Week 1: Perioperative Flashcards
1
Q
Cardiac Output
A
The amount of blood ejected from the heart in one minute
2
Q
Stroke volume:
A
the amount of blood pumped by each ventricle with each heartbeat (mL/beat)
3
Q
What are the 4 determinants of cardiac output?
A
- heart rate
- preload
- afterload
- contractility
4
Q
Preload
A
the amount of blood entering the ventricles during diastole
5
Q
ways to increase preload
A
IV fluids
stimulating the sns system
6
Q
ways to decrease preload
A
diuretics
vasodilators
7
Q
afterload
A
the pressure the ventricles must overcome to open valves and pump blood out go the heart (when the ventricles are contracting during SYSTOLE)
8
Q
ways to increase afterload
A
vasoconstrictors
9
Q
Ways to decrease afterload
A
diuretics
vasodilators
10
Q
contractility
A
how hard the myocardium contracts for a given period
11
Q
How to calculate CO
A
heart rate x stroke volume = CO
12
Q
Explain the steps of the RAAS system
A
- the body blood pressure drops
- the kidneys (juxtaglomerular cells) release renin in response to low BP
- The renin stimulates the liver to release angiotensin 1
- ACE turns angiotensin 1 into angiotensin 2
- angiotensin 2 causes vasoconstriction, aldosterone release (keep sodium and water in kidneys and no pee) and the release of ADH (stimulates thirst, keep water to increase blood volume)
13
Q
diagnosis
A
to determine the presence or extent of pathological abnormality (eg. lymph node biopsy)
14
Q
Cure
A
to eliminate or repaire a pathological condition (eg. ruptured appendix)
15
Q
Palliation
A
to alleviate symptoms without cure
16
Q
Prevention
A
to reduce the risk of developing a condition
17
Q
Cosmetic
A
to alter physical appearance
18
Q
Exploration
A
to determine the nature or extent of a disease
19
Q
Periopaerative
A
the total surgical episode
20
Q
What is the first interaction a patient has with a surgical team?
A
the perioperative admission assessment done by the perianesthesia nurse
21
Q
What happens in the perioperative admission assessment
A
physical assessment
admission data collection
consent form review
pre anaesthesia evaluation
patients weight/airway history
laboratory and diagnostic tests
22
Q
What information should the perianesthia nurse provide patients during the perioperative admission assessment?
A
policy for taking medications routinely
which medications/vitamins to stop prior to surgery/when to stop them
NPO instructions
pain management options
infection prevention and wound care
instructions for postoperative exercises
postoperative discharge and care
23
Q
What must all patients have done by the physician
A
a physical assessment completed and documented
24
Q
Day of surgery assessment the nurse does a focused assessment that includes:
A
review of existing information
reinforced teaching
review of discharge plans
25
-ectomy
exicision/removal
26
-oscopy
looking into
27
-ostomy
creating an opening into
28
-otomy
cutting into
29
-plasty
repair/reconstruction
30
Appendectomy
to remove appendix
GENERAL SURGERY
31
Gastroscopy
examining the upper digestive tract
GENERAL SURGERY
32
Colostomy
creating a stoma
GENERAL SURGERY
33
Tracheotomy
creating an opening in the trachea
GENERAL SURGERY
34
Mammoplasty
surgery to reduce breast size
GENERAL SURGERY
35
Disectomy
surgery to remove the damaged park of a disk in the spine
ORTHOPEDIC SURGERY
36
Knee arthroplasty
to resurface a knee damaged by arthritis
ORTHOPEDIC SURGERY
37
arthrotomy
requires the opening of a joint
ORTHOPEDIC SURGERY
38
total hip arthroplasty
replaces part of the hip joint with artificial implants
ORTHOPEDIC SURGERY
39
Nephrectomy
surgical removal of the kidney
UROLOGICAL SURGERY
40
Cytoscopy
looking inside the bladder
UROLOGICAL SURGERY
41
Ureterostomy
creates a new path for urine to leave the body out the abdominal wall
UROLOGICAL SURGERY
42
Cystotomy
surgical incision into the gallbladder or urinary bladder
UROLOGICAL SURGERY
43
Ureteroplasty
fixing the narrowing of the ureters
UROLOGICAL SURGERY
44
Common fears patients have regarding surgery
fear of death
fear of pain
fear of medication/body alteration
fear of anesthesia
fear of life disruption
45
What should be asked regarding health history of a patient
understanding of reason for surgery
previous surgeries, times, reactions
women's obstetric and menstrual history
family health hx
46
What conditions in a families history may predispose a patient to having similar reactions?
cardiac and endocrine disease
HTN
sudden cardiac death
MI
CAD
DM
47
Malignant Hyperthermia
Rare metabolic disease triggered by specific anesthesia that results in hyperthermia, skeletal muscle rigidity and possible death (a genetic predisposition)
48
What is important to note with ASA?
Stop 2 weeks before surgery
49
What information needs to be collected regarding medications during the perioperative admission assessment?
current medications (including OTC and herbal)
drug/substance use (tobacco, alcohol, opioids, weed, cocaine, amphetamines)
50
When should smoking be stopped in preparation for surgery?
