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NURS 1250 > GI Disorders and PeriOperative Care > Flashcards

GI Disorders and PeriOperative Care Flashcards

1
Q

What is delegation?

A

Transfer of authority, responsibility to a competent individual. The nurse remains ACCOUNTABLE

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2
Q

Benefits of Delegation

A
  • nurse can perform more complex tasks
  • delegate builds new skills, develops trust
  • more time for undelegable tasks
  • less overtime, more productivity
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3
Q

What are the 6 elements of delegation?

A

1, No judgement based on nursing knowledge needed

  1. Results predictable
  2. safely performed with no alterations
  3. no complex observation/clinical decision needed
  4. does not require repeat nursing assessment
  5. consequence of improper performance non life-threatening
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4
Q

What are the principles for delegation?

A
  • nurse must assess patient before delegating
  • task must be routine
  • nurse must know delegation policies
  • nurse must know variations in ability/training
  • nurse must foster communication, teaching, learning
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5
Q

4 Steps of Delegation

A
  1. Assessment/planning
    - is this the right task to delegate?
  2. Communication
    - communicate expectations
  3. surveillance/supervision
    - is task being done correctly?
  4. evaluation/feedback
    - any problems? job well done!
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6
Q

5 Rights of Delegation

A
  1. Right task
  2. Right circumstance
  3. Right person
  4. Right direction/communication
  5. Right supervision/evaluation
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7
Q

What is civil law?

A

rights and duties of private persons, they usually want compensation

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8
Q

Tort

A

A civil wrong against an individual or individuals property

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9
Q

Unintentional Tort Types

A

Negligence: deviates from what a normal person would do in a similar situation

Malpractice: professional negligence

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10
Q

What must you prove for malpractice?

A
  1. Duty: relationship between patient and provider existed
  2. Breach of Duty: act or omission that violates standard of care
  3. foreseeability: could you see it would cause harm?
  4. causation: did act cause harm?
  5. injury
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11
Q

What are types of Intentional tort?

A
  1. Assault: creating apprehension
  2. Battery: touching w/o permission
  3. false imprisonment
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12
Q

Some things to remember about law

A
  1. NPA is state law
  2. document!
  3. obtain liability insurance
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13
Q

What is pancreatitis?

A

inflammation of pancreas - located LUQ behind stomach

autodigestion of pancreas, trypsin released too early

Can be acute (interstitial edamatous) or chronic (necrotizing, permanent)

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14
Q

What are the possible causes of pancreatitis?

A

Gallstone - most common - blocks bile duct

Alcoholism

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15
Q

Risk factors for pancreatitis

A 
T: toxic - metabolic (alcohol)
I: idiopathic (unknown)
G: genetic
A: autoimmune
R: recurrent/sever acute pancreatitis

O: obstructive: gallstone, fat, tumor, duct scars

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16
Q

Symptoms of acute pancreatitis

A
  • mid epigastric pain to upper back
  • abdominal distention
  • hypoactive bowel sounds D/T ileus
  • tachycardia D/T hypovolemia
  • hypotension D/T hypovolemia
  • jaundice
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17
Q

Symptoms of chronic pancreatitis

A
  • pain localized in LUQ
  • anorexia D/T nausea/pain
  • N/V D/T distention
  • steatorrhea D/T lack of enzymes
  • grey turners and cullens sign D/T blood seepage
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18
Q

complications of pancreatitis

A
  • cysts and absesses
  • SIRS: inflammation through whole body! tachycardia, hypotension, low or high temp, low or high WBC, monitor vitals
  • Respiratory complications: ARDS - monitor SPO2
  • renal/hepatic failure
  • pancreatic infection
  • malabsorption/diabetes
  • hypovolemia
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19
Q

Laboratory Tests for Pancreatitis

A
  • increased WBC
  • increased amylase
  • increased lipase
  • increased bilirubin
  • increased AST
  • increased ALT
  • increased triglycerides
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20
Q

Diagnostic Tests for Pancreatitis

A
  • U/S: to see if gallstones and size
  • CT: gallstone, infection
  • ERCP: down bile duct through throat
  • MRCP: type of MRI, detailed image
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21
Q

