periop, f/e, a/b, shock, respiratory

Question 1

perioperative

Answer 1

the whole system - the moment a patient is scheduled for surgery until recover unit/admission/discharge

Goals: prevention of DVT/PE, prevention of respiratory infections/improving gas exchange, pain management, promoting peristalsis/comfort w/o N/V, promote wound healing/tissue integrity.

Key points: safety checks, teamwork, pt centered care, ethics, EBP, clinical judgement

Expected outcomes: the pt… attains/maintains adequate lung expansion & respiratory function, has appropriate wound healing w/o complications, has acceptable pain management, has return of peristalsis.

Question 2

Pre-op

Answer 2

From when surgery is scheduled until arrival to surgical suite.

Prioritization: pt ID, allergies, confirmed ride, interpreter, surgery checklist, informed consent & site marked (by surgeon), pt hx, Interprofessional collaboration and teamwork.

Question 3

intra-op

Answer 3

arrival in surgical suite until transferred to PACU.

Prioritization: critical time out (stop all moment prior to surgery w/ all remembers present), monitor subtle changes, acknowledge high risk patient issues.

Question 4

fires in surgery

Answer 4

caused by oxidizers, electrosurgical units, fiber optic light sources or laser surgery, acohol based surgical preps. Prevention, communication, fire - risk assessment & awareness

Question 5

Malignant hyperthermia

Answer 5

acute life threatening complication. Skeletal muscle exposed to specific agent causing increase metabolism, increase Ca levels into muscle cell leading to acidosis, critical high fever (>110), dysrhythmias. Genetic component (pt hx!)

S/S = tachycardia, skin mottling, tachypnea, cyanosis, increase end total volume, sudden rise in temperature

Question 6

post-op

Answer 6

arrival to PACU for recovery until admission, transfer, or discharge.

Phases: when they come out, 2 hr after surgery, when they leave

Prioritization: full assessment, critical VS, subtle changes, skin assessment/wound, pain management, postop GI system.

Education: pain management, drug therapy, safety, prevention of infection, management of drains/catheters, nutrition therapy, follow-up w/ surgeon

Question 7

Normal Sodium

Answer 7

136-145

Where sodium goes, water follows. Major cation in ECF.

Question 8

Hyponatremia

Answer 8

<136

Causes: diuretics, NPO, low salt diet, excessive ingestion of hypotonic fluids

Assessment: thirst, cerebral changes (confusion, altered LOC), NM changes (weak in arms/legs, Respiratory muscle weakness), intestinal (increase motility, diarrhea, nausea, cramping), CV (weak pulse, thready, decrease BP, orthostatic hypotension, postural dizziness, decrease skin turgor).

Priorities: monitor response to therapy and prevent fluid overload

Interventions: find cause, drug therapy (IV saline, tolvaptan if severe), nutrition (increase salt, limit fluid intake), patient safety (high risk for falls), skin protection.