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what is ectomy?
cut or remove
why would surgery be used?
for diagnosis, treatment, or cure
what does invasive mean?
to go into the body, all surgeries are invasive
what are the classifications of surgery?
diagnostic/exploratory, ablative, constructive, reconstructive, palliative, transplant, aesthetic, preventative
what does diagnostic/ expolatory surgery used for?
confirming, ex: breast surgery
what does ablative surgery used for?
removal with lasers, ex: burning layers
what does constructive surgery used for?
buliding, ex: burned pt. reconstruct part
what does reconstructive surgery used for?
building, ex: repairing damage, not from scratch
what does palliative surgery used for?
rebuilding, ex: make your pt. comfortable, not curing them
what does transplant surgery used for?
to replace or restore function
what does aesthetic surgery used for?
repair; to make it look better
what does preventative surgery used for?
to prevent problems
what are the three levels of risk factors for surgery?
- minor- very minimal
- major- high risk
- emergency- life or death
what are the perioperative phases?
preoperative, intraoperative, postoperative
when does preoperative phase begin and end?
begins with the decision to have surgery and ends when pt. enters OR
how long can anesthesia stay in system?
what tests/processes would pt. need before surgery?
- May need to have labs(1 week before), ekg, chest
- x-ray, pregnancy test,CBC, PT, artial blood gasses, type and cross match, creatine,
- fasting blood sugar, oxygen staturation,
- percentage of oxygen, advanced
- directives- do they want to be resuscitated , teaching, baseline, interventions, and nursing process
when does intraoperative phase begin and end?
- begins when you enter the OR and ends when you enter
- recovery room
when does the postoperative phase begin and end?
begins in recovery room, ends when you are completely recovered, can end when at hospital after surgery or when discharged
if pt. feels like they are going to die, what should you do?
who and when should the anestesiologist visit?
pt. and family, before surgery
what factors should you report that could affect surgery?
infection, bleeding, cardiac problems, respiratory, renal problems
what should a nurse do during the intraoperative phase?
assess: temperature changes-hyperthermic/hypo, decreased O2, bleeding, output, airway
what should a nurse do during postoperative phase?
- pain management, respiratory function,
- ambulation, bowel sounds, confusion, skin,
when would you see Hyper static pneumonia?
pulmonary problem aftersurgery
what is dangling?
hanging off side of bed right after surgery
what could help pt. recover better?
- being Well hydrated, well nourished, more protein, vitamin
- C, being the ideal weight
what are some common complications for an obese pt.?
infection, pulmonary and cardiac complications
what would you do with a dehiscence wound ?
cover with sterile dressing, and let doctor know
what are the risk for a pt. with cardiovascular disorder?
increase risk for shock, hypotension, thrombophlebitis, stroke,
what are the interventions for a pt. with cardiovascular disorders
- monitor vital signs, pulse, rate and rhythm, apical pulse, general conditions, any thing slightly wrong before surgery should be told to physician
- After surgery- skin color, chest pain, lung congestion, and peripheral edema (shows that pt. has CHF) , get them up and moving, do range of motion, deep breathing every 2 hours
what are the risks for a pt. who smokes?
- higher risk for respiratory issue, pneumonia, atolacksis(collapse
- of aveoli), bronchitis
what are the interventions for pt. who smoke?
- Do not smoke for 24 hours before, 3-4 weeks with
- chronic lung disease before a surgery·
- Monitor for respiratory complication, deep
- breath and cough, spirometery, etc.
what are the risks for a pt. who drink?
underweight, liver issue, may need more anesthetic, risk for hemorrhaging, and wound healing
what are the interventions after surgery for someone who drinks?
look for delirium tremors, monitor diet, assess for bleeding
what are the risk for a pt. with chronic disorders?
must be cleared for surgery, risk for cardio complications, delayed wound healing/infection, pt. with diabetes type I have high risk for diabetic ketoacidosis (DKA), or hypoglycemia, may get dextrose 5% depending on fluids
kidney pt. could go into renal failure due to ____.
what should be done in the preoperative admission?
subjective and objective data, medication history nursing diagnosis, goals, ask if they had any complications, assess emotional attitudes, reaction to surgery, demographic information (work and live), reason for surgery, important to know when they had last period, any hospitalizations, alcohol and smoking, family history, how they cope
what are some nursing processes to do before surgery?