Pharmacotherapy Pancreatitis

A
  • NSAID

- first line

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22
Q

Pharmacotherapy Pancreatitis

A

NSAID (1st line), opioid analgesic, H2 Blockers, Proton Pump Inhibitor, Antibiotic (preventative), Pancreatic Enzymes

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23
Q

Diclofenac NA

A

NSAID for pancreatitis

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24
Q

Morphine, Hydromorphine

A

Opioid analgesic, morphine given first than dilauded

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25
Q

H2 Blockers

A
  • Reduce the production of gastric acid
  • treat ulcers, GERD, esophogitis
  • administer according to recommended time difference between meals
  • separate drug and antacid therapy by 1 hour
  • maitenance drug therapy given at bedtime
  • famotidine ( pepcid)
  • cimetidine ( tagemet)
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26
Q

Proton Pump Inhibitors

A
  • blocks final step in acid production w/o blocking histamine 2 . decreases hydrogen (acid) production
  • administer before meals
  • omeprazole (prilosec)
  • esomeprazole ( nexium)
  • iansoprazole ( prevacid)
  • pantoprazole (protonix)
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27
Q

impenem (primaxin)

A

antibiotic

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28
Q

Pancreatic Enzymes

A
  • creon (pancreas)
  • pancreatin (cotazym)
  • pancrelipase (viokase)
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29
Q

Nursing Management Pancreatitis

A
  • Rest pancreas NPO
  • NG tube, prevent intraabdominal pressure
  • TPN
  • high carb, high protein, low fat diet
  • IV access
  • Prevent hypovolemia (watch for fluid overload)
  • assess I/O, skin turgor
  • CIWA protocol
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30
Q

Goals of patient care with pancreatitis

A
  • decrease pain
  • adequate fluid/nutrition
  • increase respiratory function
  • behavior modification (diet)
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31
Q

What is cholecystitis?

A

inflammation of the gallbladder
located RUQ, under liver
gallbladder full of bile will empty after meal

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32
Q

Cholelithiasis

A

gallstones

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33
Q

Choledocholithiasis

A

bile duct stones

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34
Q

choleangitis

A

duct inflammation

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35
Q

cholecystits

A

gallbladder inflammation

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36
Q

Risk factors for cholecystitis

A 
Female
Forty
Fertile
Fat
Family
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37
Q

Prevention of cholecystitis

A

weight loss
diet low fat low cholesterol
certain meds cause GBD like estrogen, clofibrate

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38
Q

Cholecystitis signs and symptoms

A 
RUQ pain, cramping
Fat intolerance
N/V
Jaundice
Clay colored stool
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39
Q

Cholecystitis Complications

A 
Empyema (puss)
Gangrene
Peritonitis
Pancreatitis
Sepsis
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40
Q

What is murphys sign?

A

take a deep breth while palpating RUQ and if pain murphys sign is positive

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41
Q

Cholecystitis Lab Values

A

Increased WBC
increased serum bilirubin
increased amylase
increased lipase

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42
Q

What is the normal value for bilirubin?

A

1.2

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43
Q

Cholecystitis Diagnostic Tests

A

U/S: gallstone?
Cholecystogram: pic of gb with contrast tablet
HIDA Scan: cystic duct obstruction, cholcystitis

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44
Q

GBD Pharmacology

A

NSAID (1ST LINE), Opioids, antiemetic, antibiotic (preventative), gallstone solubizing agents

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45
Q

Celecoxib (celebrex), Ketorlac (toradol)

A

NSAID to treat GBD

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46
Q

Antiemetic

A

Prevent and treat N/V

  • promethazine (phenergan) - push slowly or dilute
  • ondansetron (zofan)
  • metocolopramide (reglan)
  • scopolamine ( transderm-scop)
  • dimethydrinate (dramamine)
  • diphenhydromine ( benadryl)
  • granisetron (kytril)
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47
Q

Gallstone Solubilizing Agents

A
  • ursodiol (actigal)
  • chenodiol (chenix)
  • dissolve gallstone
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48
Q

Nursing Management GBD

A 
- Diet
    NPO or SFF
    low saturated fat, high fiber, high calcium
- IV access 
- NG tube for gastric decompression
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49
Q

