Care of the Perioperative Patient

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  1. Nurse's major roles during surgery
    • maintain patient safety
    • maintain comfort
    • return to optimal functioning
  2. The physiological neuroendocrine response to surgery
    • neuroendocrine stimulates the SNS "Fight or Flight"
    • Results in compensatory vasoconstriction, increased HR and BP
    • Results in decreased peristalsis, which can lead to anorexia, constipation, ileus
  3. The physiological hormonal response to surgery
    • Norepinephrine increases HR
    • Aldosterone increases fluid/Na retention, decreases urine output.
    • Glucocorticoids cause increased blood sugar
  4. Even when a patient is under physiologic stress, they must have this minimum volume of urine output.
    30 mL/h
  5. The physiological metabolic response to surgery
    • relative rate of starvation
    • gluconeogenesis
    • fat metabolism
    • protein breakdown
    • negative nitrogen balance
  6. Psychological responses to surgery
    • increased anxiety and fear
    • r/t cause for surgery
    • r/t poor coping skills
  7. Nursing focus pre-op
    Thorough Assessment and History
  8. Pt Hx pre-op should include
    • Meds - hold insulin, ASA, coumadin and heparin
    • weight - measurement of fluid status
    • smoking - respiratory risk factor
    • age - affects metabolic rate
    • chronic illnesses
    • allergies - latex, tape, iodine
  9. Risk factors for poor surgical outcomes in geriatric population
    • advanced age (>73)
    • multiple meds/conditions
    • poor functional status at baseline
    • poor nutrition
    • impaired cognition
    • limited support at home
  10. Strongest predictors of poor outcomes in geriatric population
    • recent MI
    • uncompensated CHF
    • unstable ischemic heart disease
    • cardiac rhythm disorders
  11. Meds for periop care
    • Valium - anti-anxiety
    • Ancef - anti-infection
    • Atropine - dries secretions, eases intubation
  12. Preoperative teaching
    • Hourly turning, C+DB, incentive spirometer (S)
    • Post-op exercises, ambulation, positioning
    • SCD's, Lovenox
    • Pain management (PCA pump, pain scales)
    • Incisions, Dressings, Tubes, Drain care
    • Diet, activity restrictions
  13. What is the typical diet following surgery?
    liquids first until bowel sounds return
  14. Pre-op checklists includes
    • ID band on and correct
    • Nail polish off (pulse ox), jewelry off or taped
    • dentures out, clothing off
    • labs/x-rays done and results available
    • pre-op meds given, IV patent
    • consent signed and on chart
  15. Informed consent
    • legal responsibility is physician's
    • RN verifies pt signature/understanding, can witness
  16. Medications used for conscious sedation
    • combo of opioids, sedatives, benzo's, anesthetics
    • Fentanyl/Versed is common
  17. Effects of conscious sedation on patient
    • Depresses LOC minimally
    • maintains airway
    • Pt. responds to stimuli/verbal commands
    • mild amnesia
  18. Effects of regional anesthesia on patient
    • does not produce LOC
    • suspends sensation in parts of body
  19. Types of regional anesthesia
    • short acting: local (lidocaine) or nerve block
    • long acting: spinal, epidural
  20. If general anesthesia is contraindicated, use this
    • regional anesthesia
    • safer
  21. Effects of general anesthesia on patient
    • suspension of sensation in entire body
    • artificial airway is necessary
    • adjust doses in elderly!
  22. What is TIVA?
    • Total IV Anesthesia (general)
    • Usually Propofol/Fentanyl
  23. Anesthesia used for high risk cases
    • inhaled
    • Isoflurane, Nitrous oxide
  24. Phases of general anesthesia
    • Pre-induction: apply monitoring equipment
    • Induction: patient asleep, endotrachial tube or laryngeal mask airway
    • Maintenance: stabilization, positioning and monitoring
    • Reversal/Emergence: wound closure, awakening, uncontrolled spasms possible, high risk for laryngospasm
  25. What are the advantages of using general anesthesia?
    • rapid
    • pleasant onset of unconscious state
    • analgesia
    • reflex loss
  26. What are the disadvantages of using general anesthesia?
    • slow excretion so complications hard to control
    • more risk for organ complications
  27. Opioid reversal agent
    Naloxone (Narcan)
  28. Benzodiazepine reversal agent
    Flumazenil (Romazicon)
  29. Complications during surgery
    • hypoxia
    • hypotension
    • bodily injury
    • hypothermia
  30. S/S of hypobentilation
  31. S/S of pneumonia
    • SOB
    • fever
    • cough
    • rhonchi
  32. S/S of atelectasis
    • SOB
    • diminished lung sounds
  33. S/S of pulmonary embolism
    • SOB
    • chest pain
    • hypoxia
  34. Respiratory assessment post-op
    • C+DB, IS q1h with assistance
    • O2 pulse ox >92%, MM pink
    • cap refill <3 sec
    • splint to cough
    • HOB >30
    • early ambulation
  35. Hematologic complications are all related to this
Card Set:
Care of the Perioperative Patient
2015-09-27 18:16:22
MedSurg lecture
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