Perioperative Nursing Med-Surg

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-ectomy -orraphy -ostomy -otomy -plasty -scopy ACE inhibitor

removal of, surgical excision to remove surgical repair of suture of surgical creation of permanent opening i.e. colonstomy, ileostomomy surgical incision of or cutting into surgical repair of reconstruction use of a scope to view an area, to explore nursing intervention: monitor blood pressure closely. May hold on morning of surgery unless HF increasing age is a greater risk factor: body is less able to adapt to physiological demands after surgery; comorbidities i.e. heart disease; decreased reserve capacity ... higher risk of being allergic to anesthesia and latex; shellfish or iodine may also be allergic to povidone-iodine early ambulation is beneficial to post op care. increased ambulation->increased circulation->helps get rid of anesthesia. allowed to walk w/assistance evening of surgery or first postop day provides care to alleviate pain and promote relaxation. Responsible for: maintaining airway, monitoring and ensuring gas exchanges, respiration and circulation, estimation and replacing blood and fluid losses; administering meds to maintain hemodynamic (blood flow) stability;managing care in a physiological crisis, communication with the team. increase risk of bleeding during/after surgery; may be discontinued 24-48 hours before surgery side effect include hypotension and bradycardia. monitor BP and HR. taken morning of surgery increases risk of bleeding postop; may stop 2 weeks before surgery a normal healthy client

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ASA 3

some functioning limitations; client with severe systemic disease that limits disease but is not incapacitating Has at least one severe disease that is poorly controlled or at end stage; possible risk of death; a moribund pt who is not expected to survive 24 hours without surgery declared brain dead and who is being kept alive for transplant elevated levels indicate heart failure deep breathing to decrease risk of pulmonary complications. Breathe out normally then takes a deep breath through nose or mouth, holds for 3 or longer and slowly releases. 5-10 per hour awake renal function b/c selection and doses of medications. renal failure pts may need dialyses prior to surgery get crash cart and start CPR a low hematocrit or low hemoglobin i.e. Hgb 11.3-14.9 Hct-35.4-49.0 - pt could need transfusion before surgery (anemia) may be postned in pts with pneumonia or significant heart failure monitor fluid and electrolyte balance and medication administration to ensure kidneys are excreting drugs in charge of room, responsible for pts care, pt advocate, hypoxia, hypotension,thpertension,cardiac dysthmia,residual muscle paralysis,hypothermia and malignant hyperthermia decrease inflammation; delay wound healing and mask signs of infection. increase risk for postop bleeding post-op clients have an increase in mucus but a decreased ability to clear due to anesthesia. can help clear mucus and facilitate full expansion therefore preventing atelectasis and pneumonia. Health care provider may write an order to avoid when contraindicated. monitor serum electrolytes; may hold morning of surgery balances are corrected prior to surgery esp. Potassium

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ASA 4

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ASA 5 ASA 6 BNP Breathing exercises

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Age

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BUN

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allergic reaction allergies

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Cardiac Arrest CBC

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ambulation

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chest x-ray Chronic Renal Failure Circulating nurse Complications with General Anesthesia corticosteroids

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Anesthesia Care Provider

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Anticoagulants

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Coughing

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antihypertensives

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antiplatelet ASA 1 ASA 2

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Diuretics Electrolytes

client with mild(controlled) systemic disease i.e. controlled diabetes; controlled hypertension

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Ephedra

for weight loss; increases cardiac stimulation:tachycardia and elevated blood pressure EBL calculated using suction containers, wound drains, chest tubes, ng tubes which is measured directly to determine actual blood loss and blood in sponges is app. from their weight 1gm=1ml of blood >500 mL needs a blood transfusion diabetes, heart disease, sudden cardiac death, malignant hyperthermia********** impairs platelet function interferes w/platelet aggregation and prolongs clotting time to increase risk of bleeding prolongs clotting time blood loss; fluid given(IV and transfusions);all medications;positioning; length of procedure; if pt was intubated; complications; dressings/drains; if foley was emptied and amount ... continuous O2; maintain open airway encourage deep breathing; take a deep breath and ball measures amount of intake; sterile remains sterile; cords off the floor if at all possible, ensure you know where fire extinguisher is;communicate morphine, hydromorphone and fentanyl. assess every 15-30 minutes do a skin test if allergic to: kiwis, bananas, avocados or health care workers, spina bifida or had multiple surgeries stimulates venous blood return preventing DVTs. 1.alternate between flexing foot and pointing toe 2. lift foot off bed and make circles using ankle 3.bend knee and lift leg off bed holding a few sec 4. with knees bent, push ball of foot into bed/floor contracting calf and thigh muscles