Surgery for GBD

A 
- laparoscopic cholecystectomy
    treatment of choice
    removal of GB
- cholecystectomy, T-TUBE
    when stones lodged
    drainage bag post op
- ERCP
    small stones
    captures stones
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50
Q

Goals for GBD

A
  • decrease pain
  • adequate fluid and nutrition
  • improve respiratory function
  • behavior/mood
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51
Q

Types of TPN

A

Central: more easily tolerated

Peripheral: Short term, nutritional needs less, used as a supplement

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52
Q

Indications for TPN

A

catabolic state, can’t eat enough to maintain positive nitrogen balance
needs cannot be met with oral/tube feeding or other IV nutrition

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53
Q

Carbs TPN

A

dextrose
energy & calories
3000-4000 cal/24 hr

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54
Q

Amino Acid TPN

A

for protein

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55
Q

Fat Emulsion TPN

A

prevent or reverse a fatty acid deficiency and provide calories
use non PVC bag or glass/piggyback

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56
Q

electrolytes, vitamins, trace elements, medications TPN

A
  • electrolytes: Na, K, Ca, Cl Ph
  • Vitamines ADEK, C, B
  • trace: zinc, copper, chromium, magnese, selenium
  • meds: insulin, heparin, histamine receptor agonist
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57
Q

Complications of TPN

A
  • hyperglycemia: dry mouth, HA, nausea, flush skin, thirst, increased urine
    • increase rate over several hours
    • check sugar every 4-6 hours
  • hypoglycemia: cold, clammy skin, weakness, hunger, tachycardia, dizziness
    • keep rate accurate, taper rate when D/C, if next bag is not available run D5W or D10W
  • infection
    • strict asepsis
    • redness, swelling, tenderness, drainage, fever, chills
  • air embolism
    • trendelenburg during cather insertion
    • use clamps or valsava maneuver during tube change
  • fluid overlad/electroyte imbalance
    • refeeding syndrome
    • cardiac arrest
  • physco aspect
    • hallucination with taste/smell
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58
Q

Peptic Ulcer Disease Patho

A

Disruption of the mucosal barrier of the stomach due to H Pylori or ulcer of the lining of the stomach, duodenum, lower esophagus

mucosal injury D/T increaed gastric acid HCL and Pepsin

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59
Q

etiology of PUD

A
  • NSAID use (most common cause)
  • alcohol, smoking, stress, antbiotic (docucycline, clindomycin)
  • zollinger-ellison (tumor in pancrease which incrase hormone that stimulates stomach acid
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60
Q

Avoid with PUD

A
  • chocolate
  • coffee
  • brined/fermented
  • fatty
  • spicy
  • acidic
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61
Q

S&S of PUD

A 
bloating, belching D/T distention
N/V
weight loss
anemia D/T bleeding
guaic positive ( check H&H)
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62
Q

gastric ulcer characteristics

A 
superficial
"gas" pain
pressure in LUQ
pain 1-2 hours after meal
common in low social status
relieved by eating
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63
Q

duodenal ulcer characteristics

A 
penetrating
cramping pain
pressure in midepigastric and upper abdomen
pain 2-4 hours after meal
stress and disease
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64
Q

Diagnostic Tests for PUD

A 
CBC - check H&H
Fecal Analysis (blood, H. Pylori)
barium swallow
C-Urea (breath in bag, if Co2 increased you have H. Pylori)
EGD
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65
Q

Pharmacotherapy for PUD

A

antacids, H2 receptor agonist, PPI, cytoprotective agents, antibiotics

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66
Q

Antacids

A

-Neutralize gastric acid t bring the pH above 3-3.5
-Most not absorbed and excreted through feces
- can cause diarrhea, constipation, effect absorption of other drugs, electrolyte alteration
- take medication 1-2 hours before or after taking antacid
- monitor electrolytes
-

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67
Q

Antacid Contraindications

A
  • Amphojel high in sodium, do not use in pt. wih HTN, CHF, renal disease D/T fluid retention
  • those containing aluminum must be used cautiously in pt with gastric disease b/c they cn cause constipation and phosphate depetion
  • those with magnesium can cause hypermagnesmia
  • those containing sodium bicarb can cause metabolic alkalosis
  • those with calcium can cause rebound hyperacidity, metabolic alkalosis, and constipation
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68
Q

