Perioperative Pats Flashcards Preview

AHI > Perioperative Pats > Flashcards

Flashcards in Perioperative Pats Deck (22)
Loading flashcards...
1
Q

under strict conditions designed to enhance patient safety

A

Modern surgery is defined

2
Q

before (preop phase), during (intraop phase), and after (postop phase) all types surgeries - togethers known as perioperative experience

A

Provide critial patient care in periods

3
Q

Consistently anticipate safety needs prior to, during, and after surgery, and carry out ways for patient well-being
Interventions can prevent anticipated problems
Surgical care improvement project

A

Safety during the surgical experience

4
Q

SCIP - set core compliance measures; reduces surg comps

A

Surgical care improvement project

5
Q

Inherited muscle disorder, acute and life-threatening comp of certain drugs for gen anesthesia
Characterized by many probs including inad thermoreg
Rxn begins in skeletal muscle exposed to drugs causing increase Ca levels in muscle cells and increased muscle metabolism; serum Ca and K levels rise as is metabolic rate leading to acidosis, cardiac dysrhythmias, and high body temp
Symp: tachycardia, dysrhythmias, muscle rigidity of jaw and upper chest, hypotension, tachypnea, skin mottling, cyanosis, myoglobinuria (muscle proteins in urine)
Dantrolene Na - muscle relaxant only one for MH

A

Malignant hyperthermia (MH)

6
Q

Perform one well in advance or immediately before surgery
Compare findings with history and review sys collected to identify new/immediate health probs, info that indicates potential anesthesia comps, risk for concerns that may occur during surgery
Begin with complete set VS
Older adult/pat with chronic health condition increased risk for comps during and after surgery: numbers serious diseases (morbidity) and deaths (mortality) during/after surgery higher in older/chronically ill
Assess CV status, respiratory status, kidney func, neurologic status, MS status, nutrition status, skin assessment

A

Phys assessment

7
Q

Most have anxiety/fear before surgery
Varies from type, perceived effects and outcome, and personality
Affect ability learn, cope, cooperate with teaching and operative procedures
Perform assessment to know level anxiety, coping ability and support sys
Provide info as needed

A

Psychosocial assessment

8
Q

Provide baseline data about patient’s health and can help predict potential comps
Choice testing dependings on age, history, type anesthesia planned
Report electrolyte imbalances/abnorm labs to team before surgery: hypokalemia: increases risk toxicity if taking digoxin, slows recovery from anesthesia, increases cardiac irritability; hyperkalemia: increases risk dysrhytmias, esp with anesthesia

A

Lab assessment

9
Q

CXR - pats with history resp probs; presence pneumonia/TB; emergency helps select anesthesia type
Other depend on history and nature of surgery

A

Imaging assessment

10
Q

ECG - history of/risk of CVD who need gen anesthesia
Prior consultations depending on if have prior prob
Drugs (nitro, beta blockers, antibiotics) for prob prevention may be needed periop phase to reduce/prevent stress on the heart

A

Other diagnostic assessment

11
Q

Day surgery - drug schedule may be altered; some drugs must be stopped until certain amount time passes

A

Regularly scheduled drugs

12
Q

Prevent injury to colon and reduce number intestinal bacteria
Bowel evac: major ab, pelvic, perineal, perianal surgery
Electrolyte imbalance, fluid volume imabalce, vagal stim, orthostatic hypo may occur

A

Intestinal prep

13
Q

Before surgery first step to reduce risk for surgical site infection
Pat may be asked to shower in antiseptic solution: chlorhexidine gluconate - reduces contamination of surgical field and number organisms at site; clean well around proposed surgical site
Remove soil/debris from surgical site/surrounding area
Increase wound contamination: bacteria in hair follicles, disruption of norm protective mechanisms of skin, nicks in skin

A

Skin prep

14
Q

Teach about potential presence and purpose to reduce anxiety
Tubes common after surgery - often placed during surgery
Drains - various shapes and sizes; often placed during surgery to remove fluid from surgical site; not kinked/pulled
Vascular access - for gen anesthesia and for most receiving other anesthesia; give drugs and fluids periopative phase
IV access - placed in arm using large-bore, short catheter (18-gauge, 1-in catheter) or in back of hand with 20-gauge; larger vein provides least resistance to fluid/blood infusion esp in emergency; can be placed whenever

A

Prep for tubes, drains, and vascular access

15
Q

Completion surgery and transfer of pat to specialized area for monitoring (PACU/ICU)
May extend beyond discharge until activity restrictions lifted

A

Postop phase

16
Q

When admitted to med-surg immediately assess airway; talking not reliable indicator of gas exchange
Continuously monitor pulse ox; check lungs q4h during first 24 and q8h
Those at higher risk of resp comps assessed more often
Check accessory muscle use, sternal retraction, diaphragmatic breathing - excess anesthetic effect, airway obstruction, paralysis - lead to hypoxia
Listen for snoring and stridor

A

Resp sys

17
Q

Assess VS postop and compare to before surgery
Decreased BP, pulse pressure, abnorm heart sounds indicate cardiac depression, fluid volume deficit, shock, hemorrhage, effects of drugs
Bradycardia - anesthesia/hypothermia
Older: risk for hypothermia
Increased PR indicated hemorrhage, shock, pain
Pulse deficit could indicate dysrhythmia
Peripheral vascular assessment performed daily

A

CV sys

18
Q

Cerebral functioning and LOC/awareness must be assessed in all pats who have received gen anesthesia/sedation
Watch for lethargy, restlessness, or irritability and test coherence and orientation
Monitory LOC q4-8h
Assess level of sensation
Eval motor func - assess strength

A

Neurologic sys

19
Q

Urinary control may/not return immediately
Assess with percussion/scanner
Report less than 30ml/hr - hypovoleia/renal comps

A

kidney/urinary sys

20
Q

Postop N&V most common postop - many who receive gen anesthesia GI upset within first 24 hours postop
Preventative drug therapy in preop phase effective reducing incidence
Postop N&V can stress and irritated abd and GI wounds, increase intracranial pressure of post head and neck surg, elevate introocular pressure post eye, increase risk aspiration
Assess for return of peristalsis; listen for BS in 4 quads and at umbilicus; abnorm cramping with distention = trapped nonmoving gas
Paralytic ileus: distended abd, abdominal discomfort, vomiting, no passage flatus/stoool
Constipation may occur

A

GI sys

21
Q

Clean surgical wound regains tissue integrity in about 2 weeks without trauma, infection, CT disease, malnutrition, or use certain drugs (steroids); complete healing 6 months-2years
Phys health, age, size and location wound, stress on wound all effect healing time

A

Integumentary sys

22
Q

Dehiscence - partial/complete separation of outer wound layer; aka splitting open of wound
Evisceration - total separation all wound layers and protrusion internal organs through open wound; surgical emergency and surgeon contacted immediately and pat to surgery
May follow forceful coughing, vomiting, straining, not properly splinting during movement
5th-10th day postop most common

A

Impaired wound healing

Decks in AHI Class (77):