6 weeks
51
What is important to note with cannabis use?
recent cannabis use has been shown to need increased doses of postoperative analgesia
52
What may increase a patients risk to latex allergy?
history of contact dermatitis and atopic immunological reactions
allergies to nuts, bananas, avocados, kiwi, chestnuts, papayas, pitted fruits
frequent exposure (HCP)
53
What risks are people with diabetes subject to when it comes to surgery?
hypoglycemia
hyperglycaemia
ketosis
cardiovascular alterations
delayed wound healing
infection
54
what risks are people with thyroid dysfunction subject to when it comes to surgery?
hyperthyroidism
hypothyroidism
55
Neurological patient assessment
orientation to time, place and person
identify presence of confusion, disorderly thinking, inability to follow commands
history of strokes, TIAs or disease of the CNS
history of headaches/issues with vision/hearing
56
Cardiovascular patient assessment
acute or chronic conditions (presence of angina, HTN, HF, MI)
palpate radial pulse for characteristics
inspect for edema
baseline BP
medication that may affect blood clotting
lab and diagnostic test review for cardio function
57
Respiratory System patient assessment
acute or chronic conditions
history of smoking
baseline resp rate/rhythm, pattern, O2
cough, dyspnea, accessory muscles cyanosis
58
Urinary system assessment
ability to void
renal function lab tests
59
Hepatic system assessment
history of substance misuse
liver lab tests
60
Endocrine system assessment
pre existing complications with bleeding or endocrine disorders
61
Integumentary system assessment
mucous membranes, skin starts
rashes boils, ulcers
skin moisture/temperature
skin turgor
wound healing problems
62
Musculoskeletal assessment
pressure point
limitations in joint pain, range of motion an muscle weakness
mobility, gait, balance
63
GI system assessment
GI disorders or complications with elimination
food and fluid intake patterns and recent weight loss
weigh patient
dentures or bridges (may be dislodged during intubation)
64
What is the ASA system
to classify patients to a physical status regarding the administration of anesthesia
65
When are preoperative laboratory and diagnostic tests completed?
on the basis of patients health history in order to identify risk and decrease the rates of unnecessary testing
66
what happens if it is a life or limb situation but there is no consent yet?
physician does what is necessary with the known information regarding wishes then obtains consent as soon as possible
67
who can consent
anyone who has the capacity and maturity to consent (Quebec is the exception where they must be 14 or older)
68
Benzodiazepines
reduce anxiety used for sedative and amnesic properties
69
Anticholinergics
reduce respiratory and oral secretions
70
Opioids
given to decrease intro operative anesthesia requirements and to decrease pain
71
Antacids
decrease gastric volume and increase gastric pH
72
when should oral medications be given?
60-90 minutes before
73
When should subcut injections be given
30-60 minutes before
74
when should IV medications be given
in the preoperative holding area or the OR
75
How does the anesthesiologist determine what anaesthetic technique will be used?
Based on:
- physical and mental status
- age
- family history
- allergies
- pain
- length of surgery
- operative procedure
- discharge plans
76
how is anaesthesia classified?
based on the effect it has on the patients CNS and pain perception
77
General anesthesia
altered physiological state characterized by reversible loss of consciousness, skeletal muscle relaxation, amnesia and analgesia
78
Local anesthesia
the loss of sensation without the loss of consciousness and can be induced topically vis intracutaenous or subcutaneous infiltration
79
Regional anesthesia
causes the reversible loss of sensation to a region of the body by blocking nerve fibres with the administration of an anesthetic
80
moderate sedation
mild depression of consciousness that is from IV sedatives, analgesias or both (can still maintain airway control)
81
When is general anesthesia indicated?
when it is lengthy surgical procedure that requires the patient to be in uncomfortable positions for the duration, when a patient has anxiety, those who refuse or contraindications to local or regional anesthetic
82
What reverses benzodiazepine induced respiratory depression?
flumazenil (benzodiazepine antagonist)
83
Administration routes for local anesthesia
topical
local
regional
IV regional block
spinal anesthesia
epidural anesthesia
84
What anesthetic commonly is the cause of malignant hyperthermia
succinylcholine
85
What are the types of opioids used during general anesthesia?
fentanyl
Morphine sulphate
sufentanil
alfentanil
86
Opioids use during surgery
induce ad maintain anesthesia, reduce stimuli from sensory nerve endings, provide analgesia during surgery
87
Types of benzodiazepines used during general anesthesia
midazolam
diazepam
lorazepam
88
Benzodiazepines use during surgery
induce and maintain anesthesia
89
What does signed consent require to complete the process?
a secondary witness signature, a nurse can do this
90
Signs of blood loss
increased HR
hypotension
91
Anaphylaxis S&S?
hypotension, tachycardia, bronchospasm, pulmonary edema
92
What is an advanced directive
a capable written instruction that gives or refuses consent to health care in the event the adult later becomes incapable of giving the instruction at the time the health care is required
92
When should a patient be intubated?
Less than 8 intubate or RR <4
93
Every post operative patient is at risk for:
Infection
Post op pneumonia
DVT
94
Normothermia
decreased ability to amount a fever response
95
What is the treatment for malignant hyperthermia?
dantrolene (slows metabolism, reduces muscle contraction, and mediates the catabolic processes associated with MH)