Common antacids

A
  • aluminum carbonate (Basalgel)
  • aluminum hydroxide gel ( Alternagel, Amphojel)
  • calcium carbonate (turns)
  • aluminum/ magnesium compounds (Maalox, Riopan plus)
  • sodium bicarbonate
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69
Q

Surgery for PUD

A
  • vagotomy (removal of vagus nerve)

- pyloroplasty ( repair pyloric sphincter)

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70
Q

Complications of PUD

A 
Pyloric Obstruction
    - anorexia, N/V
Hemmorhage
    - anemia
Perforation/Peritonitis (lethal!!!)
    - rigid, board like abdomen
    - rebound tenderness
    - no bowel sounds
    - hypotension, tachycardia, shallow respirations
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71
Q

Nursing Management of PUD

A
  • V/S and I/O
  • assess repirations and gastric status
  • maintain NG tube
  • observe for distention
  • small, frequent meals
  • minimize stress
72
Q

Goals for PUD

A
  • minimize pain
  • gastric drainage
  • nutrition
  • monitor I/O
  • observe for hemm/infection
73
Q

IBD Patho

A

chronic inflammation of GI tract (autoimmune!!). Chrons or Ulcerative Colitis

74
Q

Chrons

A

usually affects the terminal Ileum and ascending colon, can effect any portion of GI tract

75
Q

Ulcerative Colitis

A

More common! Affects colon, frequent stool

76
Q

Ulcerative Colitis S&S

A 
Diarrhea, mucousy, bloody
LLQ pain
bloody stools
fever (rare)
anemia
weight loss
dehydration
77
Q

UC Complications

A
  • chronic anemia
  • arthritis
  • skin, eye, liver, renal disease
  • hemmorage, perforated bowel
  • colon cancer
78
Q

Chron’s S&S

A
  • always diarrhea
  • abdominal pain (RUQ)
  • steatorrhea
  • fever
  • anemia
  • weight loss
79
Q

Chron’s Complications

A
  • fistula, abcess
  • SBO
  • colorectal cancer
80
Q

Nursing Management IBD

A

Diet
- NPO w/ IVF during flare up
- small, frequent meals low residue, lactose free, elemental
- high protein, high vitamin, high carlorie
IV access for antibiotics, transfusion
monitor V/S, I/O, daily weight, stool for occult blood, lab values
Educate: NO alcohol, NO smoking, LOW stress

81
Q

Pharmacotherapy for IBD

A

5-amino acids, antimicrobials, coricosteroids, immunosuppresents, antidiarrheal

82
Q

5-Amino Acids

A
  • decrease inflammation

- sulfasalazine ( Azufinide)

83
Q

Antimicrobials

A

most common

metronidazole ( flagyl)

84
Q

corticosteroids

A

metylpredisalone

85
Q

immunosupressents

A

azathioprine (imuran)

methotrexate

86
Q

Antidiarrheal

A
  • diphenoxylate HCL (lomotil)
  • record number and consistency of stools
  • can cause constipation
  • bismuth subsalicylate (kaopectate), diphenoxylate-atropine (lomotil), Ioperamide (imodium), amphorated tincuture of opium ( paragoric)
87
Q

Surgery for UC

A
  • total protolectomy

- total colectomy with ileal pouch

88
Q

Surgery for Chrons

A

intestinal resection with anastomosis

89
Q

Ileostomy Vs Colostomy

A

Ileostomy stools more liquid

colostomy stools more formed

90
Q

Goals of IBD

A
  • less pain
  • no diarrhea, fever
  • adequet nutrition and fluid
  • stress managed
91
Q

Bowel Obstruction

A

Partial or complete blockage of intestinal lumen
Small (more common) or large bowel
Needs prompt treatment
Intestine contents, gas, fluid, digested substances, accumulate proximal to obstructuion

