surgery Flashcards
substances that affect surgery
antibiotics: potentiate (increase) action of anesthetic agents
anticholinergics: increase risk of confusion, tachycardia, intestinal hypotonicity, hypomotility
anticoagulants/antiplatelets/thrombolitics: increase risk of hemorrhage (ASA, clopidogrel, NSAIDS commonly alter platelet aggregation)
!!! must be discontinued at least 48 hours prior to surgery
anticonvulsants: alter metabolism of anesthetic agens
antidepressants: lower BP during anesthesia
antidysrhythmics: reduce cardiac contractility + impair cardiac conduction during anesthesia
antihypertensives: with anesthetic agents can cause bradycardia, hypotension, impaired circulatioln
corticosteroids: cause adrenal atrophy + reduce ability of body to withstand stress
diuretics: risk of electrolyte imbalances
herbal substances: interact with anesthesia and cause a variety of adverse effects
insulin: need may be reduce due to less intake or increased because of stress response + IV glucose solutions
postoperative assessment
RESP
breath sounds:
- stridor/wheezing = partial obstruction, bronchospasm, laryngospasm
- crackles/rhonchi = atelectasis, pneumonia, pulmonary edema
- low-Fowler’s position: increases thorax size for lung expansion
!!! no supine until pharyngeal reflexes return
INTEGUMENTARY
- monitor for signs of infecton
- dressing status
- patent wound drains
GI
- monitor intake + output
- abdominal distention
- flatus + return of bowel sounds
- early ambulation to promote peristalsis
- NPO until return of gag reflex + peristalsis
- side-lying for vomiting (prevent aspiration)
RENAL
- bladder distention
- urine output at least 30mL/h
- voiding within 6-8 hours of surgery (at least 200mL)
what it is + cause + signs
pneumonia + atelectasis
pneumonia = inflammation of alveoli
- caused by infectious process (may develop 3-5 days post-operatively)
- result of infection, aspiration, immobility
atelectasis = collapsed/airless state of lung from airway obstruction
- due to accumulated secretions or failure to deep-breathe + ambulate after surgery
- usually 1-2 days after surgery
signs:
- dyspnea
- increased resp rate
- crackles
- elevated temp
- productive cough
- chest pain
postoperative complications
- pneumonia + atelectasis
- hypoxemia
- PE
- hemorrhage
- deconditioning
- shcock
- malignant hyperthermia
- intractable pain
- thrombophlebitis
- urinary retention
- UTI
- constipation
- paralytic ileus
- skin breakdown
- acute kidney injury
- wound infection
- wound dehiscence
- wound evosceration
- sepsis
what it is + cause + signs
hypoxemia
hypoxemia = inadequate concentration of oxygen in arterial blood
- can be from shallow breathing from anesthetia
signs
- restlessness
- dyspnea
- diaphoresis
- tachycardia
- hypertension
- cyanosis
- low SpO2
what it is + signs
pulmonary embolism
pe = embolus blocking pulmonary artery + disrupting blood flow to lung lobes
signs
- sudden dyspnea
- sudden sharp chest pain/upper abdominal pain
- cyanosis
- tachycardia
- drop in BP
what it is + signs
hemorrhage
hemorrhage: loss of large amount of blood in short time period
signs
- restlessness
- weak/rapid pulse
- hypotension
- tachyapnea
- cool/clammy skune
- reduced urine output
what it is + signs
shock
shock: loss of circultory fluid volune (usually hemorrhage)
signs: similar to hemorrhage
thrombophlebitis
inflammation of vein with clot formation
signs:
- vein inflammation
- aching/cramping pain
- vein feels hard + cordlike, tender to touch
what it is + signs
urinary retention
involuntary accumulation of urine in bladder from loss of muscle tone - caused by effects of anesthetics or opioid analgesics (appears 6-8 hours after surgery)
signs
- inability to void
- restlessness
- diaphoresis
- lower abdominal pain
- distended bladder
- hypertension
what it is + signs
constipation
infrequent stool passage - from anesthesia, opioid analgesia, decreased activity, decreased oral intake
signs
- failure to pass stool 48 hours after starting solid diet
- bowel souns with absence of BM
- abdominal distention
- anorexia, headache, nausea
what it is + signs
paralytic ileus
failure to move bowel contents forwards - from anesthetic medications or manipulation of bowel during procedure
signs:
- postoperative vomiting
- abdomina distention
- absence of bowel sounds, bowel movement, flatus
what it is + signs
wound infection
poor aseptic tehcnique or contaminated wound prior to surgery (usually 3-6 days after surgery)
signs
- fever + chills
- warm/tender/painful/inflamed incision site
- edematous skin at incision, tight skin sutures
- elevated WBCs
what it is + signs
wound dehiscence
wound dehiscence = separation of wound edges as suture line (5-10 days after surgery)
signs
- increased drainage
- open wound edges
- appearance of underlying tissues
wound evisceration
wound evisceration = protrusion of internal organs through incision (5-10 days after surgery)
signs
- discharge of serosanguineous fluid from previously dry wound
- appearance of abdominal contents
- popping sensation after coughing/turning