- Observe pt. vitals signs, etc., claim or anxious, baseline assessment, subjective- ask about dentures or crowns, lose
- teeth, remove dentures before surgery, jaw or neck problems, medication history- for interactions with meds , doctor will write how to take meds before surgery, anticoagulant stopped/looked at, FBS on DB pt., steroids can not be stopped suddenly will get iv med, beta blockers block electrical pulses in heart cant stop suddenly either, recreational drugs- affects anesthesia, preoperative teaching
what are some common nurisng dx?
altered body image, anxiety, fear, knowledge deficit
who should provide the information for a consent form
doctor provides information on consent form, they talk about risk for surgery, and success of procedure, alternate procedures, pt has the right to refuse surgery, witnessed to signature only when signing consent
what is on the perioperative checklist?
- ID band, hospital gown, remove jewelry, labs,
- vitals, H&P, signed consents, hearing aids/ glasses(write order if needed during surgery), contacts, orders, tin hoses, void before surgery
what should you do if order for meds has order to call on it?
give meds when you get the call to give it
what factors influence type of anesthesia?
surgery, past history, age, client preference
who transfer pt. to OR?
transfer aid takes them to surgery
how should the intraoperative team be dressed/ and the room?
- OR team , nurse, assistant, wear head covers and
- shoe covers, masks on everybody, sterile equipment on at pt. tables, control temp. in room cold to keep bacteria down
who double checks everything before surgery?
- Holding area the nurse double checks
when does malignant hyperthermia set in and what do you need/ do; S/S?
start 10-20 mins or 24 hours later after meds start, all OR have hyperthermia kits,muscle disease can trigger it, epinephrine, atropine, digitalisis,theopolein, alters calcium functions in body, s/s- increase metabolism, muscles rigid, tachycardia, tacypnea, HBP, cardiac disrrythmias, hyperkalima, metalbolic and respiratory acidosis,
what is dantreium used for?
skeletal muscle relaxant, reverses muscle rigidness; metabolic acidosis- sodium bicarbonate treatment, for mal. hyperthermia
what are the interventions for Malignant hyperthermia?
grab crash cart, give 100% O2, cooling blanket, stop surgery, cold IV fluid, start meds immediately
how long should you wait before starting a procedure with local anesthesia?
what is hypovolemic shock?
intravascular, not enough volume, effect cardiac, biggest cause is hemorrhaging, N/V, diarrhea, burns, diuaresis, lose 10% to show signs of shock, lab will not change until they lost the 10%; hypotension is a late symptom and shows when they last 30% of fluids, find cause and treat underline cause, give O2 in acute phase, look for acidosis, O2 sat. should be over 95%, panic at 89%, IV with large bore needle, replace blood loss, report any changes immediately
what is cardiogenic shock?
- heart is failing, the left side is failing, reduce blood flow, B/P will falls below 90, fast pulse, temp falls, urine output, normal output is 30ml per hour, and it dereases, confused, tx: implament order, pain meds, 100% O2 by face mask,
- morphine common pain meds, slows breathing down
- , meds digoxin to increase contractions of heart
what is distributive shock?
excessive dilation of blood vessels- anaphylactic, septic, neurogenic;
what is Anaphylactic shock?
hyper sensitivity of allergic reaction, swollen, temp. goes up, emergency, a lot of causes, large amount of histamine released affects airway, mast cells , itching, rashes, and hives, strider breathing sound, give epinephrine, B/P goes up, steroids given, give )2
what is Septic shock?
- bacteria infection, most common gram negative or strep, damage of cell, vasodilatation, flush and warm, drop in blood pressure, restless, tachycardia, thirst, temp is
- high, increased WBC, C&S lab culture, Tx: increase circulating volume, antibiotic, O2, ICU or ventilator
what is Neurogenic shock?
- Neurogenic shock- alteration in vascular smooth
- muscle cells, loss of sympathetic nervous sytem , spinal, brain and injury, from drugs or injury, decrease cardiac output, work with them quickly, B/p drops fast
what is the nursing care for all shock pt.?
airway, assess pt. , get help don’t leave pt., maintain blood flow to the brain, LOC, “glasscocoma scale”, pt. NPO initially, elevate legs except if in congestive heart failure, bleeding from head, or spinal injury, keep pt. flat, cover with blanket
what does epinephrine do to blood vessels and smooth muscles?
epinephrine constricts blood vessels and relaxes smooth muscle
what are the types of anesthesia?