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Malignant Hyperthermia

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Estimating Blood Loss

thought to be triggered by succinylocholine. muscle rigidity and spasm and a hypermetabolic state. rise in CO2,drop in O2. Intervention:discontinue trigger agent; administer dantrolene sodium to produce relaxation; hyperventilate w/100%, cooling devices, hydrate with IV NS, mobility(higher risk for DVT,skin breakdown, pneumonia); cardio(Acute heart attack, recent MI-wait 4-6 weeks to have surgery), heart failure (higher risk of postop pulmonary complications and fluid/electrolyte imbalances); pacemaker(electrocautery pad); COPD (atelectasis and pnuemonia) risk for aspiration used with opioids for pain control limited to 72 hours increase risk of bleeding. stops 2 weeks before surgery timeout;count instruments, sponges, proper positioning, PPE,antibiotics, status board, clients temp control,positioning, preventing from infection, could be heightened risk for infection postop small boluses pt controls through a push button. nurse checks cath site for infection abnormalities need to be reported; baseline functional ability nerve injury, pressure ulcers, decreased lung expansion Airway!!! LOC, carido, pain, body temp how client tolerated surgery must be within 20% of preop baseline to be discharged HR>120;hypotension:systolic <90;NEW cardiac dysrhythmia;absence of peripheral pulses; O2 <93%;resp rate < 10 breaths/min; surgery is avoided during 1st trimester quiet room/area for personnel to interview and verify documents with client. equipment should be readily available to monitor pt:oxygen, suction, electrocardiogram, pulse ox etc.

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Medical history

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Family History feverfew garlic

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ginger Handoff communication includes

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NPO NSAIDS NSAIDS i.e. aspirins Nursing interventions for preventing intraoperative complications Nutritional Assessment PCA-pt controlled analgesia Physical assessment Position Changes prevent Post Op Assessment Post Op vital signs Postop findings reported to anesthesiologiest Pregnancy Test Preop holding area

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Imbalance fluid volume Impaired Gas exchange Incentive Spirometry intraoperative safety IV pain medication Latex Allergy

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Leg exercises

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Preop Nursing Assessment

Age; allergies; medical issues; nutritional status; surgical history; Physical Assessment; family history; medications and herbal supplements; social habits; diagnostic tests prophylaxis against infection: prostheses or transplants suppress oral, respiratory and gastric secretions during surgery Given to reduce N/V Reduces anxiety, increases sedations

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surgical fire surgical history Surgical Team uncontrollable hemorrhage WBC

prevention by making sure bove is turned off when not in use, ensure jewelry is removed complications i.e. anesthesia, surgery (heart surgery); how do they wake up from anesthsia (i.e. N/V-antiemetic, pnuemonia) Surgeon;anesthesia care provider; circulating nurse; scrub nurse ... elevated could be presence of infection; delay or cancel procedure. Neutropenia may delay surgery due to an increased risk of infection directly before entering op room; foleys are inserted in OR as necessary TIME OUT

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Preop-Med: Antibiotic Preop-Med: anticholinergics Preop-Med: antiemetic Preop-Med: Benzodiazepines Preop-Med: Beta Blocker Preop-Med: Gastric Acid blocker Preop-Med: Narcotics PreopMed:Anticoagulants (low-does) Protecting from infection PT and PTT

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cardiac surgery to reduce risk of atrial fibrillation decrease gastric acid production given if pt is at high risk for pulmonary aspiration reduce pain and discomfort associated with preop procedures prevent thrombus
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when is bladder emptied Wrong Site Surgery

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practice aseptic and sterile techinque elevated levels may delay or cancel surgery- provides information on bleeding and ability to clot maintain an open airway, crash cart and start CPR early ambulation

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Respiratory arrest Respiratory: pneumonia, atelectasis or pulmonary embolism Retention of Foreign Objects Scrub nurse Social Habits

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surgical counts by the surg tech(or RN) and the circulating nurse works with surgeon in sterile field passing instruments, sponges etc. alcohol:benzodiazepines narcotics:methadone used to prevent withdrawals during surgery thoracic or abdominal incisions to prevent painful stress. use a small flat pillow to apply firm pressure over incision when performing activities that tend to pull i.e. getting out of bed, coughing, getting out of bed. helps to reduce pain responsible for making decisions r/t surgical procedure

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Splinting the incision

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Surgeon