Exam 1 (Peri-Op & Blood Products)

informed consent

voluntary consent

explanation of procedure and its risk

description of benefits and alternatives

an offer to answer questions about procedure

instructions that the patient may withdrawal consent

a statement informing the patient if the protocol differs from customary procedure

who is able to obtain informed consent from a patient?

PHYSCIAN

NOT RN

when is consent needed?

invasive procedure (surgical incision, biopsy, cytoscopy, paracentesis)

procedure requiring sedation/anesthesia

nonsurigcal procedure that carries more than a slight risk

procedure involving radiation or chemotherapy

important allergies to note during pre-op assessment

medication allergies

LATEX allergy

nurse responsibility during pre-op period

schedule diagnostic test

verify that all necessary documents are in medical record

report abnormal diagnostic results to surgeon

prepare and teach the cilent

what is a crtical pre-op test that must be done?

PREGNANCY test

purpose of dietary restrictions before a procedure

prevent asipriation

special considerations for pre-op dietary restrictions

if diabetic might need to give IV dextrose to maintain glucose levels

purpose of pre-op intestinal preparation

clean bowel out for surgery

good visualization

prevent infection

nurse role in pre-op intestinal preparation

educate on how to perform the preparation

look at mobility (fall risk)

nurse role in preparing the cilent for a procedure

have pt void right before the procedure

possible placement of tubes, drains, vascular access devices

teach about post-op proecures and exercises

pre-op nursing tasks

give a sedative and/or analgesic to reduce anxiety and decrease amount of anesthetic needed intraop

hang prophylactic antibiotics

remove jewelry, dentures, nail polish

general anesthesia complications

malignant hyperthermia

overdose

complications of specific anesthetic agents

complications of intubation

malignant hyperthermia

rare genetic component

RAPID rise in body temp (up to 40.6C)

due to hypermetabolic state and muscle contractions

muscle rigidity

clenched jaw

tachypnea

managed with dantrolene sodium/cooling blankets

dantrolene sodium ROUTE

IV

dantrolene sodium USE

malignant hyperthermia

antispasmodic

dantrolene sodium ADVERSE EFFECTS

drowsiness

muscle weakness

dysphagia

blurred vision

dantrolene sodium TEACHING POINTS

requires close monitoring by surgical team

combine with cooling blankets

do NOT combine with Ca++ channel blockers (hyperkalemia risk)

local anesthesia complications

minimal risks

local inflitration

regional anesthesia complications

headache, back pain, urinary retention, hematoma

lidocaine ROUTE

SQ

lidocaine USE

local anesthesia

NO sedation

lidocaine ADVERSE EFFECTS

not for IV

fatigue

dizziness

hypotension

lidocaine TEACHING POINTS

moniotr site of injection for ecchymosis, erythema

report dizziness

midazolam ROUTE

IV

midazolam USES

mild/conscious sedation

midazolam ADVERSE EFFECTS

risk for overhydration

memory loss

midazolam TEACHING POINTS

ask for an assist out of bed until sedation wears off

sit up/cough/deep breathe after procedure

nursing management for midazolam

administer drug per MD order

VS monitoring

Monitor Airway

monitor sedation

heart monitor

what post-op skin assessment is considered a MEDICAL EMERGENCY?

evisceration of wound

take back to OR ASAP to fix

sterile saline & gauze (hold organs in place)

biggest complications post-op

hemorrhage

infection

pneumonia

muscle deconditiong

PRBC indications

HGB

platelet indications

ITP & DIC

Plt

fresh frozen plasma indications

INR >1.6

emergent reversal warfarin

hemophilia

albumin indications

hypovolemia related to 3rd spacing of fluids

dosage of PRBC

will raise hgb by 1 gm/dl & hct by 3%

PRBC administration rules

REQUIRES informed consent

premedicate with tylenol & benadryl

FREQUENT VS (q15min for 1 hour)

USE WITHIN 4 HOURS OF ARRIVIAL

platelet administration rules

infuse over 30 minutes

do not ADD other medications

shelf life of platelets

5 days after donation

fresh frozen plasma shelf life

12 months after donation

fresh frozen plasma administration rules

ABO compatible to extent

do NOT add other medications

infuse over 30-60 minutes

where does albumin come from ?

PHARMACY

NO ABO COMPATIBILITY NEEDED

albumin administration rules

use tubing with an airvent

do NOT dilute

start SLOW

large gauage needle

Acute hemolytic transfusion reaction

ABO compatibility issue (on us)

develops QUICKLY (~15 min)

acute hemolytic transfusion reaction symptoms

anxiety

dyspnea

fever

can progress to DIC & shock

acute hemolytic tranfusion reaction nursing management

Careful checking (double check)

STOP transfusion

normal saline/diuretics

send EVERYTHING to blod bank for investigation

allergic (anaphylaxis) transfusion reaction symptoms

URTICARIA, HIVES, fever , edema, dizziness

bronchospasm, stridor, extreme hypotension

allergic transfusion reaction nursing management

STOP transfusion

send everything to blood bank

PO/IV diphenhydramine, IV hydrocortisone

febrile nonhemolytic transfusion reaction symptoms

FEVER but NO destruction of red cells

fever

hives

urticaria

rhinorrhea

headache

back pain

febrile nonhemoyltic transfusion reaction nursing management

STOP transfusion

send EVERYTHING to blood bank

administer acteaminophen & diphenhydramine

transfusion related lung injury

lung injury that occurs within 6 hours on transfusion

exact cause is unknown

transfusion related lung injury symptoms

SOB

crackles in the lungs

Acute Resp. Distress

Pulm Edema

Hypotension

transfusion related lung injury nursing management

support respiration to let lungs rest/recover

O2

IV fluids support

vasopressors to support BP

AVOID diuretics

delayed hemolytic reaction

pt who has been sensitized to RBC antigen has a low level reaction

right blood type but sensitized reaction to RBC antigen

occurs between days to 2 weeks post transfusion

delayed hemolytic reaction symptoms

itching

hives

fever

Low H/H 1 week post transfusion (no benefit from the blood)

post-transfusion purpura (PTP) platelet complication

thrombocytopenia 5-10 days post transfusion

sensitivity to human platelet antigen 1 (HPA-1)

ALL platelets are destroyed

fresh frozen plasma (FFP) complications

DO NOT SEE transfusion reactions

allergic reaction

acute lung injury

hypervolemia

albumin complications

hypersensitivity

hypervolemia/hemodilution

electrolyte imbalance

coagulation abnormalities

Human Virus Transmission (VERY RARE)