- Surface or topical, local, nerve block, epidural block, spinal
- anesthesia, conscious sedation(Regital), lidocaine with epiphernie causes heart
- to race some
what do you when pt. enters PACU after surgery?
admission, assessment, airway, LOC, bleeding, V/S, pain management, O2, monitor for complications, car planning starts right away
what are some complications after surgery?
- shock, hemorrhage(circle it), DVT(blood clot),
- pulmonary Embolus, pneumonia, atelectasis, urinary retention,
- bowel sounds, elimination
what are some wound complications after surgery?
Wound complications- hematoma, infection, dehiscence, evisceration-“guts” come out, place pt. in low flowers position, moist sterile dressing, get them back in surgery,watch for shock (drop in B/P). poor wound healing uses wound vac.
what is shock?
organs failing, have inadequate tissue perfusion, life threating
what are the classic signs of shock?
Drop in b/p decreased heart rate classic signs
what is the compensatory stage?
- body takes over, tries to maintain, blood volume
- starts to falls, picked up by the aortic and carotid barrier receptors, sympathetic system shoots every thing up,
- stimulate release of adrenaline, heart rate goes up, Vasoconstriction to help give blood to the brain and heart; brain can died in 4-6 min., kidney is extremely sensitive, urine output decreased, watch output,
what are the signs and symptomsof compensatory shock?
S/S-irritable, restless, orthostatic hypotension,pulse bounding over a 100,respiration over 20 , cool pale skin, elevation blood glucose, respiratory alkliosis- to much sodium bicarbonate
what is the progressive stage of shock?
when compensatory stage starts to fail it starts, sodium collects inside the cells,potassium is leaking outside anaerobic metabolism is forming getting respiratory acidosis, getting vasoconstriction and blood gets trapped in capillaries, and increases hyperstatic pressure, fluid leakage into surrounding tissue, blood gets thicker, concentrated, moves very slowly
what are the S/S of the progressive stage?
S/S- no energy, confused, B/P falls, weak thread pulse, body temp drops, skin cold clammy pale,thristy, dry mouth, muscles weak
what is the refactory stage of shock?
- vital organs fail, pt. will die, cant reverse
- the shock
what are the S/Sof the refactory stage?
S/S-unconscious, B/P continue to drop, diastolic will drop almost to 0, slow irregular pulse, scant urine output, cyanotic , cold
includes outpatient, same-day, or short-stay surgery that does not require an overnight hospital stay
period of time that begins with transfer of the patient to the operating room table and continues until the patient is admitted to the post anesthesia care unit
- period of time that constitutes the surgical
- experience; includes the preoperative, intraoper-ative, and postoperative
- phases of nursing care
period of time that begins with theadmission of the patient to the postanesthesia care unitand ends after follow-up evaluation in the clinical settingor home
period of time from when thedecision for surgical intervention is made to when thepatient is transferred to the operating room table
Surgery may be performed for various reasons-
may be diagnostic (eg, biopsy, exploratory laparo-tomy), curative (eg, excision of a tumor or an inﬂamed ap-pendix), or reparative (eg, multiple wound repair), may be reconstructive or cosmetic (eg, mammoplasty or a facelift) or palliative (eg, to relieve pain or correct a problem—for in-stance, a gastrostomy tube may be inserted to compensate for the inability to swallow food). Surgery may also be classiﬁed according to the degree of urgency involved: emergent, ur-gent, required, elective, and optional.
Patient requires immediate attention; disorder may be life-threateningII. Without delay; Severe bleedingBladder or intestinal obstructionFractured skullGunshot or stab wounds Extensive burns
Patient requires prompt attention Within 24–30 hours; Acute gallbladder infection Kidney or ureteral stones
- Patient needs to have surgery Plan within a few weeks or months; Prostatic hyperplasia without bladder obstruction
- Thyroid disorders Cataracts
Patient should have surgery Failure to have surgery not catastrophic; Repair of scarsSimple herniaVaginal repair
Decision rests with patient Personal preference; Cosmetic surgery
genetic conditions that may cause complications with anesthesia-
including the following: Malignant hyperthermia, Central core disease (CCD), Duchenne muscular dystrophy, Hyperkalemic periodic paralysis, King-Denborough syndrome
Preoperative Family History Assessment
- Obtain a thorough assessment of personal and family history, inquiringabout prior problems with surgery or anesthesia with speciﬁc attention to complications such as fever, rigidity, dark urine, and unexpected reactions. •Inquire about any history of musculoskeletal complaints, history of heat
- intolerance, fevers of unknown origin, or unusual drug reaction.•Assess for family history of any sudden or unexplained death, especially during participation in athletic events.