92
Q

Etiology of bowel obstruction

A
  • increased pressure, distention
  • increased pressure obstructs arterial blood flow
  • fluid leaks into peritoneal cavity, hypovelmic shock, bowel necrosis, dehydration
93
Q

Risk Factors for Bowel Obstruction

A
  • adehesions (fibrous tissue after sx.)
  • volvulus (twisted bowel)
  • hernia
  • tumor
  • fecal impaction
  • paralytic ileus D/T sx., infection, opioids
94
Q

S&S of bowel obstruction

A
  • distention
  • pain, cramping
  • diarrhea/constipation
  • obstipation (severe constipation, no gas)
  • S/O dehydration (tachycardia, fever)
  • peritoneal signs (if perforated)
  • bowel dounds borborygmi above obstruction, absent below
95
Q

Diagnostic Tests for Bowel Obstruction

A 
CBC (low H&H, increased WBC)
BMP (electrolytes)
urinalysis (UTI D/T pressure?)
abdominal X-RAY, CT (string of perles)
EGD, colonoscopy
barium enema
96
Q

Nursing Management for BO

A

NPO
IV access
GI decompression (NG tube)
monitor V/S I/O, bowel function, labs

97
Q

Surgery for Bowel Obstruction

A

bowel resection - 30-45 day recovery
bowel resection w/ colostomy - temporary a few months
- lysis of adhesion - scar tissue from abdominal SX.

98
Q

Goals of Bowel Obstruction

A

decrease pain, maintain nutrtion, prev. respiratory complications, relieve obstruction

99
Q

Cytoprotective Agents

A
  • sucralafate
  • treatment of PUD
  • forms an ulcer adherent paste that protects ulcer from further damage
  • constipation side effect
  • instruct pt, to take med 30 min to 1 hour before meals or 2 hours after meals and at bedtime
  • do not give antacids within 30 mins of sucralfate admin
  • misoprotsol (cytotec)
  • prostaglandin analogue
  • contraindicated in pregnancy
  • PUD
100
Q

Gastric Stimulants

A
  • improves gastric emptying
  • relief of GERD sypmtoms
  • prevention of nausea by chemo or sx.
  • facilitation of small bowel intubation
  • metoclopramite (Reglan)
101
Q

anticholinergics

A

decrease gastric secretions
side effect is drowsiness, dry mouth, urniary retention
- encourage increaed fluid intake
- avoid driving until effects are known
- belladonna alkaloids (atropine, scopolamine), propatheline (pro-bathine)

102
Q

What is perioperative care?

A

Care provided before, during, and after sx.

103
Q

What is preoperative care?

A
  • 2-3 weeks before sx.
  • preadmission testing PAT (not always done by nurse)
  • bring list of medications including supplements
104
Q

Nurses Role Intraoperative

A

promote safety and privacy
prevent wound infection
promote healing

105
Q

nurses role post operative

A 
prompt pain control
assessment of surgical site
assessment of drainage tubes
monitor rate and patency of IV
assess patients level of senstaion, circulation, and safety
106
Q

Classifications of Surgical Intervention

A

Emergent: must be done now
Urgent: must be done soon w/i 24-48 hours
Elective: preplanned

107
Q

Preoperative: Pre Admission Testing

A

Initiates teaching appropriate to patient

  • who will drive patient home?
  • does patient understand surgery?
  • medication/food restriction
108
Q

Informed Consent - Preoperative

A

Required! Nurse must be sure it’s ON FILE, prior to pre-medication, nurse is the patient’s advocate
Nurse can serve as witness

  • pt must understand before signing, be able to make decisions
109
Q

Preoperative Nursing Assessment

A

A. Nursing History
B. Physical Assessment (objective data)
C. Assess patient’s needs

110
Q

Nursing History

A
  • nutrition, diet, normal elimination pattern, normal sleep pattern, sexulatity, reproductive, etc.
111
Q

Physical Assessment

A

Head to Toe - Focus on the system that needs surgery

112
Q

Pyschological Needs

A
  • medical decisions
  • emotional support - who will take care of patient? how are they feeling?
  • cultural considerations - do they want priest? blood transfusion?
113
Q

