When does the preoperative period begin?  When does it end?

The preoperative period begins when the client is scheduled for surgery and ends at the time of transfer to the surgical suite.

• Age
• Use of tobacco, alcohol, or illicit substances, including marijuana
• Current medications (over the counter and any herbals)
• Use of complementary or alternative medicines, such as herbal therapies, folk remedies, or acupuncture
• Medical history
• Prior surgical procedures and experiences
• Prior experience with anesthesia
• Autologous or directed blood donations
• Allergies, including sensitivity to latex products
• General helath
• Family history
• Type of surgery planned
• Knowledge about and understanding of events during the perioperative period
• Adequacy of the clients support system (someone there to help bathe, prepare meals)

Antidysrhythmias

antihypertensives

corticoisteroids

anticoagulants

antiseizure meds

glaucoma meds

antidiabetic meds

fears and anxieties

surgical procedure

preop routines (NPO, enemas...)

invasive procedures ( caths, lines)

coughing, turning, deep breathing

incentive spirometer

lower extremity exercises

stockings and pneumonic compression devices

splinting

pain management

Informed concent

dietary restriction

home meds (what to take, what not to take)

specific preparation for surgery (special scrub)

postop exercises

plans for pain management

-nature and reason for surgery

-who will be performing surgery and who is present

-all available options and risk associated with each

-the risks associated with surgical procedure and its potential outcomes

risks assocaited with the use of anesthesia

Breathing exercises

incentive spirometry

coughing and splinting

leg procedures and exercises

early ambulation

ROM

cigarette smoking

physical inactivity

obesity

psychological factors- stress, anger, depression, and hostility

Thickening/hardening of arterial wall as someone ages

the arteries become narrowed and blood flow decreases

Bruits- when you listen over the carotid artery, it sounds like swishing or turbulence (water over rocks)

Cholesterol >200

HDL<35

LDL>100 (60-180)

Triglycerides >200

Homocysteine >15

Diet low fat <30% total intake

Low sat. fat

stop smoking

exercise

weight reduction

drugs: Questran, Lipitor, Mevacor

Someone is diagnosed with hypertension when they have a consistent high blood pressure

SBP > 140

diastolic > 90 (the more problematice- when heart is at rest)

they treat it the most aggressively cause it could damage the lumen

Baroreceptors

Renin-angiotensin

Regulation fluid volume

Vascular auto regulation

essential

secondary

No known cause

> age 60

family history

obesity

sedentary lifestyle

alcohol >

> lipids- high lipid intake

Aferican american

smoking

renal vascular disease

aldonteronism

phoechromocytoma- adrenal tumor, release of angiotensin (once you remove tumor HTN goes away)

cushings

coarctation of aorta- narrow and more rigid (genetic)

brain tumors- impact serotonin

medications

renal carcinoma

none at first

headache

dissiness

visual disturbance

confusion

reduce or address all controllable risk factors

diuretics- lasix (reduces the fluid volume- decrease preload so decrease blood pressure)

ACE inhibitors- dilation

Beta-blockers (lol) dialate arteries

calcium channel blockers- reduce amt of calcium availability

vasodilators (apresoline) reduce afterload

Nitroprusside (Nipride) for HTN crisis

Nitroglycerie drip

10% >70

men > 45

post-menopausal women

Pain- intermittent claudication

outflow: pain legs, feet, calves

Inflow: back pain, buttocks (higher up)

decreased or absent pedal pulses

decreased pain at rest or with feet in dependent position

foot ulcers, gangrene (great toe), painful

would have that red color and then it would ulcerate

Encourage walking

discontinue cigarette smoking

control weight, hypertension, hyperlipidemia, and diabetes

ensure good foot care

Arteriogram

exercise tolerance testing

exercise

positioning

keep extremities warm

no smoking

meds

PTA- percutaneous transluminal angioplasty (inflated balloon)

laser assisten angioplasty

atherectomy

aorta-femoral bypass graft

ileo-femoral popliteal bypass graft

Risk for occlusion- 24 hours

check pulses every 15 min for first hour, then every hour along with color and temp

mark location of pulses

assess for pain

keep leg straight

risk reduction

activity- walking

positioning

and when to call the doc

substernal chest discomfort

it radiates

precipitated by stress or exertion

relieved by nitro (NTG)- take sublingually every 5 min, up to 3, if not releived cal EMS, or exertion

lasts <15 min

5 E's: exertion, elimination, extreme changes in temp, eating a heavy meal, and emotion

substernal chest pressure (elephant)

radiates to arms and jaw

occurs without cause

relieved only by opiods

30 min or more

nause (may be vomiting)

diaphoresis, dyspnea, (cold and clammy)

fear of empending doom

initially they may deny anything is wrong since it is just pressure (esp women)

weight

activity

diabetes

HTN

smoking

cholesterol

age

sex

race

family history

labs: troponin (.04 or less)