- •Assess for subclinical muscle weakness.
- •Assess for other physical features suggestive of an under-lying genetic condition, such as contractures, kyphoscoliosis, and pterygium with progressive weakness. Management Issues Speciﬁc to Genetics
- •Inquire whether DNA mutation or other genetic testing has been performed on an affected family member.
- •If indicated, refer for further genetic counseling and evaluation so that family members can discuss inheritance, risk to other family members, availability of diagnostic/genetic testing.
- •Offer appropriate genetics information and resources.
- •Assess patient’s understanding of genetics information.
- •Provide support to families with newly diagnosed malignant hyperthermia.
- •Participate in management and coordination of care of patients with genetic conditions and individuals predisposed to develop or pass on a genetic condition.
To allow collagen deposition and wound healing to occur; Collagen deposition leading to impaired/delayed wound healing Decreased skin and wound strength Increased wound infection rates
Arginine (amino acid)-
To provide necessary substrate for collagen synthesis and nitric oxide (crucial for woundhealing) at wound siteTo increase wound strength and collagen depositionTo stimulate T-cell responseAssociated with a variety of essential reactions of intermediary metabolism; Impaired wound healing
Carbohydrates and fats-
- Primary source of energy in the body and consequently in the wound healing process To meet the demand for increased essential fatty acids needed for cellular function after an injury To spare protein To restore normal weight;
- Signs and symptoms of protein deﬁciency due to use of protein to meet energy requirements Extensive weight loss
Water - To
replace ﬂuid lost through vomiting, hemorrhage, exudates, fever, drainage,
dieresis To maintain homeostasis; Signs, symptoms, and complications of
dehydration, such as poor skin turgor, dry mucous membranes, oliguria, anuria,
weight loss, increased pulse rate, decreased central venous pressure
- To replace ﬂuid lost through vomiting, hemorrhage, exudates, fever, drainage, dieresis To maintain homeostasis; Signs, symptoms, and complications of dehydration, such as poor skin turgor, dry mucous membranes, oliguria, anuria,
- weight loss, increased pulse rate, decreased central venous pressure
Vitamin C -
Important for capillary formation, tissue synthesis, and wound healing through collagen formation Needed for antibody formation; Impaired/delayed wound healing related to impaired collagen formation and increased capillary fragility and permeability Increased risk for infection related to decreased antibodies
Vitamin B complex -
- Indirect role in wound healing through their inﬂuence on host
- resistance; Decreased enzymes available for energy metabolism
Vitamin A -
Increases inﬂammatory response in wounds, reduces anti-inﬂammatory effects of corticosteroids on wound healing; Impaired/delayed wound healing related to decreased collagen synthesis; impaired immune function Increased risk for infection
Vitamin K -
Important for normal blood clotting Impaired intestinal synthesis associated with the use of antibiotics; Prolonged prothrombin time Hematomas contributing to impaired healing and predisposition to wound infections
Essential cofactor for many enzymes that are involved in the process of protein synthesis and wound repair; Impaired/delayed wound healing (impaired collagen production)
Required cofactor in the development of connective tissue; Impaired wound healing
Involved in DNA synthesis, protein synthesis, cellular proliferation needed for wound healing Essential to immune function; Impaired immune response
The liver is important in the
biotransformation of anes-thetic compounds.
The kidneys are involved in
- excreting anesthetic med-ications and their metabolites; therefore, surgery is con-traindicated if a patient has acute
- nephritis, acute renal in-sufficiency with oliguria or anuria, or other acute renalproblems . Exceptions include surgeriesperformed as lifesaving measures or those necessary to im-prove urinary function (ie, obstructive uropathy).
develop during anesthesia or postoperatively from in-adequate carbohydrates or excessive administration of in-sulin. Hyperglycemia, which can increase the risk for surgi-cal wound infection, may result from the stress of surgery,which can trigger increased levels of catecholamine.
Prednisone (Deltasone) Cardiovascular collapse can occur if discontinued suddenly. Therefore, a bolus of corticosteroid may be administered intravenously immediately before and after surgery.
