Foundation 3

Urgent

requires attention to prevent worsening

Emergency

immediate, life-saving

STAT

highest priority, requires instantaneous action

Diagnostic Surgery

biopsy, diagnostic laparoscopy/exploratory laparotomy (abdominal)

Ablative Surgery

removing a diseased body part (appendectomy/thyroidectomy)

Palliative Surgery

relieve/reduce intensity of disease (debridement)

Reconstructive Surgery

restore function/improve self concept (plastics/ortho - fracture)

Transplantation Surgery

replace organs

Constructive Surgery

restore function to congenital abnormality

Common Risks of Surgery

• surgical site infection

• clotting

• blood loss/hemorrhage

• hypoglycemia

• malignant hyperthermia

Perioperative Phases

1. Preoperative

2. Intraoperative

3. Postoperative

Preoperative Phase

• decision to have surgery (consent)

• until pt is transferred to OR or procedural bed

• NPO

• Teaching begins

Intraoperative Phase

pt is transferred to OR bed to post-anesthesia care unit (PACU)

Postoperative Phase

from PACU to recovery area to complete recovery & last follow-up health provider visit

Advanced Dirctives

• living will

• durable power of attorney

• DNR

Rules for Obtaining Informed Consent

• obtained by provider

• uses everyday language

• explains alternatives, risks & benefits

• who is performing procedure

• witness

General Ax

• vital signs

• medical/surgical hx/allergies

• med reconciliation

• social hx

• skin ax

• signs of infection

Surgical Risks of Medications

• anticoagulants

• diuretics (electrolyte, respiratory)

• tranquilizers (hypotension)

• adrenal steroids (CV collapse)

• antibiotics (respiratory paralysis)

Presurgical Screening Test

• chest X-ray

• ECG

• CBC

• electrolyte levels

• urinalysis/UPT

Pre-OP Teaching

• splinting

• coughing/deep breathing

• incentive spirometer

• leg exercises

• turning in bed

• early ambulation

General Anesthesia

IV / Inhaled drugs

Moderate Anesthesia

“conscious sedation”

• short-term

• minimally invasive (endoscopy)

• no memory, but follow commands

Regional Anesthesia

nerve/TAP block

• injected near a nerve

• less bowel dysfunction

Types of Regional Anesthesia

• peripheral nerve block

• spinal (subarachnoid) anesthesia

• epidural anesthesia (C-section)

Peripheral Nerve Block

decreases sensation/movement; still feel pressure

Spinal (subarachnoid) anesthesia

lower abdomen/perineum/legs

Topical & Local Anesthesia

used on mucous membrane, open skin, wounds, burns

Lidocaine Toxicity

• facial tingling

• oral numbness

• restlessness

• vertigo

• tinnitus

• slurring

• seizures

Phases of General Anesthesia

1. Induction

2. Maintenance

3. Emergence (wake up)

Types of Anesthesia Medications

• sedatives (anxiety)

• anticholinergics (dry)

• narcotic analgesics (sedation)

• Neuroleptanalgesic agents (calm/sleepy)

• Histamine-2 receptor antihistamines (decrease gastric secretion)

Nociceptive Pain

• visceral (vascular & others)

• somatic (somatic)

Neuropathic Pain

• CNS

• PNS

Nociceptive Pain

1. stimuli

2. transduction

3. transmission

4. modulation

5. perception

Pathway of Pain (Transduction)

1. periphery (nociceptors)

2. chemical response (to spinal cord)

   1. initiates action potential

Resting Membrane Potential

-90 mV

Action Potential Propagation

1. Voltage gated Na+ channels open

2. Na moves inside cell

3. depolarization

4. action potential generated

End of Action Potential

1. voltage gated K channel opens (more K)

2. recovery: Na+/K+ ATPase pump restores composition of cell.

