Chapter 17

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swansokj02
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196088
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Chapter 17
Updated:
2013-01-28 18:36:04
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Care Intraoperative Patients
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Intraoperative nursing
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  1. optimal surgery room atmostphere
    between 68 and 73 degrees F with low humidity (20%-60%)
  2. insufflation
    injecting gas or air into the cavity before surgery to separate organs and improve visualization
  3. purpose of anesthesia
    block nerve impulse transmission, suppress reflexes, promote muscle relaxation, achieve a controlled level of unconciousness.
  4. general anesthesia
    • reversible loss of consciousness induced by inhibiting nueronal impulses in several areas of the CNS.
    • Can be achieved with a single agent or a combination of agents.
    • **used most often in surgery of the head, neck, upper torso, and abdomen**
  5. 3 types of general anesthesia
    Inhalation (most controllable), Intravenous, and Balanced
  6. Malignant hypothermia
    Begins in the skeletal muscle exposed to a specific agents, causing increased calcium levels in muscle cells and increased muscle metabolism. Serum calcium and potassium levels are increased, as is metabolic rate, leading to acidosis, dysrythmias, and high body temperature.
  7. indications of MH
    tachycardia, dysrythmia, muscle rigidity, hypotension, tachypnea, skin mottling, cyanosis, myoglobinuria, unexpected rise in the end tidal carbon dioxide level with a decrease in O2 saturation.
  8. 4 stages of general anesthesia
    • Stage 1- analgesia and sedation, relaxation
    • stage 2- excitement, delerium
    • stage 3- operative anesthesia, surgical anesthesia
    • stage 4- danger
  9. stage 1 of G.A.
    patient feels drowsy and dizzy, has reduced sensation to pain, hearing is exaggerated. BEGINS WITH INDUCTION AND ENDS WITH UNCONSCIOUSNESS.
  10. stage 2 of G.A.
    BEGINS WITH LOSS OF CONSCIOUSNESS AND ENDS WITH RELAXATION, REGULAR BREATHING, AND LOSS OF EYELID REFLEX. Laryngospasm or vommiting may occur.
  11. stage 3 of G.A.
    BEGINS WITH GENERALIZED MUSCLE RELAXATION AND ENDS WITH LOSS OF REFLEXES AND DEPRESSION OF VITAL FUNCTIONS. jaw is relaxed, breathing is quiet and regular. Patient cannot hear, sensations are lost.
  12. stage 4 of G.A.
    BEGINS WITH DEPRESSION OF VITAL FUNCTIONS AND ENDS WITH RESPIRATORY FAILURE, CARDIAC ARREST, AND POSSIBLE DEATH. Resp. muscles are paralyzed, apnea occurs. pupils are fixed and dilated.
  13. Local or regional anesthesia
    briefly disrupts sensory nerve impulse transmission from a specific body area or region. Pt. remains conscious. It is often supplemented with sedatives, opioids, or hypnotics.
  14. Local anesthesia
    delivered topically (applied to the skin or mucous membranes of the area to be anesthetized) and by local infiltration.
  15. regional anesthesia (4 types)
    • type of local anesthesia that blocks multiple peripheral nerves in a specific body region.
    • Field Block
    • Nerve Block
    • Spinal anesthesia
    • epidural anesthesia
  16. Field Block
    • a series of injections around the operative field
    • used most commonly for chest procedures, hernia repair, dental surgery, some plastic surgeries
  17. Nerve Block
    • injection of the local anesthetic agent into or around one nerve or group of nerves in the involved area.
    • most commonly used for limb surgery or to relieve chronic pain
  18. Spinal anesthesia
    • Injection of an anesthetic agent into the cerebrospinal fluid in the subarachnoid space.
    • most commonly used for lower abdominal, pelvic, hip, and knee surgery
  19. epidural anesthesia
    • injection of an agent into the epidural space.
    • most commonly used for vaginal, perineal, hip, and lower extremity surgeries
  20. moderate sedation
    • conscious sedation.
    • reduces the level of consciousness but allows the pt. to maintain a patent airway and to response to verbal commands
    • used for endoscopy, cardia catheterization, closed fracture reduction, cardioversion

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