Hydrochlorothiazide (HydroDIURIL) During anesthesia, may cause excessive respiratory depression resulting from an associated electrolyte imbalance
Chlorpromazine (Thorazine) May increase the hypotensive action of anesthetics
Diazepam (Valium) May cause anxiety, tension, and even seizures if withdrawn suddenly
Interaction between anesthetics and insulin must be considered when a patient with diabetes is undergoing surgery. Intravenous insulin may need to be administered to keep the blood glucose within the normal range.
Erythromycin (Ery-Tab) When combined with a curariform muscle relaxant, nerve transmission is interrupted and apneafrom respiratory paralysis may result.
Warfarin (Coumadin) Can increase the risk of bleeding during the intraoperative and postoperative periods; should bediscontinued in anticipation of elective surgery. The surgeon will determine how long before theelective surgery the patient should stop taking an anticoagulant, depending on the type ofplanned procedure and the medical condition of the patient.
Intravenous administration of medication may be needed to keep the patient seizure-free in theintraoperative and postoperative periods.
Levothyroxine sodium (Levothroid) Intravenous administration may be needed during the postoperative period to maintain thyroid levels.
Long-term use of opioids for chronic pain (6 mo or greater) in the preoperative period may alter the patient’s response to analgesic agents.
The patient is transferred to the holding area about ___minutes
The patient is transferred to the holding area or presurgical suite in a bed or on a stretcher about 30 to 60 minutes be-fore the anesthetic is to be given.
a rare life-threatening conditiontriggered by exposure to most anesthetic agents induc-ing a drastic and uncontrolled increase in skeletal muscle oxidative metabolism that can overwhelm the body’scapacity to supply oxygen, remove carbon dioxide, andregulate body temperature, eventually leading to circula-tory collapse and death if untreated. Malignanthyperthermia is often inherited as an autosomaldominant disorder
previously referred to as conscioussedation, involves use of sedation to depress the levelof consciousness without altering the patient’s ability tomaintain a patent airway and to respond to physicalstimuli and verbal commands
monitored anesthesia care-
- moderate sedation adminis-tered by an anesthesiologist or
- an anesthetic agent is injected aroundnerves so that the area
- supplied by these nerves is anes-thetized
area in the operating room where scrubattire and surgical masks are required; includes operat-ing room and sterile core areas
registered nurse, licensed practical nurse, orsurgical technologist who scrubs and dons sterile surgi-cal attire, prepares instruments and supplies, and handsinstruments to the surgeon during the procedure
area in the operating room wherescrub attire is required; may include areas where surgi-cal instruments are processed
- achieved when a local anesthetic agentis introduced into the
- subarachnoid space of the spinalcord
absence of microorganisms in the surgi-cal environment to reduce the risk for infection
area in the operating room thatinterfaces with other departments; includes patient re-ception area and holding area
a state of narcosis, analgesia, relaxation, andloss of reﬂexes
physician trained to deliver anesthesiaand to monitor the patient’s condition during surgery
the substance, such as a chemical orgas, used to induce anesthesia
health care professional, such as a nurseanesthetist, who is trained to deliver anesthesia and tomonitor the patient’s condition during surgery
circulating nurse (or circulator)-
- registered nurse who co-ordinates and documents patient
- care in the operatingroom
- state of narcosis, analgesia, relaxation,and loss of reﬂexes
- achieved by injecting an anestheticagent into the epidural space of the spinal cord
- state of narcosis, analgesia,relaxation, and loss of reﬂexes
- produced by pharmaco-logic agents
- injection of a solution containing theanesthetic agent into the
- tissues at the planned incisionsite
Airborne bacteria are a concern. To decrease the amount of bacteria in the air,
- standard OR ventilation pro-vides 15 air exchanges per hour, at least three of which are fresh air (Phillips, 2007). A room temperature of 20C to24C (68F to 73F),
- humidity between 30% and 60%, and positive pressure relative to adjacent areas are maintained. Staff members shed skin scales, resulting in about 1000bacteria-carrying particles (or colony-forming units[CFUs]) per cubic foot
- per minute. With the standard air exchanges, air counts of bacteria are reduced to 50 to 150CFUs per cubic foot per minute. Systems with high-efficiency particulate air (HEPA) filters are needed to remove particles larger than 0.3 µm
Stage I: beginning anesthesia-
As the patient breathes in the anesthetic mixture, warmth, dizziness, and a feeling of detachment may be experienced. The patient may have a ringing, roaring, or buzzing in the ears and, although still conscious, may sense an inability to move the extremities easily. During this stage, noises are exaggerated; even low voices or minor sounds seem loud and unreal. For this reason, unnecessary noises and motions are avoided when anesthesia begins.
