NRSG 327 Week 2

3 components of surgical stress response

SNS, RAAS and pancreas

SNS role in surgical stress response

Fight or flight response

Dilated pupils, increased RR and HR, bronchodilation, change in cardiac output and blood flow to organs

Epi and Norepi impact the alpha, beta1 and beta2 receptors

How does bloodflow change during SNS response?

Redirected to the lungs, heart and brain

How do epi/norepi impact alpha receptors?

Dilate pupils, decrease urine, change in blood flow

How do epi/norepi impact beta1 receptors?

Increase HR, increased BP, change in blood flow

How do epi/norepi impact beta2 receptors?

Increase RR, bronchodilation

RAAS role in surgical stress response?

Increase renin production > angiotensinogen > angiotensin 1 > angiotensin 2 > increases aldosterone

What part of the RAAS system do ACEIs work on?

The conversion of angiotensin 1 to angiotensin 2

Pancreas role in surgical stress response

Increased glucagon production, decreased insulin

This is why we may see increased BG in post-op

Purpose of PACU/what is needed for patient to come to ward

Maintaining airway

Respiratory stability

Hemodynamic stability

Thermoregulation

W/F and preventing N/V

Pain control

Post-op assessment components

Airway, breathing, circulation, disability/dextrose/discomfort, environment/exposure, full set of VS, give comfort, H2T, inspect the posterior

Post op ax: airway

Talking can show that the airway is open, can look for rise and fall of chest, listen for snoring/apnea

What kind of snoring is more concerning?

Throaty and making lots of gutteral noise

Put pt in recovery position

Post-op ax: breathing

Rise and fall of chest, WOB, RR (rapid or slow), regular or irregular

Post-op ax: circulation

Colour, warmth, movement and sensation

Post-op ax: disability, discomfort and dextrose

LOC, devices (glasses, hearing aids etc), pain, BG if needed

Post-op ax: equipment/environment/exposure

All needed equipment is there and working, environment safe, PPE if needed

Post-op ax: give comfort

Reassure pt, warm blanket, reassess pain and treat if low rating here (if high should have treated earlier)

Post-op ax: inspect the posterior

Look for pressure sores, spinal alignment, incisions on back, ensure no bleeding or blood pooling

How can poor nutrition impact risk of perioperative complications?

Leads to poor wound healing and electrolyte imbalance

How can use of anesthetic or analgesics impact risk of perioperative complications?

May impact respiratory status (resp. depression) or decrease LOC

How can surgical incisions impact the risk of perioperative complications?

Risk of bleeding, infection, wound healing, dehiscence

How can use of IV fluids impact risk of perioperative complications?

Fluid overload, IV infection, electrolyte imbalance

How can pain impact the risk of perioperative complications?

Slows healing, decreased desire to mobilize or follow care orders

Neuropsychological complications

Delirium, fever, hypothermia, pain, postoperative cognitive dysfunction

GI complications

Delayed gastric emptying, distension and flatulence, hiccups, NV, postoperative ileus

GU complications

Infection, retention

Respiratory complications

Airway obstruction, aspiration, atelectasis, bronchospasm, hypoxemia, pneumonia, pulmonary edema, pulmonary embolus

CVS complications

Dysrhythmias, hemorrhage, hypertension, hypotension, superficial thrombophlebitis. venous thromboembolism

Integumentary (incision site) complications

Dehiscence, hematoma, infection

Fluid and electrolyte complications

Acid-base disorders, electrolyte imbalances, fluid deficit, fluid overload

Non-pharm pain management

Repositioning, distraction, heat and cold therapy, spiritual activities

Pharm pain management

Acetaminophen, NSAIDs, opioids/narcotics

LOTARPS pain assessment

Location, onset, timing, associated symptoms, radiation, precipitating factors, severity

Neurotransmiters associated with nausea

Serotonin, dopamine, histamine

What medication is used to combat serotonin in nausea?

Ondansetron

What medication is used to combat dopamine in nausea?

Metoclopramide

What medication is used to combat histamine in nausea?

Dimenhydrinate

Assessment of emesis

Colour, consistency, amount

Causes of elevated temperature

Wind (atelectasis), water (UTI), walking (DVT), wound (post-op infection), wonder drugs (quick adverse reactions)

When does "wind" occur

Post op day 1

When does "water" occur

Post op day 3-5

When does "walking" occur

POD 4-6

When does "wound" occur

POD 5

When does "wonder drugs occur"

Quickly after admin

What organ does K imbalance impact most

Heart

What organ does Na imbalance impact most

Brain

What should you do if a wound is dehisced

Cover with saline soaked gauze

What can cause delirium

Withdrawal, circulatory/respiratory causes, metabolic disturbances, pain, anxiety, medications, anesthesia etc

PRISME

What can cause altered neuro status (AEIOUTIPS)

Alcohol, epilepsy, insulin, overdose, underdose, trauma, infection, psyche, stroke/shock

Virchow's Triad

3 main factors that contribute to thrombosis

Hypercoagulability, stasis, endothelial injury/dysfunction