ATI Perioperative Flashcards
(28 cards)
Pt recovering from spinal anesthesia, sensations return in what order?
touch first
pain second
warmth third
cold fourth
Preop med history. Med that interacts with anesthetics?
Captopril (Capoten)- antihypertensives can cause hypotensive crisis when given with anesthetics.
Most critical pt?
pt post thoracotomy with 150 mL bright red blood in collection chamber in the past hour- could indicate hemorrhage.
Postop pt has calf that is red, swollen, warm what to do?
DVT. elevate extremity- promote venous return
Tongue swollen, obstructing airway-
insert nasal airway
Conscious Sedation-
expect to feel sleepy several hours after procedure. avoid activities requiring concentration.
Meds used for moderate sedation are given IV which results in quick onset/recovery.
NPO 6-8 hours before bronchoscopy.
Pt vomiting past 24h, small bowel obstruction, pain 8/10, hard distended abdomen, absent bowel sounds. tell dr then?
insert NG tube- greatest risk to pt is F&E imbalance due to accumulated fluid and gas in GI tract. put down NG tube to begin decompression of the bowel.
Other actions, not priority- draw blood for electrolytes, administer pain meds, initiate intake and output.
Qualifications for DC from PACU:
move all 4 extremities on command.
BP cant drop 25% or greater.
Maintain o2 sat of at least 92% on RA
Surgical Asepsis
Finger and wrist jewelry must be removed.
You should open dressing packages before applying sterile gloves because the outside wrapping of dressing packages is non sterile.
Hold hands above the waist.
Gown the surgeon first, then assist with the surgeons gloves.
Penrose Drain
change dressing with sterile technique.
Drain sponge should be used. Gauze pad should never be cut and used around drain due to risk of dressing fibers being embedded in the wound.
Never clamp.
Open system, drains by gravity.
Surgery rooms are maintained at a cool temp with low humididy b/c it reduces
risk of fire secondary to volatile anesthetic agents used.
Reaction to anesthetic
malignant hyperthermia
PCA pump
Dont let family push button when sleeping to prevent excessive dosing.
It is still possible to overdose b/c tolerance levels of opioids vary.
Pin pca button to pts gown for easy access to prevent it from falling out of reach.
Dont wait until pain is severe.
Post Mastectomy
Start hand exercises (squeezing ball) the first day after surgery.
Wait 3-4 weeks to do water aerobics.
Avoid having blood drawn & BP from arm.
You can shower after the drain is removed.
Prevent thrombi formation-
dorsal/plantar flexion of the feet q hr- help prevent venous stasis in the lower legs and decrease likelihood of thrombophlebitis.
Change position q2.
Dont put pillow under calves- pressure on popliteal is bad.
Pt nervous about gastrectomy
provide concise factual information- allows for open communication
Jackson Pratt drain
Empty and compress the drain reservoir as needed.Compressing the reservoir produces the suction necessary for the drain to fx properly.
Dont clamp drain- continuous drainage is required.
Secure the drain to the pts gown or clothes to prevent dislodgement.
Drain should be kept lower than the incision to facilitate drainage.
Pt is recieving succinylcholine (Anectine) during surgery, what should nurse do if pt develops malignant hyperthermia?
administer dantrolene (Dantrium)p IV 2-3 mg/kg to reverse malignant hyperthermia.
Status post total hip, risk factor for infection?
long term use corticosteroids- inhibit leukocyte response, increasing risk of infection.
Med to DC 48 hours before surgery
warfarin (Coumadin)- increases bleeding risk
furosemide, digoxin, and prednisone dont need to be DC before sx
Pt recieving moderate sedation with versed and fentanyl. RR goes from 16 to 6, o2sat goes from 92 to 85. what to do?
administer reversal agents- this will increase the respiratory rate. greatest risk is respiratory arrest.
(May be necessary but Not priority- assist with intubation, obtain equipment necessary for CPR, obtain stat ABGs)
Pt has NG tube set to continuous low suction after gastrectomy. what should nurse report to PCP?
gastric distention- sign that ngt may not be patent. Report to dr to prevent complications at the anastomosis.
(absent bowel sounds are normal after abdominal surgery, incisional pain is normal- treat with prescribed analgesics, small amount of bloody drainage in NG tube is common)
During surgery help prevent neuromuscular complications by…
Support bony prominences with foam padding to help prevent pressure on nerves and blood vessels and reduce the potential for neuromuscular complications.
Joints should be slightly flexed.
Post abdominal surgery DC teaching?
Encourage ambulation and activity- dont encourage bed rest.
Return to work in 6 weeks.
Eat foods high in protein and vitamin C during recovery- essential for healing.
Call dr if increased temp or wound drainage- may indicate infection.
