Exam 4: Perioperative Nursing

SBAR questions to answer and details needed

• important during hand off nursing the process

• Situation → why is the client here? Introduction to everyone

• Background → what brought the client to this point?

• Assessment → what were your findings

• Recommendation → what should be done

When will discharge be discussed?

during PREoperative phase → client isn’t as coherent during post

Three stages of surgery

preoperative → informed consent, explanation of procedure, discharge info, making sure everything is known and correct

intraoperative → sterile field in OR

postoperative → PACU patient recovered and evulated

normal vitals?

• RR: 12-20

• BP: 120/80

• HR: 60-100

• Temp: 36-38 C

• Sat: 95-100

Emergent, Urgent, Expedited, Elective surgeries

• emergent: done right now required to save life in minutes → car accident, hemorrhaging

• Urgent: required to safe life within hours

• expedited: in the next few days

• elective: no urgency plan when there is an opening

NSAIDS, Anticoagulants (lovenox), Alcohol, Weed and surgery

all impact the bodies ability to form blood clots → higher bleeding risk

Informed consent

• writing of non-emergent surgery

• provider must come and explain the procedure not the nurse

• in emergency situations this is not needed

Preoperative assessment

• medication

• beliefs → can affect surgery

• family history → especially making giant hyperthermia

• clear liquids up to 2 hours → aspiration risk

• anything in the mouth? Choking hazards? jewewly?

MALIGNANT HYPERTHERMIA

• hypermetabolic storm, where the body system starts to fail → body too hot

• urgently!

• Family history puts more at risk

• hot, pallor, fast heart rate, muscle spams

How much urine should be seen after surgey?

30 ml/hr

Blood sugar and procedures

• check for all clients

• diabetics/hyperglycemia → slower healing

• stress can make it high

• what to do? monitor and give juice/food when allowed

Considerations for those on corticosteroids

• Do not stop suddenly!! should be taken before procedure

• decrease immune response

What foods indicate a client might have an allergy to latex

• banana

• kiwi

• avocado

What foods indicate a client might have an allergy to Diprivan? What is Diprivan

• Eggs

• propofol → milk of amnesia given for sedation

What foods indicate a client might have an allergy to iodine

shellfish

Why do we not stop corticosteroids? even before surgery

• cardiovascular collapse → bp goes to nothing

• ends in SONE

Opioids cause what negative side effect?

• respiratory depression and constipation

What does garlic put you at risk for?

bleeding, know if client takes this

what does st. John’s Wort put you at risk for?

increased sedation know if client takes this

Before going into the OR you want to confirm what?

Patient, Procedure, Site

What does the circulating nurse do?

• leadership role

• manages OR monitoring aseptic technique, checks, documents

• whats going on and off the field? is the environment safe?

Scrub role does what

• set up sterile field and equipment

• anticipate what surgeon will need

• count whats there before during and after

• specimens

What temp is th surgical environment?

• cold 68-73 degrees

Types of sedation

• minimal → client can respond

• Moderate → client can maintain own airway

• Deep → aka general cannot be easily awakened and incubated

Client reports ringing, roaring, or buzzing in the first state of sedation, what does the nurse do?

• ensure client it is normal thats just them falling asleep

• stage 1

Stage 2 of anesthesia

• client can go from being very alert to nothing in seconds this is normal

Importance of Succinylcholine

• muscle relaxant used for anthesis

• classically the cause of malignant hyperthermia

• check potassium levels might see a spike

use for regional anesthesia ? positioning?

• epidural, spinal, local blocks

• pregnancy and chronic pain

• laid down or back bent over

Medications that help with N/V

• IntraOp

• Sodium Citrate → Bicitra

Hypothermia risk why? do what?

• low temp, cold fluids, gas inhalation, open body cavity

• warm fluids, remove wet clothing, cover skin, warm gradually

Malignant Hyperthermia def? when it happens?

• rare and genetic triggered by anesthesia

• can occur during or after procedure

Malignant Hyperthermia symptoms

• Tachycardia

• Tachypnea

• Cardiac arrhythmias

• Hyperkalemia → potassium

• Hypercarbia

• Muscular rigidity

• Rapid & extreme rise in

body temperature

what med stops Malignant Hyperthermia?

dantrolene/dantrium

When is the postop phase?

Time patient leaves the

OR thru last FU visit with

the surgeon

What is considered an hemorrhage? what labs?

• more than 1,000mL of blood loss

• low h/h, bp, and loc

• high HR, pale and dizzy

what do you apply for hemmorage?

no rebreather

what can cause hemorrhaging?

• blood loss from surgery

• pooling in extremities

• med side effects

pain medications

• Opioids

• Opioid Antagonist

• fentanyl (Duragesic)

hydromorphone (Dilaudid)

meperidine (Demerol)

morphine sulfate

• Naloxone hydrochloride

(Narcan)

• Non opioids

• Acetaminophen, Ibuprofen

why is early ambulation important?

• helps recovery

• prevents atelectasis, pneumonia, gi discomfort, andf circulatory issues

closed suction device

• JP drain

• Hemovac

open drain

• Penrose

• measure output on gauze

When to expect next void postop?

6-8 hour

Hematocrit levels

F: 37-47

M: 42-52

• hypovolemic shock/myocardial infarction risk if low

Hemoglobin levels

F: 12-16

M: 14-18

• hypovolemic shock/myocardial infarction risk if low

H&H risk

tissue hypoxia

Platelet count

150,00-400,000

• clotting factor → low = bleeding risk, high=clots

WBC levels

5,000-10,000

• low → patient has a harder time recovering from surgery sand higher infection risk

BUN

10-20

• poor healing or hypotension

Glucose

74-106

• high → infection risk, poor healing

• low → shock/brain damage

Calcium levels

9-10.5

• low → airwya’s spams

• high → heart stop

Magnesium

1.3-2.1

• heart rhythms

• Mg

Potassium

3.5-5

• most urgent! heart function

• K

Sodium

• 126-145

• Na

Prothrombin Time (PT) value

11-12.5 seconds

INR value

0.6-1.0

aPTT

30-40

PT/INR/aPTT risk if abnormal

• if hight bleeding risk

• if low clotting risk

Morphine side effects

• constipation, pruritus (itching), nausea

What should we do after surgery for the lungs?

• deep breathing and coughing → can use I.S

• splinting can help mobilize

• mobilized secretions, reduce risk of atelectasis and pneumonia

Zones in hospitals (unrestricted, semi restricted, restricted)

• unrestricted: street clothes

• semirestricted: scrub clothes

• Restricted: scrubs clothes, shoe covers, mask

Explain general anthesthia

• state of narcosis

• CNS suppressed

• cannot be aroused

• unable to maintance ventilation

Purpose of post op

• reestablish equilibrium

• pain relief

• prevent compilations

• educate client about self care