PreOp Nutrition/Hydration

A

NPO 8-12 hours

Check institiution Policy

114
Q

Medication Reconciliation

A

Stop Taking: anticoagulants, NSAIDS, diuretics, eye drops/inhalers, herbal supplements

115
Q

Preoperative Medications

A
  • Benzodiapines
    • midazolam (versed)
    • diazepam ( valium)
    • relax pateitn, amnesic effect
  • Barbiturates
    • phenobarbital
    • sedation
  • anticholinergics
    • atropine So4
  • opiod analgesic
    • fentanyl
  • Histamine 2 receptor antagonist
  • antiemetics
    • metoclopramide hydrochloride (Reglan)
    • odansetron hydrochloride ( Zofran)
    • promethazine (phenergan)
    • scopolamine (transdermal patch)
  • phenothazine derivitives
  • antibiotics
116
Q

Preop Teachings

A
  • deep breathing
  • incentive spirometer
  • turning and positioning
  • VTE prophalylaxis
117
Q

Patients With High Risk

A
  • old
  • diabetes/ chronic disease
  • obesity
118
Q

Intraoperative Care

A

When the patient is placed on the OR table and ends when the patient is transferred to the PACU

119
Q

Role of RN

A
  • Remains sterile

- safe and optimal outcome is goal

120
Q

Role of Circulating Nurse

A
  • Not sterile, inform family, maintain privacy
121
Q

What are SCIP procedures?

A

Actions that are required to be completed within the standard perioperative time frame

122
Q

Universal Protocol

A

Call time out to ensure

  1. Correct patient
  2. Correct procedure
  3. Correct surgical site
123
Q

Nursing Management Intraoperative

A
  • maintain asepsis
  • assist with transfer
  • provide for privacy/modesty
  • provide patient safety
  • position patient
124
Q

Types of Anesthesia

A

I General : completely unconscious
II Local: just the area is numb
III. regiona: ex. epidrual
IV: MAC: twilight zone

125
Q

General Anesthesia: Pre Induction

A
  • pre-op assessment
    • check and confirm consent form
    • call “time-out”
    • time when pt. could have problems, maximum attention on patient.
    • attach patient to monitoring machines
126
Q

General Anesthesia: Induction

A
  • initiation of medication
  • airway secured
  • monitor the devices
127
Q

General Anesthesia: Maitenence

A

maintain patient safety, positioning of patient

128
Q

General Anesthesia: Emergence

A
  • assist in placement of dressing
  • safety of patient
  • prepare for pacu
129
Q

General Anesthesia: IV induction agents

A
  • most common
  • Barbiturate Hypnotics
  • Nonbarbiturate Hypnotics
130
Q

Barbiturate Hypnotics

A
  • thiopental ( pentothol)
  • methohexital (brevitol)
  • rapid induction w/i 20-60 seconds
  • sedation and hypnosis
  • NOT analgesia
  • may have post op nausea
131
Q

Nonbarbiturate Hypnotics

A 
etomidate (amidate)
   - little change in cardiovascular status
   - useful in unstable patients
   - minor resp depression
propofol (diprivan)
    - rapid onset
    - new
    - can maintain anesthesia
    - rapid elimination
    - less N/V

BOTH:
- observe for abormal skeletal movement, N/V, hypotension, hypoglycemia, bradycardia

132
Q

General Anesthesia: Inhalation Agents

A

through tube or mask
trauma to teeth, lips, vocal cords, or trachea may occur
laryngospasm or bronchospasm
volatile liquid: liquid at room temp. , mixed with O2
gasses: gas at room temp

  • depress neurotransmitter in CNS
133
Q

Nitrous Oxide

A
  • Gas
  • adjunct to IV drugs
  • commmon induction agent
  • avoid in pt with bone marrow depression
  • give with O2 to prevent hypoexmia
  • smells like perment marker
134
Q

Volatile Liquids

A

Exhibit respiratory depression, hypotension, and myocardial depression, muscle relaxation!

