Test 1 Flashcards
(125 cards)
0
Q
Anesthesia
A
State of depressed CNS activity, marked by depression of consciousness, loss of responsiveness, and muscle relaxation.
1
Q
Moderate Sedation
A
Type of anesthesia in which that client does NOT loose consciousness but induction of amnesia and analgesia is still achieved.
2
Q
General anesthesia
A
Loss of sensation, consciousness and reflexes. (Used from major surgery)
Can be injected or inhaled.
3
Q
Local Anesthesia
A
Loss of sensation. NO loss off consciousness.
- Blocks transmission along nerves
- loss of autonomic function to a specific area of the body
4
Q
How many stages of general anesthesia are there?
A
Three:
1) Induction
2) Maintenance
3) Emergence
5
Q
Inhaled Anesthetics
A
Volatile gases or liquids that are dissolved in O2
6
Q
Injectable Anesthetics
A
Usually given through IV.
- Propofol (diprican) is the most common.
- patients allergic to eggs or soy bean oil may be allergic to Propofol.
7
Q
Opioids
A
For pain
8
Q
Benzodiazepines
A
Reduces anxiety
9
Q
Antiemetics
A
For nausea and vomiting
10
Q
Anticholinergics
A
Decrease risk of Bradycardia during surgery
11
Q
Sedatives
A
Sedation
12
Q
Neuromuscular blocking agents
A
Relaxation of muscles
13
Q
Nursing actions before surgery
A
- consent is signed
- have client void before meds
- ensure bed is low/side rails up
- monitor airway and 02 saturation
- monitor lab values
- monitor cardiac rhythm
- monitor temperature
- monitor drains
- assess levels if sedation
- monitor hypotension
- notify surgeon if abnormalities
14
Q
Local anesthesia routes
A
Topical, injection, regional nerve block (injection around specific nerve)
15
Q
Spinal nerve block
A
Injection into CSF in subarachnoid space
16
Q
Epidermal nerve block
A
Anesthetic injected into epidural space in thoracic or lumbar areas
17
Q
Nerve block
A
Around or into area of nerves to block sensation
18
Q
Field block
A
Nerve black around operative field
19
Q
Peripheral nerve block
A
Specific nerve for analgesic or anesthetic use
20
Q
Moderate sedation
A
Patient is relaxed but can respond
21
Q
Preoperative nursing care takes place….
A
At the time a client is scheduled for surgery, until care is transferred to operating suite
22
Q
Nursing assessment in Preoperative care include…
A
History, allergies, anxiety level, lab results, and head to toe, vitals, baseline data
23
Q
Nurses job during Informed consent
A
- nurse can clarify information but can not provide new information
- must witness clients signature
- make sure client is 18 or older, mentally capable, not under meds.
*two witnesses are required if patient signs with X
24
Preoperative teaching includes?
*pain control
*importance of splinting,coughing,deep breathing
*ROM exercises
*early ambulation
*stockings and compression devices
*postoperative diet
*invasive devices
*incentive spirometer
*hold smoking 24 hrs
Asprin should be stopped 1 week before
*herbal meds stopped 2-3 weeks b4
*cannot eat 6hrs/ clear liquids 2 hours
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PACU
Post anesthesia care unit
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What is the priority care in PACU?
Airway patency and ventilation
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What position should unconscious patients be in?
Lateral (left or right) to prevent aspiration
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Alderete score system
**Monitors recovery from anesthesia
Scores: activity, consciousness, respirations, o2, circulation
*needs to have a score of 8-10 to be discharged
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Hypovolemic shock
Massive loss of blood
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Paralytic ileus
Absent bowel sounds
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Wound dishisance
Spontaneous opening of wound
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Evisceration
Intestine through the incision
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Intracellular fluid (ICF)
2/3 of bodies water
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Extra cellular fluid (ECF)
1/3 of bodies water
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Fluid volume deficits (FVDs)
Hypovolemia-isotonic:loss of water and electrolytes from extra cellular fluid
Dehydration-osmolar:loss of water with no loss of electrolytes
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Hemoconcentration
Occurs with dehydration, resulting in high HCT, serum electrolytes, and urine specific gravity
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Hypovolemia vitals
```
Hyperthermia
Tachycardia
Threads pulse
Hypotension
Tachypneic
Hypoxia
```
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Hypovolemic shock
Decreased hemoglobin, O2 saturation
*administer o2, provide fluids, administer vasoconstrictors
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Teaching method
Demonstrate, have patient explain back to you, have patient demonstrate
40
PCA
Patient controlled anesthesia
41
Older adults surgical risk factors
*Decreased cardiac output/peripheral circulation.
