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What are the three primary types of surgeries?
Emergent, urgent, and elective
What is the preoperative phase?
patient's first experience with surgical services
What is the intraoperative phase?
preop checklist, operation, transfer to recovery
What is the postoperative phase?
recovery unit, patient is stable to go home or hospital room
What are the priorities during the perioperative experience?
safety requiting teamwork and interprofessional communications
What 3 organizations oversee pt safety in the perioperative area?
The joint commission(TJC), the association of perioperative registered nurses(AORN), and the world health organization(WHO)
The joint commissions universal protocol is?
preventing wrong site, wrong procedure and wrong person surgery
What is the three sections of the universal protocol?
-The procedural time-out (done in the OR) -the procedural site marking (done in the Pre-op area) -the procedural time-out(done in the OR)
What are the types of consent forms a patient may need to complete prior to surgery?
-informed consent -anesthesia consent -blood or blood products consent
What are the three zones in the surgical suite are?
unrestricted zone, semi-restricted zone, and restricted zone
What are the priorities of the OR RN?
-Surgical scrub -surgical attire -sterile set up(aseptic technique) -traffic flow/surgical suite occupants -skin preparations -antibiotics prophylaxis(within 1 hour prior to incision)
What are the four standard positions commonly used for surgical procedures?
supine, prone, lateral and lithotomy
What is anesthesia?
induced state of partial or total loss of sensory perception, with or without loss of consciousness
What are the complications of anesthesia?
hypotension, malignant hyperthermia, fluid and electrolyte imbalances
What is phase one of the pacu?
involves the nursing care provided in the immediate post-anesthesia period. stabilize the pt vitals, wake the patient fully and pain control
what is phase two of the pacu?
focus on pt. discharge to an extended-care environment or home
what is phase three of the pacu?
extended observation
The CNS is made up of?
the brain and the spinal cord
The PNS is made up of?
cranial nerves, spinal nerves, and the ans
What are the 4 focus areas that assess a pts level of consciousness using the Glasgow Coma Scale
Cognitive, cranial, motor, and sensory
What does the mini mental status examination measure?
a patients cognitive function
What information can a cranial nerve assessment provide?
shows neurological impairment due to disease or trauma to the brain
What is the required safety for the joint commission?
-national patient safety goals -comprehensive surgical goals -universal protocol
What is the required safety for the WHO?
comprehensive surgical checklist
What is the required safety for AORN?
-comprehensive surgical checklist -guidelines for practice
What medication will the patient continue to take even if they are going to surgery?
beta blocker
When does the H & P need to be completed?
within 30 days
When does the H & P addendum need to be completed?
within 24 hours
What is cardiac clearance?
all patients over 50 years of age need an ECG
What does a nurse need to do for patient preparation of surgery?
-iv access -bowl and bladder preparation -a pregnacy test for women of childbearing age -removal of jewelry, prosthetics and clothing -inform anesthesia and surgical team of implants -surgical site preparation(showering, hair removal, site marking) -medications given (beta-blocker, benzos, and antimetics)
what do you use the shave skin prior to surgery?
electric clipper (never a razor due to risk of microcuts)
What is surgical attire?
caps, masks, gloves, eyewear, surgical gown, hospital only shoes
What is induction?
iv access and place monitors, infusion of narcotics/ muscle relaxants, induction with sodium pentothal(propofol, ketamine or etomidate), adequate sedation
what is intubation?
place and secure airway
what is maintenance?
maintain patient using balanced anesthesia
what is emergence?
suction patient to decrease the chance of laryngospasm and aspiration, reverse residual muscle relaxant, provide oxygen to wash out inhalation agents, remove airway when patient is breathing on his or her own and follows commands
what is recovery?
patient transported to pacu or intensive care unit, vital signs monitored and oxygenation continued until stable
Early signs and symptoms of malignant hyperthermia
-unexplained increas in CO2
unexplained tachycardia or arrhythmia(usually v-tach) -masseter muscle rigidity(after administration of Succinylcholine)
generalized flushing and warm skin -mixed respiratory and metabolic acidosis -hyperkalemia
Late signs and symptoms of malignant hyperthermia
-hyperthermia( can increase 1 degree C every few minutes) -hypoxemia -cyanosis and skin mottling -coagulapathy( disseminated intravascular coagulation) -myoglobinuria from rhabdomyolysis( causing dark urine) -kidney failure
What is used for the treatment of malignant hyperthermia?
Dantrolene Sodium (Ryanodex)
What is dehiscence?
A separation of the wound incision
What is evisceration?
protrusion of visceral organs through a wound opening
What is the Aldrete Score?
a measurement of recovery after anesthesia. monitors activity, respiration, circulation, consciousness, and o2 saturation. 10 is the best score. need 9/10 to be discharged
What is general anesthesia?
causes loss of sensation, consciousness, reflexes and memory
What is regional anesthesia?
causes reducation of sensation in selected parts of the body due to blockage of peripheral nerves or spinal cord. (local conduction or field block, epidural, spinal or nerve block)
What is local anesthesia?
topical application of an anesthetic agent to the skin or mucous membrane. can refer to any anesthesia that is not monitored
What is stage 1 of general anesthesia?
beginning analgesia and relaxation. might feel dizzy and detached
what is stage 2 of general anesthesia?
