GLUCOCORTICOIDS IN NON-ENDOCRINE DISEASE PRE/INTRA/POST OP

Glucocorticoid main actions

Reduce inflammation & suppress immune system

Glucocorticoid effect on metabolism

Increase glucose production (gluconeogenesis)

Glucocorticoid cardiac effect

Increase BP via vasoconstriction

Glucocorticoid respiratory effect

Increase surfactant production in stress

Why taper glucocorticoids?

Prevent adrenal insufficiency

Risk of long-term glucocorticoids

Adrenal suppression

Glucocorticoid electrolyte effect

Causes sodium & water retention

Glucocorticoid potassium effect

Causes potassium loss (hypokalemia)

Glucocorticoid bone effect

Can cause osteoporosis

Glucocorticoid infection risk

High - due to immune suppression

Glucocorticoid GI risk

Can cause peptic ulcers

Glucocorticoid contraindication

Active infection

Take glucocorticoids with food?

Yes - decreases GI upset

Stress dosing for steroids?

Yes - increase dose during illness/surgery

Pre-op priority

Safety & preventing complications

Required before sedation

Informed consent signed

Who explains procedure?

The surgeon

Nurse role in consent

Witness signature only

NPO requirement

Typically 8 hours before surgery

Best anti-DVT measure pre-op

TEDs + SCDs + leg exercises

Pre-op potassium importance

Abnormal K+ increases cardiac risk

Malignant hyperthermia cause

Reaction to anesthesia drugs

Malignant hyperthermia hallmark

Elevated CO2 and muscle rigidity

Malignant hyperthermia treatment

Dantrolene

Pre-op teaching includes

TCDB + IS use

Pre-op anxiety intervention

Teach sensory expectations of OR

Pre-op vital concern

Report fever or infection signs

Older adult surgical risk

Reduced cardiac/resp reserve

Common pre-op labs

CBC, electrolytes, BUN/Cr, coagulation

Immediately pre-op checks

ID band, site marked, NPO verification

Pre-op medication category

Sedatives, anxiolytics, anticholinergics

Anticholinergic pre-op purpose

Reduces secretions

Intraoperative priority

Client safety

Purpose of surgical "time out"

Correct patient, procedure, site

Circulating nurse role

Manages environment & documentation

Scrub nurse role

Maintains sterile field

General anesthesia risk

Respiratory depression

Regional anesthesia risk

Hypotension and urinary retention

Stage II anesthesia concern

Laryngospasm

Malignant hyperthermia first sign

Rapid rise in end-tidal CO2

Robotic surgery benefit

Smaller incisions, faster recovery

Hypothermia risk in OR

Cold environment + anesthesia

Prevent hypothermia

Warm blankets, limit skin exposure

Instrument count importance

Prevents retained surgical items

Neuromuscular blocker purpose

Facilitates intubation & muscle relaxation

Common intubation complication

Sore throat

Fire triangle elements

Fuel, ignition source, oxidizer

Priority after surgery

Airway, breathing, circulation

Most common postop respiratory issue

Atelectasis

Prevent atelectasis

IS every 2 hours + deep breathing

Signs of hypoxemia

Restlessness & low SpO2

Minimum urine output

>30 mL/hr

DVT signs

Calf pain, warmth, swelling

Avoid with DVT suspicion

Do NOT massage legs

Early sign of shock

Tachycardia

Wound dehiscence definition

Separation of wound layers

Evisceration definition

Organs protruding through incision

First step for evisceration

Sterile saline dressings over organs

When to call surgeon

Temp >100, redness, purulent drainage

Older adult confusion cause

Often early sign of infection

Post-op bowel function return

Flatus indicates return

Post-op pain med caution

Check RR <10 for opioid sedation risk

Normal postop drainage progression

Sanguineous → serosanguineous → serous