Transmission of Pain

action potential travels from site of damage to spinal cord

Phases of Transmission

1. injury site to spinal cord

2. spinal cord to brain stem & thalamus

3. thalamus to cortex

Central Structures involved in pain perception

• reticular system

• somatosensory cortex

• limbic system

Substances that inhibit nociceptive impulses

• endogenous opioids

• serotonin

• norepinephrine

PAINAD

Pain Ax in Advance Dementia Scale

SMART Goal

Specific

Measurable

Achievable

Relevant

Time-Bound

Pasero Opioid-Induced Sedation Scale

S: sleep, easy to arouse

1. awake & alert

2. drowsy, easy to arouse

3. frequently drowsy & sleeps during convos

4. somnolent w/ minimal to no response to stimuli

Guided Imagery

replacing negative & stressful feelings w/ pleasant images

Holistic Healthcare

dimensions that compromise the whole person, not just the illness

Morbidity

how often a disease occurs

Mortality

number of deaths resulting from the disease

Disease

pathological changes in the structure or function of the body or mind

Illness

response of the person to a disease (process where a person’s level of functioning is changed compared with a previous level)

Remission

chronic disease present but no symptoms

Exacerbation

symptoms reappear

Health Equity

attainment of the highest level of health for all people

Primary Health Prevention

promoting & prevention

Secondary Health Prevention

screening for early signs

Tertiary Health Prevention

starts after diagnosis & treatment; to reduce disability & rehabilitate

Examples of Primary Level of Prevention

• diet

• no smoking, alcohol, or drugs

• exercise

• immunization

Examples of Secondary Level of Prevention

• screenings

• family counseling

• pap smears

Examples of Tertiary Level of Prevention

• medication

• physical/occupational therapy

• rehab

Healthy People Objective

eliminate health disparities

Stages of Change

1. pre-contemplation

2. contemplation

3. preparation

4. action

5. maintenance

6. relapse

7. repeat

Health Literacy

ability to access, read, understand, evaluate, communicate, and act on health information to promote, maintain, and improve health

Assessment

• learning needs

• learning readiness

• emotional readiness

• learning style

• learning strengths

Learning Preferences (VARK)

Visual

Aural (audio)

Read/Write

Kinesthetics

[Multi-modal]

Bloom’s Taxonomy

• cognitive

• psychomotor

• affective (changes in attitude)

Teach-Back Method

• loop process

• open-ended questions

• chunk & check (summarize throughout)

• “ask me 3…”

Physiologic Homeostasis

• Local Adaption Syndrome

• General Adaption Syndrome

Local Adaption Syndrome (LAS)

involves only one specific body part (reflex pain or inflammatory response)

General Adaption Syndrome (GAS)

biochemical model of stress (alarm, resistance, exhaustion)

Alarm Reaction

• fight or flight

• short

• shock & counter-shock phases

Stage of Resistance

• adapt to stressor

• body reaction returns to normal

• regains homeostasis

Stage of Exhaustion

• adaptive mechanisms are depleted

• rests & returns to normal

Psychological Homeostasis

• physiological needs

• safety needs

• love & belonging

• esteem

• self-actualization

Developmental Stress

occurs when person progresses through stages of growth and development

Situational Stress

does not occur in predictable patterns

Sleep is for

• Learning and memory

• Removal of waste products

• Metabolism

• Immune response

• Neurotransmitter uptake and mood

Hypersomnolence

• idiopathic hypersomnia

• narcolepsy

Idiopathic Hypersomnia

• excessive daytime sleepiness

• not relieved by sleep

• mostly affects adolescents

Narcolepsy

• neurological

• associated w/ cataplexy

• sudden bouts of sleep

Circadian Rhythm Disorders

• Shift work disorder (night shift)

• Jet Lag

Parasomnia

involves usual & undesirable experiences that disrupt sleep

• common in children

• S/S: sleepwalking, wetting bed, sleep eating, terrors

Restless Leg Syndrome

affects mostly middle aged adults

Periodic Limb Movement Disorder

• triple flexion (knee, hallux, ankle)

• occurs multiple times per hours during NREM

Sleep Bruxism

• teeth grinding

• can lead to

  • TMJ

  • HA

  • head & neck pain

Stage 1 of Sleep

• very light

• sense of falling

• NREM

Stage 2 of Sleep

• light

• temp & HR decreases

• NREM

Stage 3 & 4 of Sleep

• slow wave / Delta

• body repairs itself

• NREM

Stage 5 of Sleep

• dreaming

• brain activity similar to waking levels

• REM

Sleep Apnea

SNS activates & pt awakens

• arrhythmias

• HTN

Risk Factors of Sleep Apnea

• age

• weight

• neck circumference

• gender

• family hx

• smoking

• alcohol

S/S of Sleep Apnea

• daytime fatigue

• mood disorders

• decreased mental acuity

Sleep Apnea is diagnosed by

polysomnography

Sleep Screening Tools

• Pittsburg Sleep Quality Index

• Epworth Sleepiness Scale