Preop Flashcards

Question

Diagnostic surgery

Answer 1

going in the patient looking

Answer 2

providing relief

Answer 3

the removal or destruction of a body part or tissue or its function.

Answer 4

one to correct facial and body abnormalities caused by birth defects, injury, disease, or aging

Answer 5

pre-anesthesia evaluation and sedation to reduce pt anxiety administration of anesthetic with endotracheal intubation positioning pt, prepping skin, surgical procedure, anesthesia maintained surgery complete, anesthetics are decreased, pt begins to waken, airway removed

Answer 6

I- poor chest expansion; poor cough P- uneven expansion; decreased excursion; absent or decreased “99” where no air is moving P- consolidation=dullness on percussion A- crackles, decreased breath sounds,

Answer 7

due to ̄ mobilization of secretions/stasis – RT poor C&DB, secretions, lying in bed, poor resp effort

Answer 8

mechanical / chemical reaction in the lungs

Answer 9

symptomatic unless pneumonia

Answer 10

1. Venous stasis 2. Injury to vessel wall 3. Increased blood coagulability

Answer 11

nDehydrated, fluid volume deficit nStroke pts – 75% in affected side nSpecific surgeries – Gyn – esp vaginal / abdominal hysterectomy, prostate, bladder, orthopedic nDrugs – hormonal replacements, birth control nFamily history of DVT nBedrest, occupations with prolonged sitting/standing nVaricosities, obesity, elderly, smokers

Answer 12

Symptoms: palpable, cordlike vein. Surrounding area may be itchy, tender, reddened and warm. Treatment: arm/leg exercises, TEDS, ambulation, ASA, NO massage/rubbing to area, (anticoagulant therapy is not usuallyneeded for superficial vein thrombus)

Answer 13

nTenderness on palpation nPain, severe cramping, or heaviness nEdema; discoloration nPositive Homan’s sign (if leg vein) nMalaise, fever Location: axillary or subclavian veins of arms; femoral or iliac veins of legs

Answer 14

nBloodwork: H & H; aPTT; INR; bleeding time; platelet level; D- dimers nDoppler ultrasound nVenogram : CT and/or MRI

Answer 15

nPrimary Goal for all surgical patients = Prevention of DVT formation nEarly ambulation or T & P Q2hr minimum if on bedrest nHip and knee flexion exercises if not contraindicated nPneumatic Compression Devices: Flowtrons, Foot Pumps; DVT cuffs, etc. nCompression stockings - TEDS, JOBST, ace bandages

Answer 16

nUH: Heparin n Vitamin K Antagonists: warfarin (Coumadin) nLMWH: Lovenox, Fragmin nDirect Thrombin Inhibitors: Arixtra

Answer 17

nUH, LMWH, or Factor Xa Inhibitor and warfarin nMonitor appropriate labwork - watch out for shaving nUH, LMWH, or Factor Xa Inhibitor and warfarin nMonitor appropriate labwork nBleeding precautions nThrombolytic agent nMonitor for & prevent PE nSurgical : nVenous thrombectomy nGreenfield Filter

Answer 18

PE: Blood clot/ mass of cells lodged in pulmonary artery nPartial or total occlusion resulting in loss of blood flow to 1 or more lobes of lung nEmbolism may be bone, fat, air, blood, foreign object, amniotic fluid Life threatening!!! Diagnosis: V/Q scan; ABG; Chest x-ray; CT

Answer 19

Pulmonary Embolus S/S: Vary on size of embolus n Chest Pain ( head of the bed with oxygen) n Tachycardia, n tachypnea, n Dyspnea, n Skin changes- n LOC changes- hypoxia n Hemoptysis- blood in sputum n Cough, crackles, wheezes, cyanosis

Answer 20

nUH (Heparin SC) and LMWH (Low molecular weight heparin) nWhen given as prophylaxis – given in low doses that and routes that do not change lab values significantly or need monitoring

Answer 21

given according to WEIGHT BASED at first then adjusted to aPTT time q6h ® qd to prevent further thrombus

Answer 22

n Normal also referred to as control; varies according to type of reagent/test used by lab nControl/Normal aPTT value = 30 – 40 seconds

Answer 23

nFor treatment of DVT need anti-coagulated values which is an aPTT at 1.5 – 2.5 times control (also called therapeutic level)

Answer 24

protamine sulfate***

Answer 25

Warfarin (Coumadin) Therapy: nUsually started within 24 hrs of heparin initiation nOral dosage nAdjusted daily according to Prothrombin time (PT) and International Normalized Ratio (INR) nPT normal nNormal also referred to as control; varies according to type of reagent/test used by lab nNormal/Control/ value PT - 11 – 12.5 seconds n PT Therapeutic levels - 1.5 – 2 X control value nINR therapeutic levels- 2 – 3 (normal = 0.75-1.25) nAntidote for Coumadin = Vitamin K

Answer 26

Tells you how long it takes for your blood to clot

Answer 27

Preferred INR 1.5-2.0 2.0-3.0 2.0-3.0 3.0-4.0

Answer 28

nNo razor (electric ok) nIM very cautiously with pressure after n pressure on bleeding areas nSoft toothbrush nAvoid trauma- risk of internal bleeding nOn coumadin – Health teaching patients to keep Vit. K foods consistent (Dark green veggies) Don’t change amount daily.