Isoflurane (Forane)
    - can cause airway irritation
    - no increase in ventricular irritability
    - no nephro or hapto toxicity
    - use with caution in cardiac patients
Desflurane (Suprane)
    - fastest onset and emergence
    - ambulatory settings
    - use with caution in cardiac patients
Sevoflurane (Ultane)
    - rapid acting
    - non irritating to airway
    - may be associated with emergence delirium
Halothane (fluothane)
    - bronchodilation
    - may cause hepatotoxicity
135
Q

Local Anesthesia

A

Interrupts nerve impulses
Blocks motor (movement) and sensory (feeling) impulses
Topical most common, can be local infiltration, nebulized, or opthalmic

136
Q

Regional Anesthesia

A

Injection of local anesthesia around or near nerve groups
Regional (peripheral nerve block
IV reginal block (Bier’s block)- short term
Spinal Block (dural sac)
epidural

137
Q

Side effects of local/reginal anesthesia

A

Regional:
Spinal Headache - result of CSF leaking. r/t needle gauge. Blood patch treatment

Local:
palpatations, tachycardia, temor, pallor, diaphoresis - similar to hyperglycemia

138
Q

MAC anesthesia

A
  • benzodiazepines
  • opioids
  • maintain own airway
139
Q

Nurse role during/after procedure

A
  • monitor v/s
  • document
  • LOC
  • maintain airway - #1 priority
  • discharge criteria (v/s stable, pt breath on own?)
140
Q

Malignant Hyperthermia

A

rare, metbolic disease, dominant, inherited

  • caused by depressed hypothalmus
  • rise in body temp of 6 degrees C/hour
  • often fatal
  • succinylcholine
  • tachycardia, tachypnea, hypercarbia, ventricular ectopy, hyperthermia
  • treat w/ cooling blanket, cool IV fluid
141
Q

Anaphylactic Reaction

A
  • if shows sypmtoms of anaphylaxis stop infusing
  • hypotension
  • tachycardia
  • bronchospasm
142
Q

What is a sentinel awareness?

A

patient aware during sx. Report to JCAHO

143
Q

PACU

A

Immediately after surgery until patient is discharged to regular nursing floor

144
Q

What does the intake nurse need to know on admission to the PACU

A

Full report from anesthesia, why did they do the procedure? Medication received? complications? Fluid status - how much blood lost? IV fluids?

145
Q

What is the aldrete score?

A

When patient can be safely discharged from PACU - need 7/8.

if less ask doctor why and document!

146
Q

Primary Focus in PACU

A
  • maintain airway #1
  • prevent aspiration
  • maintain tissue perfusion
  • prevent injury
147
Q

complications in PACU

A
  • airway obstruction D/T tongue falling back is most common

- hemmorhage (check V/S, BP, output, HR)

148
Q

Assessment Requirements in PACU

A
  • every 5-15 minutes until stable
  • then every 30 minutes for 1-2 hours

make sure V/S completed by surgen before accepting patient

149
Q

Respiratory Status - PACU

A

1 priority
Assess for airway devices (ETT, OPA, Tracheostomy)
- O2 sat
- respiratory rate, quality, chest expansion, breath sounds, oxygen
- Complication is hypoxemia PaO2 < 60
- hypoventilation ( hypoexmia, hypercapnia) - shallow rapid breathing
- prevent airway obstruction
- prevent complications by side lying position, HOB elevated

150
Q

Circulation - pacu

A
  • ekg, BP, temp./skin color, cap refill, peripheral pulse
  • Hypotension most common compliation D/T fluid loss
  • Cardiac Arrythmia (hypovolemia, hypoxia/hypercapnia)
  • Hypertension D/T pain, anxiety, bladder distention
151
Q

Neurovascular - PACU

A

Check pulse below sx. site. Especially for regional anesthesia

152
Q

Neurological - PACU

A

Ability to follow commands
PERLA
Emergent delerium (restlessness, agitiation, disoreiented, thrashing, yelling)
Delayed Emergence - too long to wake up

153
Q

Body Fluid/Genitourinary

A

I/O, I/V fluids, if urine <30 mL/hr notify HCP!

