastamosis surgeries
–Interventions: paper bag, CO2, Thorazine |
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Term
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Definition
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Causes: loss of blood, NPO, failure to feed, or failure to eat, NPO longer than 5-7 days
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S/S: negative nitrogen balance, decreased albumin, dehydration, alteration in many labs
–Interventions: give calories, protein, vitamins
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Term
| Ileus/ non-mechanical bowel obstruction |
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Definition
↓ peristalsis secondary to loss of nerve innervation
–Occurs 1st 2 days post-op
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Paralytic ileus if last longer than 2 days.
[image]Causes:
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Manual manipulation of the bowel, hypokalemia, anesthesia, anticholinergics, stress, pelvic and abdominal surgery
[image]Sign/Symptoms:
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Bowel sounds absent, distention, n/v, increase NG drainage
[image]Interventions:
–Mobilize, NPO, potassium if low, antiemetic, No tube feeding
[image]Resolved when there are bowel sounds, flatus, and/or stool
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Term
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Definition
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Most common in abdominal or pelvic surgery after sixth day
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Causes: meds, decreased activity, decreased intake
–Interventions: hydrate and ambulate |
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Term
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Definition
POD# 4-5
[image]Causes:
–Poor healing
–Poor asepsis
–Contamination
–Poor technique
–Dirty wound before surgery
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[image]Signs/Symptoms:
–Inflammation
–Purulent drainage
–Tenderness
–Increase Body temperature
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Wound odor
[image]Interventions:
–Keep wound clean/dry
–Use aseptic technique for dressing change
–ATB as ordered
–Shower no bath
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Term
| anaerobic wound infections |
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Definition
POD# 7
[image]Causes:
–Poor healing
–Poor asepsis
–Contamination
–Poor technique
–Dirty wound before surgery
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Excessive body cavity exposure
–Inflammation
–Purulent drainage
–Tenderness
–Increase Body temperature
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Wound odor
[image]Interventions:
–Keep wound clean/dry
–Use aseptic technique for dressing change
–ATB as ordered
–Shower no bath
–
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Term
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Definition
[image]Spillage of intestinal content into peritoneal spaces (anastamosis surgeries)
[image]Sign and symptoms:
–Fever, abdomen rigid, nausea, distension, guarding
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Risk for Septic shock
[image]Interventions: Prepare for OR, IV, NG, NPO
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