Stage II: excitement. The excitement stage-
- characterized variously by struggling, shouting, talking, singing, laughing, or crying, is often avoided if the anesthetic agent is administered smoothly and quickly. The pupils dilate, but they contract if exposed to light; the pulse rate is rapid, and respirations may be irregular. Because of the possibility of uncontrolled movements of the patient during this stage, the anesthesiologist or anesthetist must always be
- assisted by someone ready to help restrain the patient. Manipulation increases circulation to the operative site and thereby increases the potential for bleeding
Stage III: surgical anesthesia-
- reached by continued administration of the anesthetic vapor or gas. The patient is unconscious and lies quietly on the table. The pupils are small but contract when exposed to
- light. Respirations are regular, the pulse rate and volume are normal, and the skin is pink or slightly ﬂushed. With proper administration of the anesthetic agent, this stage may be aintained for hours in one of several planes, ranging from light (1) to deep (4), de-pending on the depth of anesthesia needed.
Stage IV: medullary depression-
- This stage is reached if too much anesthesia has been
- administered. Respirations become shallow, the pulse is weak and thready, and the pupils become widely dilated and no longer contract when exposed to light. Cyanosis develops and, without prompt intervention, death rapidly follows. If
- this stage develops, the anesthetic agent is discontinued mmediately and respiratory and circulatory sup-port is nitiated to prevent death. Stimulants, although rarely used, may be administered; narcotic antagonists can be used if the over dosage is due to opioids.
During anesthesia, the patient’s temperature may fall.
Glu-cose metabolism is reduced, and, as a result, metabolic aci-dosis may develop. This condition is called hypothermiaand is indicated by a core body temperature that is lower than normal
- is a rare inherited muscle dis-order that is chemically induced by anesthetic agents(Rothrock, 2007). MH can be triggered by myopathies, emo-tional stress, heatstroke, neuroleptic malignant syndrome,strenuous exercise exertion, and
- trauma. Susceptible people include those with strongand bulky muscles, a history of muscle cramps or muscle weak-ness and unexplained temperature elevation, and an unex-plained death of a family member during surgery that was ac-companied by a febrile response
This disruption ofcalcium causes clinical symptoms of
hypermetabolism,which in turn increases muscle contraction (rigidity) andcauses hyperthermia and subsequent damage to the centralnervous system.
nursing diagnosesmay include the following:
Anxiety related to surgical or environmental concerns•Risk of latex allergy response due to possible exposureto latex in OR environment
partial or complete separation of wound edges
protrusion of organs through the surgical incision
method of healing in which woundedges are surgically approximated and integumentarycontinuity is restored without granulation
Phase I PACU-
area designated for care of surgical patientsimmediately after surgery and for patients whose condi-tion warrants close monitoring
Phase II PACU-
area designated for care of surgicalpatients who have been transferred from a phase IPACU because their condition no longer requires theclose monitoring provided in a phase I PACU
Phase III PACU-
- setting in which the patient is cared for inthe immediate
- postoperative period and then preparedfor discharge from the facility
postanesthesia care unit (PACU)-
- area where postopera-tive patients are monitored as they
- recover from anes-thesia; formerly referred to as the recovery room orpostanesthesia recovery room
method of healing in whichwound edges are not surgically approximated andintegumentary continuity is restored by the processknown as granulation
method of healing in which surgi-cal approximation of wound edges is delayed andintegumentary continuity is restored by apposing areasof granulation
when would you be in phasesI,II,III?
- phase I PACU,used during the immediaterecovery phase, intensive nursing care is provided.
- In thephase II PACU,the patient is prepared for self-care orcare in the hospital or an extended care setting.
- In phaseIII PACU,the patient is prepared for discharge.