CPK

LDH

SGOT

M- morphine for pain

O- oxygen to hyperoxygenate

N- nitroglycerine- dilate coronary arteries

A- aspirin- reduce platelet aggrivation, chew it

IV access

vital signs, BP every 5 min

EKG

Labs- cardiac cath in first hour

chest pain subsides abruptly

sudden onset of PVC's

resolution of ST changes- the elevate one will return

markers (enzymes) of myocardial damage peak at 12 hours and will return back down

blood flow reestablished by tPa or by angioplasty

minimally invasive direct coronary artery bypass

doesnt require the heart lung machine

avoids splitting sternum because it is a small incision

designed to bypass one or two coronary arteries

fluid and electrolytes- keep calcium level

hypotension- keep systolic BP between 90 and 130

hemorrhage- will see hemorrhage in amt of chest tube drainage- mark for baseline, dark cherry

hypothermia- rewarm to 98.6, dont heat too fast

if pacemaker- protect wires

chest tubes- >150 cc per hour

ventilator- wean the evening of surgery

level of consciousness- know baseline, and move all extremitites, speak and follow commands

up in chair

remove mediastinal tubes

changes chest and leg dressings

discontinue foley cath

discontinue Swan ganz cath- make sure supine when taking it out

Hep lock IVs

take NG out

anti-emboli stockings

AAT diet

change to oral meds

discontinue morphine

Tylox for pain control

Lasix for diuresis- take foley out last

start ASA once chest tubes are removed

and transfer to step-down unit for increased ambulation

treatment with medications and rest

valve replacements

Xenograft or autograft

meds- anticoagulantss

prophaylactic antibiotics

dietary restrictions of food with vit K, dont eat green leafy veges

feverm night sweats, malaise, fatigue

anorexia, weight loss

cardiac murmur

heart failure

systemic embolization

petechiae

Osler's nodes hands/feet tender lesions

Janeways lesions nontender hard lesions on hands and feet

spliner hemorrhages: nails

pain radiating to left side of neck

crating and oppressive pain aggrivated by breathing, coughing, swallowing

pain worse when supine

susides when sitting and leaning forward

may hear precordial friction rub- squeeky sound

ST wave elevation

anti-inflammatory agents ( motrin, naprisin, but most effective endosin)

no anticoagulants

pericardiocentesis

atherosclerotic or inflammatory processes causeing lumen narrowing (stenosis)

thrombus formation (usually associated with underlying atherosclerotic disease)

Remember the 6 P's

pallor (pale)

pain

pulselessness

paresthesia

paralysis

poikilothermia (cold)

-inflammation in the aorta, which may cause its wall to break down

- some believe it may be associated with atherosclerosis or risk factors that contribute to it- like HTN

-being a man over 60

-having an immediate relative

-high blood pressure

-smoking

pulsation in upper abdomen

abdominal, flank, or back pain

may be asymtomatic

hypotension

diaphoresis (excessive sweating)

cold clammy

decreased level of consciousness

oliguria- decreased urine output

abdominal distension

hematoma of flank

arrhythmias

back pain

dyspnea

hoarseness

dysphagia- diff swallowing

rupture is also an emergency

acute and profound shock (first sign is restlessness)

chest x-ray shows it

CT scan-determines size and location

assess graft patency (change in pulse, color, temp, abd distention, severe pain)

renal function

resp distress

paralytic ileus

assess for paralysis

cardiac arrhythmias

hemorrhage

positive Homans sign

tenderness

swelling of extremity

warmth over site

venous doppler studies

stasis leg ulcer- they dont heal from poor venous return

edema in extremities

results of prolonged HYN

long term care

heart rate increases

improved stroke volume

arterial vasoconstriction

sodium and water retention

myocardial hypertrophy

most common cause is MI, with HTN longstanding diagnosis

more men than women

decreased cardiac output

fatifue, weakness

oliguria, angina, confusion, dizziness

tachycardia, cool extremities

weak pulses

pulm congestion, cough, dyspnea

crackles, pink frothy sputum

S3-4 gallop

Jugular vein distention

enlarged liver, spleen

anorexia

dependent edema

distended abdomen

polyuria

weight fain- fluid retention

BP changes

head of bed 45 degrees

oxygen

measures to reduce fluid overload

meds to improve contractility- digoxin

elevate feet and legs to improve venous return

anti-emboli stockings

reduce fluid volume overload

daily weights

input and output

electrolytes

pulses

2-3 gm sodium diet

fluid restriction

peripheral vascular disease

arterial

peripheral vascular disease

venous