154
Q

Nursing Interventions For PACU

A
  • Safety
    • positioning for airway compliance, turn frequently, stay with patient if restless and find cause
  • Pain Relief
    • PRN medications before pain, elderly need pain meds even if they don’t feel pain because they have delayed response D/T anesthesia,
  • N/V
    • Comfort measures, anti-emetics
  • Thermoregulation
    • hypothermia (less than 35 C 95 F), increase infection, bleeding, cardiac problems
    • give blankets, bair hugger, meperidine (demerol)
  • Psychological Support
    • orient while coming out of anesthesia, reassure them
155
Q

Criteria for discharge from PACU

A
  • stable V/S
  • acceptable aldrete score
  • adequent respiration/circulation
  • awake
  • complications under control
  • SPO2 > 90
  • report given
  • if pt going home, must have responsible adult
156
Q

Postoperative Phase

A

When patient is admitted to PACU and ends when patient no longer needs sx. related nursing care

157
Q

Initial Assessment in post op care

A

Any pre op orders dont apply

Temperature may increase 1st 48 hours, if temp increase for greater than 2 days may be another problem

158
Q

Plan of Care for Respiratory function post op

A

No pneumonia, no atelectasis, promote gas exchange, RR 12 - 20 SPO2 >95 room air

159
Q

Plan Of Care for Urinary Function Post Op

A

SCIP - remove foley within 24-48 hours (MD order)

  • must void within 8 hours of sx. or removal of foley
  • palpate bladder for retention
  • bladder scan
  • provide measures to help trigger spontaneous voiding
160
Q

Plan of Care GI function Post Op

A
  • enforce dietary orders (NPO to ADAT)
  • note for signs/symptoms of ileus (bloated, N/V, constipation, cramps, watery stool)
  • antiemetics PRN
  • NGT patency
161
Q

Pharmacologic Management Post Op

A
  • Nonopioid
    • 1st choice
    • for mild to moderate pain
    • NSAID (prevent prostaglandin synthesis)
    • tylenol (can cause liver damage)
  • Opioid
    • moderate to severe pain
    • monitor for sedation/resp depression
  • Adjuvant Analgesic
    • local anesthetics (blacks Na channels prev. induction of nerve impulses)
    • antivonvulsants ( stabilize nerve membranes)
    • antidepressents ( increase level of neurotrans in spinal cord that blocks nerve transmission)
162
Q

Wound Maintainence Post Op

A
  • superficial wound infection most common
    • assess for pain/discharge
    • aseptic technique
    • HCP changes first post op dressing
  • incisional cellulitis/ deep tissue absess
    • with bowel SX.
    • wound will require vacuum, packing, or frequent dressing changes
    • deep abscesses may need re-exploration
  • Gangrene
    • rare, life threatening
    • painful, rapid swelling, bloody discharge
    • crepitius
    • emergency surgery
163
Q

Discharge Criteria

A 
comfort control
activity tolerance
knows when to notify HCP
measures to promote healing
health promoion/agency support
restoring wellness
164
Q

Cystitis

A

inflammation/infection of the bladder - urethra to bladder

165
Q

Pyelonephritis

A

inflammation/infection of kidney - uretrha to kidney

166
Q

Bacteriuria

A

Bacteria in the urine

167
Q

Bacteremia

A

bacteria in the blood

168
Q

urosepsis

A

infection starts in UT and spreads into blood stream

169
Q

Most common cause of UTI

A

CAUTI

170
Q

Lab Work UTI

A
  • CBC
    • leukocyte esterase
  • nitrates (normally in urine) to nitrities (when infected)
  • WBCs
  • Urine Culture
171
Q

Risk Factors UTI

A
  • female
  • sexual activity
  • use of birth control
  • menopause
  • catheter
  • supressed immune system
  • ut abnormailites
  • bloackage in UT
  • recent urinary procedure (cystoscopy)
172
Q

Escherichia Coli

A

caused by wiping back to front

173
Q

Kiebsiella

A

common with CAUTI

174
Q

Enterococcus

A

From caregiver or pt. to pt.

175
Q

Proteus

A

pseudomonas
enterobacter
canidida

CAUTI common

176
Q

Obtaining Urine Specimens

A

Clean catch
sterile urine bag
urethral cath
suprapubic aspiration

177
Q

Treatment UTI

A
  • antibiotic
  • fluids
  • phenazopyridine (pyridium)
    • can cause orange/red fluids

NURS 1250 (6 decks)

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