Answer 29

nHeparin –protamine sulfate (aPTT) nCoumadin –Vitamin K (PT/INR)

Answer 30

nAny existing bleeding – vaginal, rectal, urinary, open wounds, aneurysm nAlcoholism

Answer 31

Heparin- aPTT Coumadin- PT/INR

Answer 32

Causes- 1. Anesthesia 2. Pain 3. Manipulation of internal organs 2. Pain 3. Manipulation of internal organs

Answer 33

v NPO, progressing to clear to full liq to regular diet nOften order written as “Advance as tolerated” v Antiemetic meds v Pain meds v N/G tube prn v Prevent injury to suture line

Answer 34

A.Paralytic Ileus – define : Peristalsis does not return to parts of the bowel within 3-5 days post op Signs and symptoms – ØUpper intestine- discomfort, mild distention, nausea / vomiting ØLower intestine –Colicky pain, distention evident, tympany on percussion, vomiting- may look like fecal matter (but usually pt has been NPO and bowel emptied before OR)

Answer 35

Diagnosis: nX-ray - Flat plate abdomen nEndoscopy nGI series nIAPP

Answer 36

ØOOB and AMBULATE!!! ØNPO until + bowel sounds – listen carefully ØNG tube in or unclamped ØGive metoclopramide (Reglan) if ordered –GI stimulant ØAvoid meperidine (Demerol) – slows smooth muscle. Ø Pt should lie on RIGHT side when in bed

Answer 37

vIntussusception vTumors vStrictures / hernias vAdhesions from previous surgeries (scar tissue that grows in peritoneum between and around organs) vAbscesses

Answer 38

v Pain – crampy, wavelike, colicky vAbdominal distention vLeakage or passing blood or mucus rectally vNo stool, No flatus vVomiting intestinal contents vS/S dehydration-?? 3rd spacing

Answer 39

fluid shifts to an area not contributing to equilibrium

Answer 40

nSurgical trauma- esp. bowel surgery of bowel obstruction, burns, peritonitis, bleed into joints causes inflammatory process. nS/S - imbalance of fluid – more in than out nOliguria, look of dehydration, poor VS but lots of IV fluid in. nBowel can sequester (hold) up to 12 Liters nWeight gain – each Liter of fluid retained =1kg = 2.2 lbs. nRx – hypertonic IV to draw fluid from cells to intravascular spaces

Answer 41

Abdominal x-ray, CBC, Chemistries Treatment – NPO, monitor VS esp Temp., minimal pain meds until Dx made. vNG tube (Salem sump), Miller-Abbott tube vEndoscopy vExploratory laparoscopy/laparotomy

Answer 42

Used to decompress stomach & upper GI tract, rest GI system, decompression for obstruction Levin- single lumen Salem Sump- double lumen with air vent Pt NPO Assess- nPlacement, drainage, patency, tape/pin nSuction (intermittent or low continuous) nI/O, Fluid &Electrolyte balance, Labs nOral care, nasal care, HOB , T&P q2h nAssess bowel sounds (turn off suction first)

Answer 43

nDehydration nFluid &Electrolyte imbalance nHyponatremia – low sodium (Na+) nHypokalemia –low potassium (K+) nMetabolic alkalosis nHunger-irritable- assess depression nGood oral care

Answer 44

nSodium (Na+) imbalance – fluid & electrolyte shifts. ̄ Na+ = less water retained Na+ = fluid volume excess nPotassium (K+) imbalance – muscle contractility affected – esp heart muscle ̄K+ OR K+ -both need attention and medical collaboration - meds

Answer 45

nCheck lab values of K+ and Na+ often nEKG done if ordered nMust have urine output >30cc/hr- KCL is excreted by kidneys nEKG done if ordered nMust have urine output >30cc/hr- KCL is excreted by kidneys nNever more than 80 mEq / liter of IV flds -40 mEq/L preferred amt nIVPB – NEVER IV PUSH nRate of infusion

Answer 46

Wound Drains: Reduce edema, drainage 1. Penrose 2. Jackson Pratt drain- works by suction, must be compressed . 3. Hemovac- must be compressed Must empty drains every shift and prn

Answer 47

nAssess q time of vitals and more often prn nMaintain compression of JP drains and Hemovac nExpect large amount of drainage on drsg. with penrose drains nDon’t expect much drainage on drsg with JP & Hemovac drains if working. nBe careful when moving pt.- drains are not always sutured in!!

Answer 48

Wound Separations nDehiscence – wound edges open and disintegration of underlying layers S/S – open incision. Serous oozing. Wound pain nEvisceration – contents of body cavity protrude through dehiscence S/S – organs through skin, gush of fluid nEvisceration – contents of body cavity protrude through dehiscence S/S – organs through skin, gush of fluid pt. Feels something pop! Or let go! TREATMENT – NS soaked STERILE Drsg- must keep moist CALL surgeon STAT

Answer 49

refers to when doctors close a wound using staples, stitches, glues, or other forms of wound-closing processes. Secondary wound healing, or secondary intention wound healing, occurs when a wound that cannot be stitched causes a large amount of tissue los delayed primary closure, occurs when there is a need to delay the wound-closing process.

Answer 50

measures the airflow (ventilation) and blood flow (perfusion) in your lungs. You breathe in and are injected with radioactive material while a provider takes pictures of your lungs

Preop Flashcards

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