Exam 2 Not complete doe

Perioperative Nursing Responsibilities

• Collect Health Data

• Working with patients to ensure documents are signed

• Coordinate care & delivery

• Evaluating patient condition pre-op, intra-op, post-op

• Educating the patient on best practices for patient recovery

Pre-Op Terms

• Pre-Op Phases

  • Pre-op

  • Operative

  • Post-Op (PACU)

Types of Surgeries

• Inpatient vs. Outpatient (ambulatory)

• Major vs. Minor

• Elective, Urgent, Emergent

• Laparoscopic

Why rates of ceseran in US is high

• Fewer midwives in the US

• Hospital scheduling and inconvenience

• More medical interventions being used (epidural, inductions)

• Repeat C-sections

• Patient preference

Ceserean Indications

• Breeching

• Repeat/previous C-section

• Non-reassuring fetal status (ex: poor heart rate, contractions, accelerations)

• Active herpes lesions

• Placenta previa and abruption

• Stalled labor

• myomectemy

• Specific cardiac disorder (maternal0

• Elective

Breech babies are born via c-section since

• Head entrapment may occur and birth injuries and oxygen deprivation is more common

  • Exception being a second twin 

External Cephalic Version

• External manipulation done by provider to get fetus from breech or transverse to cephalic 

  • Provider may use an epidural or terbutaline to relax the uterus

Types of Ceserean Sections

• Scheduled 

• Unplanned

  • Failed progression of labor or fetal intolerance 

• Emergent

  • Same with unplanned except indicators of fetal or maternal distress that was measured for immediate delivery

Types of Anesthesia

• General Anesthesia

  • IV and inhalation drugs

  • Loss of consciousness, analgesia, amnesia, relaxed skeletal muscles and depressed reflexes

  • Risk: Respiratory, depression, low blood pressure
    
    Moderate Sedation

  • Minimal invasive procedures

  • IVV sedative or analgesics

• Regional Anesthesia

  • Inject near nerve pathaway; stop sensory stimuli

  • Awake, less sensation in certain area

Spinal Anesthesia

Similar to an epidural

• Needle is inserted into spinal space

• Usually a 1 time injection

• Effect is more immediate (lasts 1-2 hours)

• Removes sensation and motor function 

• Side effects: hypertension, severe headache postpartum

Inscions on Ceserean Section

• Skin incision:

  • Vertical

  • Transverse

• Uterine incision types:

  • Vertical- low or classical

  • Transverse 

Pre-operative care

• Signed consents

• Blood work

• Maternal VS

• NST

• Peripheral IV start and at least 1L of Fluids 

  • Need to stop hypotension (low BP), because they may lose lots of blood

Informed Consent

• 18 years old or emancipated minor

  • Parent signs for a dependent child 

• Competent to sign

• Alert and oriented

  • Considered if narcotics or was sedated 

• Not necessary if patient is under a life threatening situation or legally authorized person cannot sign

  • 2 physicians must sign 

• Nurses role

  • Advocate for patient understanding

  • Witness appropiate person signs

RN Roles in C-section

• Circulator

  • Passes instruments and laps, helps with prep

• Recorder/second RN

  • Recording events in surgery, such as people coming in and out.

• Baby RN (Nicu)

  • Stabilizing baby

Adverse Events

Never Event 

• Medical error that should not occur 

• Preventable but devastating

  • Example: Leaving tools in patients, breaking sterility during surgery

• Sentinel Event

  • Not foreseeable, or preventable if it occurs

  • Example: Technology shut down, power is off etc.

Use surgical counts, checklists, and define roles for never events. 

C-section Medication

Cephazolin

• Indication: Antibiotic given to decrease risk of possible infection
  
  
  Sodium Citrate(Bicitra)

• Indication: Neutralizes stomach acids, given before preop. Reduces chance of throwing up in surgery and decrease infection

Ephedrine/Phenylephrine

• Indication: Increases blood pressure since sedations are used and may affect heart.

Ondasteron

• Interop or post op, prevents nausea and vomitting

Acetominophen (tylenol)

• Pain reducer, anti-inflammatory like NSAIDS

Ketorolac

• NSAID, short-term moderate to severe pain reduces pain and inflammation.

Fentanyl

• Severe pain management, used in short procedures, pain med opiod. IV. Used for post Op.
  