- Based on the assessment data, major nursing diagnoses mayinclude the following:
- •Risk for ineffective airway clearance related to de-pressed
- respiratory function, pain, and bed rest
- •Acute pain related to surgical incision
- •Decreased cardiac output related to shock or hemorrhage •Risk for activity intolerance related to generalizedweakness secondary to surgery
- •Impaired skin integrity related to surgical incision
- and drains
- •Ineffective thermoregulation related to surgical envi-ronment and anesthetic agents
- •Risk for imbalanced nutrition, less than body require-ments related to decreased intake and increased needfor nutrients secondary to surgery
- •Risk for constipation related to effects of medications,surgery, dietary change, and immobility
- •Risk for urinary retention related to anesthetic agents
- •Risk for injury related to surgical procedure/positioningor anesthetic agents
- •Anxiety related to surgical procedure•Risk for ineffective management of therapeutic regi-men related to wound care, dietary restrictions, activ-ity recommendations, medications, follow-up care, orsigns and symptoms of complications
- Collaborative Problems or Potential Complications Based
- on the assessment data, potential complications mayinclude the following:
- •Pulmonary infection/hypoxia
- •Deep vein thrombosis (DVT)
- •Hematoma or hemorrhage
- •Pulmonary embolism
- •Wound dehiscence or evisceration
circulatory shock state resulting froma severe allergic reaction producing an overwhelmingsystemic vasodilation and relative hypovolemia
messenger substances that maybe released by a cell to create an action at that site orbe carried by the bloodstream to a distant site beforebeing activated; also called cytokines
shock state resulting from impairmentor failure of the myocardium
shock state resulting fromdisplacement of blood volume creating a relative hypov-olemia and inadequate delivery of oxygen to the cells;also called distributive shock
intravenous solutions that contain molecules thatare too large to pass through capillary membranes
intravenous electrolyte solutions that movefreely between the intravascular compartment and interstitial spaces
shock state resulting from decreasedintravascular volume due to ﬂuid loss
multiple organ dysfunction syndrome-
presence ofaltered function of two or more organs in an acutely illpatient such that interventions are necessary to supportcontinued organ function
shock state resulting from loss of sym-pathetic tone causing relative hypovolemia
circulatory shock state resulting fromoverwhelming infection causing relative hypovolemia
physiologic state in which there is inadequate blood ﬂow to tissues and cells of the body
systemic inﬂammatory response syndrome-
overwhelming inﬂammatory response in the absence of infectioncausing relative hypovolemia and decreased tissue perfusion
management in all types and all phases ofshock includes the following-
- •Support of the respiratory system with supplementaloxygen and/or mechanical ventilation to provide optimal oxygenation •Fluid replacement to restore intravascular volume •Vasoactive medications to restore vasomotor tone and improve cardiac function
- •Nutritional support to address the metabolic requirements that are often dramatically increased in shock
When vasoactive medications are administered-
When vasoactive medications are administered, vitalsigns must be monitored frequently (at least every 15 minutes until stable, or more often if indicated). Vasoactive medications should be administered through a central venous line, because inﬁltration and extravasation of some asoactive medications can cause tissue necrosis and sloughing. An IV pump or controller should be used to ensure that the medications are delivered safely and accurately
- is initiated to assess the patient’sresponse to treatment. In many
- institutions, this is per-formed in the intensive care unit (ICU), where an arterialline can be inserted.
Medications commonly combined to treat cardiogenic shock include
dobutamine, nitroglycerin, and dopamine.
produces in otropic effects by stimulating myocardial beta-receptors, increasing the strength of myocardial activity and improving cardiac out-put.
IV nitroglycerin in low doses acts as a venousvasodilator and therefore reduces preload. At higher doses,nitroglycerin causes arterial vasodilation and therefore re-duces afterload as well.
is a sympathomimetic agent that hasvarying vasoactive effects depending on the dosage. It may be used with dobutamine and nitroglycerin to improve tissue perfusion.
vasoactive agentsthat may be used in managing cardiogenic shock include-
norepinephrine, epinephrine, milrinone, vasopressin, and phenylephrine.
Drotrecogin alfa(Xigris) -
- Drotrecogin alfa(Xigris)- acts as an antithrombotic, anti-inﬂammatory, andproﬁbrinolytic agent.
- Drotrecogin alfa- acts as an anti-inﬂammatory cytokine, it stimulates
- ﬁbrinolysis- restoring bal-ance in the coagulation–anticoagulation homeostatic processof the body’s inﬂammatory response to injury and infection.
- Drotrecogin alfa- has provided a signiﬁcant breakthroughin the successful pharmacologic treatment of patients with sepsis.
It is important to elevate and maintain the head of the bed at least __ degrees to prevent neurogenic shock when a patient receives spinal or epidural anesthesia.
It is important to elevate and maintain the head of the bed at least 30 degrees to prevent neurogenic shock when a patient receives spinal or epidural anesthesia.
what are some inhalation anesthetic drugs?