client might feel delirious, act excited and can be loud or crying
What is stage 3 of general anesthesia?
operative anesthesia, surgical anesthesia, sensation lost, client cannot hear, pupils small but reactive
What is stage 4 of general anesthesia?
dangerous level of anesthesia, vital organ function is depressed to the point of respiratory failure and cardiac arrest. death can occur
What is the parasympathetic response?
rest and digest, constricts pupils, stimulates saliva production, decreases heart rate and cardiac contractility, constricts bronchi, stimulates stomach, stimulates urination, promotes erection of genitals
what is the sympathetic response?
fight or flight, dilates pupils, inhibits saliva, dilates bronchi, increases heart rate and cardiac contractility, stimulates epinephrine and norepinephrine, stimulates glucose, inhibits stomach, inhibits urination, promotes ejactulation and vaginal contractions
concious
awake with appropriate speech and behavior
confusion
disorientation, bewilderment, difficulty following commands
lethargic
sleepiness; slow and delayed response to stimulus
obtundation
Somnolence with drowsiness between sleep states, lessened interest in environment, slowed responses to stimulation
stupor
minimal movement without stimulus, requires strong vigorous stimulus and then drifts back to unresponsiveness
coma
not arousable and unresponsive
What is the Glasgow Coma Scale?
-A brain injury severity scale that assesses depth and duration of impaired consciousness and coma. -Used by clinicians to gauge deterioration or improvement at the emergent and acute stages of brain damage or lesions. -Predicts ultimate functional outcome. 15 is the best score
atrophy
decrease in muscle mass
paresis
slight or incomplete paralysis
plegia
complete loss of muscle function
contraction
shortening or tightening of a muscle
involuntary movements
uncontrolled movements
spasm
involuntary nuscle contraction
spacticity
increased muscle tone that creates stiff movement
what is the normal plantar response?
toes down (flexion)
What is the Babinski sign?
dorsiflexion of the big toe and fanning of other toes
What are the three primary signs that indicate an increase in intracranial pressure (Cushing's triad)?
increased systolic bp, decreased pulse, decreased respiration
What are the three primary signs of shock?
decreased bp, increased pulse, increased respirations
automatism
motor activity usually occurring when cognition is impaired
Aura
a subjective ictal phenomenon that may precede and observable seizure
clonic
jerking, either symmetric or asymmetric, that is regularly repetitive and involves the same muscle groups
epilepsy
disease of the brain with at least two unprovoked seizures...
myoclonic
sudden, brief involuntary single or multiple contracts of muscles
Myoclonic-tonic-clonic
one or a few jerks of limbs bilaterally, followed by tonic-clonic seizure
seizure
a transient occurrence of signs and symptoms due to abnormal excessive neuronal activity in the brain
tonic
a sustained increase in muscle contraction lasting a few seconds to minutes
tonic-clonic
a sequence consisting of tonic followed by a clonic phase
What are signs and symptoms of seizure?
confusion, aura, sudden falls, staring, uncontrollable jerking movements, strange sensations and emotions, loss of consciousness or awareness
What are signs of meningitis?
brudzinski sign and kernig sign
What is Brudzinski's sign?
as the neck is flexed there is stretch on the inflamed meningse and the knees flex involuntarily to decrease pain
What is kernigs sign
as the hip and knee are flexed and then straightened there is pain in the hamstring
What are the results of meningitis?
CSF is cloudy(bacterial) or clear(viral), elevated WBC, elevated protein, decreased glucose(bacterial), elevated CSF pressure
What is encephalitis?
inflammation of the brain
what are symptoms of encephalitis?
headache, fever, confusion, stiff neck, and vomiting
What are treatments for encephalitis?
antivirals, anticonvulsants, and corticosteroids
What is Parkinson's disease?
Movement disorder caused by the death of cells that generate dopamine in the basal ganglia and substantial nigra.
What are the symptoms of parkinsons?
resting tremor, slowed movement, rigidity of facial muscles, and shuffling gait, and reduction in capacity for language
What is multiple sclerosis?
a neuromuscular disorder that results in uncoordinated muscle movement, is caused by the damage of myelin sheath.
S/S of multiple sclerosis
limb weakness, loss of coordination and balance, loss of sensation, speech impediment, mental changes, visual disturbances, muscle spasms, tinnitus
What is the first sign of increase in intercranial pressure?
change in LOC
What is autonomic dysreflexia?
spinal cord injury at T-6 or higher. vasodilation above causes increased bp, flushed face, headache, distended neck veins, decreased heart rate and increased sweating. vasoconstriction below becomes pale, cool and no sweating
What is myathenia gravis?
autoimmune disease that attacks nicotinic receptors- results in paralysis
What is trigeminal neuralgia?
a nerve disorder that causes a stabbing or electric-shock-like pain in parts of the face.
What is an ischemic stroke?
a stroke caused by a blockage
What is a hemorrhagic stroke?
A stroke caused by bleeding into the brain
What is the health stroke scale?
tool used by healthcare providers to objectively quantify impairment caused by stroke. 0=no stroke 21-42=severe
S/S of increased intracranial pressure
changes in LOC, impaired eye movement, decreased motor function, headache, seizures, cushings triad, vomiting, changes in speech
how to calculate mean arterial pressuer
diastolic *2 +systolic= total/3 =map
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