Hydromorphone (Dilaudad) 

• Narcotic, administered IV. Used for pain often for post op or chronic pain 

Spinal Morphine (D

• Given post op/intra op, provides extended pain control for c-sections.Monitor sedation and respiratory levels

Endometriosis

• Growth of endometrial tissue where tissues grows outside the uterus. Thickens in menstural cycle, estrogen thickens, breaks it down, and bleeds. 

• Symptoms: Pelvic pain, dyspareunia (painful sex), dysmenorrhea (mensutration cramps), abnormal vaginal bleeding, painful urination/bowel movemnet

• Pharamcologic

  • Anovulation, amenorrhea, decreased pain, interruption of lesion development

  • Risks: medicually induced menopause 

• Oral contraceptives

  • NSAIDS for pain managment

  • Suppress ovulation/ menstruation

Menopause

• Absence of period for a year

• Symptoms: Irregular periods, vaginal dryness, urinary incontinence, recurring UTI’s, pain with sex, hot flashes, night sweats, mood swings

• Risks: Osteoperosis, and Heart Disease

• Pharamcologic Managment

  • Recommended for women <60 years.

  • Hormone therapy: progesteron-estrogen therapy 

  • Administration options: oral, topical, transdermal, suppositories, vaginal rings

  • Side effects: Swelling, weight gain, breast soreness, brown spots on skin, eye dryness, depression

  • Long term: blood clots, hypertension, stroke

Erectile Dysfunction

• Persistent inability to achieve or maintain erection

• Causes

  • Neurlogic: spinal cord injury, stroke, parkinson

  • Hormona: endocrine disorder, aging,

  • Vascular: atrophy, fibrosis of smooth muscle

  • Drug induced: antidepressants, antipsychotics, etc.

• Sildenafil (Viagra)

  • Smooth muscle relaxant to increase blood flow into the corpus cavernosa 

  • Cant be used with nitrates (such as treating angina), dilate blood vessels. 

  • Side effects: Flushing, hypotension, dizziness 

  • Other options include vacumn devices, psychosexual therapy, IC injections.

Benign Prostatic Hyperplasia

• Hyperplasia of prostate

• Obstructive to nearby organs such as: prostate, urethra, bladder, penis 

TURP( Transurethral Resection of the Prostate)

• Surgical restriction to carve out the tissue blockage 

Pharmacologic Treatment

• Prazosin, Tamsulosin

  • Relaxes smooth muscle of bladder neck and prostate - Better Urine Flow

• Finasteride

  • Prevents testosterone conversion> decreases prostate size> urine flow

• Side effects: sexual dysfunction

STI’s

Transmission Routes

• Sex, needles, fluid exchange, skin-to-skin, blood-to-blood, oral transmission

3 Types of Virals

• Viral

• Bacterial

• Parasitic

5 P’s 

• Partners: gender/partner

• Practices: What kind of sex?

• Protection: Methods use to protect? Have you talked with your partner to prevent/protect? 

• Past History: Have you or your partners been tested/diagnosed for STI in the past, have you and partner injected drugs?

• Pregnancy: How important is it for you to pregnancy are you using form of birth control

STI Bacterial’s

Chlamydia & Gonorrhea

• Transmitted via sexual contact (vaginal, oral, anal)

• Symptoms: asymptomatic, abnormal discharge, burning urination, bleeding, burning with urination 

• Treatment: antibiotics 

Syphilis 

• Transmission: Sexual contact, congenital (mother to fetus)

• Symptoms: Painless sores (chancres) on genitalia, rectum, or mouth. Rash on palms, sores, fever, fatigue

• Treatment: antibiotics, penicillin G

STI Virals

Hepatitis A

• Transmitted orally, can be food transmission, fecal-oral exchange

• Symptoms: flu-like, Malaise, fatigue, anorexia, nausea, itching, fever, RUQ pain 

• Treatment: Vaccine, anti-viral treatment

Hepatitis B & C

• Transmitted as blood borne virus (IV, needles, blood-to-blood) 

• Symptoms: Silent infection/asymptomatic, jaundice, dark urine, clay stools

• Treatment: Hep B Vaccine 

Herpes Simplex Virus

• Transmitted via skin-to-skin, asymptomatic

• Symptoms: Painful, recurrent ulcers on genitals, rectum or mouth, fever, chills, malaise, severe dysuria