*increased BP
Considerations:
*chronic illnesses
*malnutrition
*impaired self care ability
*allergies
Stress from surgery
Mental status changes
Risk for falls
*inadequate support system
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Elective surgery
Not an emergency
43
Urgent surgery
Needs to be done quickly
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Emergent surgery
ASAP (trauma)
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Simple surgery
Example: biopsy
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Radical surgery
Very extensive
| Ex: removing something
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Minimally invasive surgery (MIS)
Decreased risk of infection and blood loss
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Latex allergy indication
Bananas and kiwi
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Hypercoagulation
Clots easy
50
Hypocoagulation
Bleeds easy
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Patients at risk for VTE (venous thromboembolism)
* decreased mobility
* obesity
* age 40 or older
* history of cancer
* spinal cord injury
* history of VTE, PE, varicose vein, edema
* *oral contraceptives
* smoking
* decreased cardiac output
* hip fracture or total knee/hip replacement
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Intestinal preparation for surgery
* performed to prevent injury to colon, reduced number or intestinal bacteria
* enema or laxative night before it morning of surgery
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Preoperative patient prep.
* provide gown
* leave valuables with family or lock up
* tape rings in place if can't be removed
* ensure patient is wearing ID band
* Provide patient with warmed blanket
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Hypothermia
* increased chances of wound infection
* alters metabolism of meds
* coagulation
* cardiac dysrhythmia
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Prophylactic Antibiotics
1 hour before surgery
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Circulating nurse
Coordinates all activities in OR, sets up, and checks equipment, prepares patient, documents all care and events, completes count of sponges and instruments.
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Scrub nurse
Sets up sterile field, drapes patient, hands sterile instruments, supplies to surgeon, maintains accurate count of sponges and equipment.
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Grounding pads
Needed with Minimally invasive surgery (MIS)
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Who scrubs in for surgery? Who doesn't have to?
Surgeon, surgical assistant, scrub nurse have to scrub in.
Anesthetist and circulating nurse don't have to.
60
Four stages of general anesthesia
Stage 1- analgesia and sedation, relaxation
Stage 2- excitement, delirium
Stage 3- operative anesthesia, surgical anesthesia
Stage 4- danger
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Balanced anesthesia
Combination of iv drugs and inhalation to obtain specific effects.
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Complications from general anesthesia
* Malignant hyperthermia
* Overdose
* unrecognized hypoventalation
* problems with anesthetic agents
* intubation problems
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Symptoms of malignant hyperthermia
Tachycardia, tachypnea, elevated temp, muscle rigidity, skin mottling, cyanosis, myoglobinuria, decreased pulse ox
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Dantromine
Iv muscle relaxant
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Postoperative period
Begins with completion of surgery and transfer to PACU, ambulatory care unit, or ICU.
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Returning from local or regional anesthesia....
Touch comes back first, followed by movement, pain, warmth, and cold
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Meds for nausea and vomiting
Ondansetron (Zofran)
| Meclizine (Antivert, Dramamine)
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How much does 1 L of water weigh?
1 kg or 2.2 lbs
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Extracellular fluid consist of?
Intravascular and interstitial fluid
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Hydrostatic pressure
Caused water to push against a membrane when fluid is confined
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Water moves...
From a high to low pressure gradient
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Diffusion
Movement of particles across a permeable membrane
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Osmosis
Movement of water only through a simi-permeable membrane
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Hypotonic
Osmolar of less than 270 mOsm/L
*0.5 normal saline
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Isotonic
Osmolarity of 270-300 mOsm/L
*0.9% sodium chloride
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Hypertonic
Osmolarity if greater then 300 mOsm
*give 1.5 or 3% normal saline
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Aldosterone
Excreted by the cortex or the adrenal gland in response to low Na+ levels, prevents sodium and water loss.
78
Antidiuretic hormone (ADH))
Produced in the posterior pituitary, acts in kidneys to make kidneys reabsorb more water so that the body can retain more fluid.
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Natriuretic peptides (NPs)
Secreted by cells that are the heart or vascular system in response to increased volume levels. Fluid is released
80
Renin angiotensin system
Released to raise BP back to normal.
Renin activates angiotensin 1 which is then converted by angiotensin-converting enzyme into angiotensin 2 (the active form).
Angiotensin 2 is a vasoconstrictor which causes kidneys to constrict and not release water.
81
Third spacing
Retaining fluid in extra cellular fluid
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Diabetic ketoacidosis
Patient urinates often
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Dehydration-osmolar
Loss of water only, not electrolytes.
Hematocrit and hemoglobin becomes high
84
Fluid volume deficit signs and symptoms
Symptoms: dizziness, weakness, lethargy, fatigue
Signs:hyperthermia, tachycardia, hypotension, syncope, confusion, diminished cap refill, weight loss
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Crystalloids
Used for dehydration.
