adult I

Card Set Information

adult I
2011-07-17 22:57:49
peri op anesthesia

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  1. perioperative nursing
    wide variety of nursing functions associated with the patient's surgical procedure
  2. perianesthesia nursing
    wise variety of nursing functions associated with the patient's care before and after anesthesia
  3. preoperative phase
    • begins when decision for surgical intervention is made
    • ends with transfer of the patient to the operating room table
  4. preoperative teaching
    • assess level of understanding
    • explain pre and post-operative procedures
    • medications
    • coughing and deep breathing exercises
    • splinting of incision (putting a blanket/pillow over an abdominal incision when coughing)
    • turning side-to-side
    • leg exercises
  5. preoperative medication restrictions
    OTC drugs - stop taking two weeks prior to surgery

    all other prescribed meds are usually taken up until the day of surgery, unless otherwise stated
  6. with informed consent, the patient understands:
    • nature and reason for surgery
    • who will perform the surgery & others who will be present
    • all available options and risks associated with each
    • risks associated with surgical procedure and potential outcomes
    • risks associated with anesthesia
  7. preoperative medications: antianxiety
    diazepam (valium)
  8. preoperative medications: sedatives
  9. preoperative medications: analgesics
    morphine sulfate
  10. preoperative medications: anticholinergics (decrease oral secretions = decrease in chance of aspiration)
    • atropine sulfate
    • glycopyrrolate
  11. preoperative medications: H-2 Receptor antagonist (for patients at risk for vomiting)
    zantac, axid, tagamet
  12. intraoperative phase
    • begins when patient is admitted or transferred to the surery department
    • ends when patient is admitted to the recovery area (post anesthesia/PACU)
  13. universal protocol for preventing wrong site, wrong procedure, wrong person surgery
    • preoperative verification process
    • marking with operative site
    • "time out" immediately before starting the procedure
  14. anesthesia induction
    the point at which anesthesia is inititated just prior to the first incision cut
  15. general anesthesia
    • controlled loss of consiousness
    • protective reflexes lost
    • sedation and analgesia
    • muscle relaxation
    • IV agents, inhalation agents, narcotics
  16. general anesthesia complications
    • CNS: emergence delerium; delayed emergence
    • CV: hypotension, dysrhythmias, MI
    • hypothermia (temp less than 95)
    • repiratory: laryngospasm
    • malignant hyperthermia
  17. malignant hyperthermia (MH)
    • chain reaction of abnormalities
    • pharmacogenetic disease of skeletal muscle (muscle breakdown = heat production)
    • inherited disorder (single defective gene)
    • laboratory tests: caffiene, halothane contracture test
  18. MH signs and symptoms
    • early signs: muscle rigidity, tachycardia and dysrhythmias
    • cutatneous changes
    • tachypnea
    • pyrexia (hallmark of disease but late sign)
  19. management of MH crisis
    • discontinue anesthesia/surgery
    • administer 100% oxygen
    • administer Dantrolene ASAP (reconstitte with 60 mL PF sterile water) - ONLY drug that can treat MH
    • patient cooling
  20. types of regional anesthesia
    • spinal
    • epidural
    • caudal
    • peripheral nerve block
    • intravenous (bier block)
    • infiltration block
    • field block
    • topical
    • local
  21. advantages of regional anesthesia
    • fewer complications
    • decreased pain
    • faster recovery
  22. dermatomes
    • used to determine level of block
    • access level using a sharp, dull, or cold test item
  23. MAC
    • monitored anesthesia care
    • administered by anesthesia provider
    • pt maintains own airway
    • all IV
  24. conscious/moderate sedation
    • minimally depressed level of consciousness in which the patient retains the ability to maintain a patent airway independently and continuously and is able to respond appropriately to verbal commands
    • administered by a non-anesthesia provider who has received speial training
  25. postoperative phase
    • begins with the admission of the patient to the recovery area
    • ends with a follow-up evaluation in the clinical setting or at home
  26. PACU care
    monitoring patient for sings and symptoms of anesthesia and/or surgery/procedure complications
  27. postoperative assessment
    vital signs are the first item assessed -- RR is most important!
  28. wound dehisscence
    • seperation of the wond edges
    • more likely wih vertical incisions
    • may be caused by a bacterial infection or poor wont healing
  29. evisceration
    • protrusion of loops of bowel accompanied by escape of pink, serous drainage
    • more likely in patients who are older, obese, diabetic, or malnourished
    • emergency situation - patient must be readmitted to OR
    • prevention: splint incision
  30. common complications
    • urinary retention
    • pulmonary problems: atelectasis, pneumonia, embolus
    • thrombophlebitis
    • decreased GI peristalsis (prevented by BG tube, encourage early ambulation)