• Treatment: Antiviral medications 

• Active lesions on genitalia indicate C-section 

HIV 

• Transmission: sexual contact, blood borne, mother-to-child

• Symptoms: Flu-like illness, fever, night sweats, malaise

• Treatment: Antiretroviral therapy, controls virus, imprvoes immune function 

HPV

• Transmission: Sexual Contact

• Symptoms: Genital Warts, asymptomatic, cervical abnormalities 

• Treatment: HPV topical, surgery removal, Gardasil, vaccination

STI Parasitic

Trichomoniasis

• Transmitted skin to skin, unprotected sex

• Symptoms: Foul smelling discharge (yellow, white, frothy). inflammation of vagina/vulva, itching, painful urination

• Treatment: Antibiotics

Pubic Lice

• Transmitted: bedding or clothing that has lice

• Symptoms: Visible crawling, attached to hair itching 

• Treatment: Shave and anti-parasitic cream 

Bacterial Vaginosis

• Vaginal infection, overgrowth of NL flora of vagina

• Potential cause: use of antibiotics, sexual activity on new partners

• Symptoms: thin, white/grey vaginal discharge, fishy odor, itching/irritation, painful urination/sex

• Treatment: antibiotics

Prevention Practices

• Education about safe sex 

  • Condoms, etc,

• STI education

• Inspecting genatalia

• Tested regularly

• Vaccines: Hep B, Hep A, HPV 

• Condoms, male or female, topical spermicides

STI Risks and Pregnancy on Maternal and Neonate

• Maternal

  • Preterm Labor

  • Pre rupture of membrane

  • SAB

  • C-section delivery

• Neonatal

  • Sepsis

  • Eye infections

  • Fetal/Neonatal Death

  • Birth Defects

  • Chronic carrier/infection with Hep B

APGAR

Appearance, Pulse, Grimace, Activity, Respiratory

• Score must be >7, 8 is considered Normal. Anything less than 7 (less than or equal to 6 is abnormal!!)

• Purpose: Baby is transitioning and using organs, supports resuscitation

“Golden Hour”

• 1st hour of babies life

• Benefits:

  • Promotes bonding (mother rewleases oxytocin hormone)

  • Latches easier for long term breast feeding

  • Stabilizing heart and breathing rate

Abnormal Apgar Score

• Bring baby to radiant warmer

• For Airway and Color

  • Obstruction: Bulk suction or manual suction (at warmer)

  • Breathing issues: positive pressure ventilation (PPV) to open alveoli

• For circulation

  • Same as airway and color, except assess HR within 15-30 seconds

  • Ideal 100 BPM>

Delayed Cord Clamping

• Waiting to clamp cord 30-60 seconds

• Benefits:

  • Increased Hgb

  • Increased Iron Stores

  • Preterm infants: higher blood volume

• Lotus birth

  • Leave cord attached to baby & placenta until cord naturally falls off

Respiratory in Babies

• Stethoscope

• Normal findings in babies

  • BPM 30-60 per minute

  • Quiet and effortless

  • Iregular pattern or short pauses

  • Pinkish color)

• Abnormal Findings

  • Grunting

  • Retractions

  • Nasal Flaring

  • Crackles

Cardiovascular

• Assess via: temperature, capillary refill, listening for heart rate

• Normal findings:

  • HR 110-160 BPM

  • Regular rhythm (no sounds)

  • cap refill < 3 seconds

  • no murmurs

• Abnormal findings:

  • Arcoyanosis, irregular HR, mumurs beyond 24 hrs

  • Central cyanosis

Hypothermia

• Temperature less than 36.5 * C

• Method of heat loss and intervention to prevent

  • Evaporation

  • Immediately dry newborn

• Convection

• Conduction

• Radiation

Hyperthermia

• Temperature >37.5 (99.9 F)

• Causes: Sepsis, inappropriate use of external heat sources

  • Large surface area and lack of sweat glands

• Symptoms: skin is flushed, red, warm to touch

  • Extension

• Risks

  • Seizures,

Reflexes

• Babinski Reflex

  • Bottom of foot is stroked, big toe bends

• Root reflex

  • Baby's mouth is stroked, baby will open their mouth

• Moro Reflex

  • Triggered by a sudden loud noise or movement. Baby extends the arm and palms up

• Sucking Reflex

  • Infant will begin to suck when an object or finger touches the top of the mouth

• Tonic Neck Reflex

  • Infant turns their head one side, legs and arms will extend while other leg will flex

• Palmar Grasp

  • Grasps my fucking finger around adults finger when palm is touched.