Isotonic fluids
Lactated ringers and normal saline
86
Colloids
Used for patients that are bleeding.
| Large molecules that draw fluid into intravascular space
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Fluid volume excess (FVE) signs and symptoms
Symptoms: confusion, sob, lethargy, muscle weakness
Signs: tachycardia, hypertension, tachypnea, weight gain, crackles, JVD, edema
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Sodium serum levels
135-145 mEq/L
Major cation of the ECF
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Hyponatremia
Sodium levels lower then 136
Causes cell water to shift to ICF causing cerebral edema
Hypotension, muscle weakness, hyperactive bowel sounds
90
Hyponatremia treatment
```
Fluid restrictions if cause by fluid overload.
Administration of diuretics
Hypertonic fluids (3%NaCl)
Encourage intake of high sodium foods
```
Do not correct sodium levels too quickly!!
91
Hypernatremia
Serum sodium greater then 145 mEq/L
Hyperthermia, tachycardia, hypotension, hyperactive bowel sounds, oliguria
92
Hypernatremia treatment
Hypotonic iv fluids or isotonic iv fluids
93
Potassium (Kalemia)
Normal 3.5-5.0 mEq/L
Vital to muscle contractions, cell metabolism, and electrical impulse transmission. In the Intracellular fluid
Can cause cardiac problems if too high or low
94
Hypokalemia
High potassium
| Muscle cramps, constipation, fluttering in chest. Hypotension, weak pulse, confusion, inverted T wave
95
Hypokalemia treatment
Administer oral K+ (best way)
Administer iv K---NEVER bollus!
Should be corrected as quickly as it can be safely done!
96
Hyperkalemia
High potassium.
Levels higher then 5.0 mEq/L
Restlessness, weakness, nausea, irregular pulse, tall peaked t wave, diarrhea, oliguria.
97
Hyperkalemia treatment
Administer calcium to get potassium into cells.
| Insulin will cause potassium to go into cells and D50 will keep sugar from bottoming out
98
Calcium
Causes skeletal muscle problems
9-10.5 mEq/L
Most is stored in bones
99
Hypocalemia
Low calcium levels (below 9.0)
Frequent muscle cramps
Parenthesis in extremities and face
100
Hypocalcemia treatment
Replace calcium orally or iv.
Administer vitamin D
At risk for falls because muscle spasms
101
Hypercalcemia
Above serum calcium levels 10.5
Greater risk for dvts because fast clotting
Muscle weakness
Lethargy
Abdominal cramping
EKG changes, tachycardia for mild and bradycardia for severe
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Hypercalcemia treatment
Stop intake of calcium and vitamin D
Isotonic solutions to restore balance
Lasixs, calcium binders
Dialysis
103
Phosphorus normal serum levels
3.0-4.5
Will be the opposite of calcium
104
Hypophosphatemia
Serum levels of phosphorus below 3.0
Generalized weakness
Bradycardia
Decreased bone density
Will be the opposite of calcium
Hypercalcimia
105
Hypophosphatemia treatment
Iv phosphorus
| Discontinue anti acids
106
Hyperphosphatemia
Serum levels of phosphorus above 4.5
Causes muscle spasms
107
Magnesium serum levels
1.3--2.1
108
Hypomagnesemia
Levels below 1.3
Usually occurs with Hypocalcemia
Deep tendon reflexes
109
Hypermagnesemia
Serum levels above 2.1
Lethargy, muscle weakness, reduced deep tendon reflex
110
Frontal lobe function
Thought/speech, voluntary movements
Helps control mood
Making judgments
111
Parietal lobe function
```
Spatial awareness
Temperature
Touch
Taste
Movement from rest of body
```
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Temporal love function
Hearing
Memory
Language function
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Occipital lobe function
Processes visual information
114
Cerebral cortex
Higher function of brain, processing and communicates info from PNS
115
Motor cortex (in frontal lobe)
Controls voluntary movement
| Corticospinal tracts begin here
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Contralateral
Damage to the right affects the left and vise versa
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Ipsilateral
Same side!
| Right side if cerebellum controls right side
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Alert
Awake and responsive
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Lethargic
Drowsy or sleepy but easily awakened
120
Stuporous
Arousable only with stimulation
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Comatose
Unconscious and cannot be aroused
122
Glasgow coma scale
15 is normal nerve function
| Below 8 is a coma
123
First aid for siezure steps
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Keep calm
Prevent injury by clearing area
Ease person on floor
Put something under head
Turn person on side
Time seizure
Remove anything around neck
Call if longer then 5 min
```
124
Seizures
Abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in loc
