the most serious side effect/ complication of using opiates
psychological dependence-addiction and cravings for drug
physical dependence- withdrawal
what is addiction
primary chronic neurobiologic disease with genentic, psychosocial, and environmental factors. behaviors include impaired control over drug use, compulsive use and continued use despite harm and cravings
Addiction occurs of long time-not one hospital stay
created by undertreatment of pain
patient behaviors such as anger and escalating demands for more or different medications
Pseudoaddiction can be distinguished from addiction by- when pain is treated the behaviors stop
state of adaption in which patient becomes tolerant to a drug after taking it for a while the body gets used to it and it takes more to work
patient will have withdrawal when medication is stopped
the best way to prevent addiction from occurring in a pt who is physically dependant
slowly decrease the med so the patient does not feel it
what are the S/S of withdrawal?
how do antagonists work?
they remove the opioid from the receptor and cover so the opioids cannot reattach.
completely reveres the effect of the opioid
best used for....
teach to only take rec dose. it has ceiling effect and taking more will only cause liver damage
watch for hepatic necrosis, and hepatic toxicity
best used as antipyretic
Does not treat inflammation
examples of NSAIDS
Side Effects of NSAIDS
Nursing Implications for NSAIDS
watch for S/S bleeding, gastris upset and nausea
Give with food
Should be DC several days prior to surgical procedure
Troadol is only IV NSAID
ASA is a ______ but it is technical considered a _______
Guide for treatment of pain
1-4 mild use nonnarcotic meds
5-7 moderate use narcotic and nonnarcotic, PO Meds
8-10 severe use narcotics parenteral (IM,IV)
Always Reassess PO Meds 1 hour after
IM or IV 30mins after
What is a TENS Unit
Transcutaneous Electrical Nerve Stimulator
provides skin stimulation to produce pain relief
works for acute and chronic pain
What is a Spinal or Epidural
Epidural catheter is placed in epidural space near not spinal cord and left in as long as needed
Spinal is an injection into the cerebrospinal fluid that produces loss of autonomic, sensory and motor nerve conduction, it lasts about 2 hours
good for lower abdominal and pelvic surgery
patient controlled analgesia pump
preset amount of med, patient can push the button and med is delivered at preset intervals
meds that are given along with a narcotic to enhance the effect
what is it and how is it obtained?
consent implies that the patient has sufficient info and understandsreason for surgery, who will preform, all options and risks, risks associated with anesthesiaObtained by nurse but is surgeons responsibility
who can sigh consent
must be over 18
parent an sing for minor
medical power of attorney
if pt cannot write they can put an X but it must be witnessed by 2 nurses
what is importance of baseline assessment
to document everything about a patient it will be used after surgery
example patient has weak pulses prior to surgery and not documented, after surgery nurse checks and finds weak pulse and they will think it is new onset and complication
what is involved in Baseline pre-op assessment?
use of alcohol, drugs and Rx drugs
Prior Surgical History
Did Pt Donate their own blood
General Health & Family History
Complete Physical Exam
what is the purpose of pre-op meds?
to decrease anxiety
inhibit gastric secretions
decrease the amount of anesthesia required for induction
If any abnormals are found before surgery who needs to be notified?
Surgeon and Anesthesia
What is the purpose of having a patient NPO?
How Long should they be NPO?
To prevent Aspiration
8 hours, includes smoking
What are the roles of a circulator nurse?
RN who coordinates, oversees and is involved in the clients nursing care performed in the OR
performs counts ad time out
Monitors Traffic in the room
Assesses the amount of urine and blood loss
records what procedure was done
ensures sterility by surgical team
anticipates needs and provides supplies
CN is not sterile
What is the role of scrub nurse
sets up sterile field
assists team with gowning and gloving
maintains accurate count of sharps, sponges and instruments
1st count procedure
2nd start to come out
3rd half way out
4th right before close
What are the dangerous items in the OR
Sharps, scalpel, suture instruments
What causes malignant hypothermia
what is the importance of surgical positioning?
prevent skin breakdown
prevent joint pain, stiffness after
What are the 4 stages of anesthesia
1:Analgesia and sedation, relaxation
3:Operative Anesthesia, Surgical Anesthesia
what is balanced anesthesia
combination of agents to keep from using as much gas
Stage 1 of general anesthesia
begins with induction and ends with loss of consciousness
feels drowsy and dizzy reduced sensation to pain
HEARING is EXAGGERATED
Stage 2 of general anesthesia
begins with loss of consciousness and ends with relaxation, regular breathing loss of eyelid reflex
Vomiting may occur
Patient susceptible to external stimuli DO NOT MOVE OR TOUCH
Stage 3 general anesthesia
begins with generalized muscle relaxation and ends with loss of reflexes depressed vital functions
patient cannot hear all sensations are lost
Nurse should PREP and position
Stage 4 general anesthesia
may have respiratory or cardiac arrest
early S/S of Malignant Hyperthermia
sinus tachycardia, tachypnea
Muscle Rigidity esp jaw and upper chest
late S/S malignant hyperthermia
extremely elevated body temp
treatment of malignant hyperthermia
NG Tube irrigation with ice water
treat other s/s
if caught before late S/S (Temp Change) pt has better chance
what is local infiltration
when is appropriate
how to give
injection of a anesthetic agent directly into the tissue surrounding an incision, wound or lesion
it blocks the nerve impulses to specific site
make sure to aspirate
what is the purpose of anesthesia
to block nerve impulse transmission
promote muscle relaxation
and achieve a controlled level of unconsiousness
what is significant assessment for a pt who is intubated?
check for equal breath sounds and bilateral chest expansion
this is to make sure the tube did not move or become displaced
Restlessness and Agitation are most often early signs of.....
always care for patient with____ in mind especially in the PACU
Consciousness (mental Status)
Patient with gastric surgery should never have ....
their NG tubes moved or irrigated without a specific order
After surgery it is important to compare......
compare all findings with baseline pre-op findings
you should report any change in VS that is __ change from baseline VS
if patient has 25% change in VS notify physician
Evisceration: what is it?
what to do when it happens?
what causes it?
1st have pt lie flat with knees flexed, stay with patient, cover wound with sterile NS soaked gauze, call for help
Call Dr to notify
Find out pts NPO status
what is wound dehiscence?
how is it treated and what is the cause
splitting or partial opening of an incision
usually from infection
Should be left open to drain, treat with Abx and wet to dry dressing
S/S of a post op infection?
Swelling around the incision
Purulent or Odorous drainage
REPORT TO SURGEON
Who is at risk for DVT postoperatively?
lower extremity trauma
use of oral contraceptives
pts on chemotherapy
presence of PE (current or past)
pts with PVD
what are complications of immobility that we worry about postop?
Bowel Sounds should be auscultated postop, but until the pt is 24 hours postop ______ is a normal finding
no bowel sounds is a normal finding for 1st 24 hours after surgery, Document the findings
what is paralytic ileus?
decreased or absent peristalsis
S/S: few or absent bowel sounds, N/V, abdominal pain, abdominal distention
Tx: NGT to low suction for GI rest, NPO for GI rest, IV Fluids, wait for bowel sounds to return
Dx by abdominal x-ray
Types of Post Operative Hemorrhage
Concealed - bleeding inside the body. Pain and swelling around incision
Evident- Bleeding outside the body via incision
Signs of hypovolemia from blood loss
Later signs: decreasing HGB, decreasing O2 sats, paleness and pallor
treatment for hypovolemia
trendelenburg or modified trendelenburg
IV Fluids: Lactated Ringers (volume expanders)
continuous pulse Ox
check HGB and HCT
If evident bleeding put pressure over bleeding area