peri op nursing

• surgical impact physical stress

  - risk for infection

  - organ function during manipulation
• surgery impact psychological


  - fear/ anxiety

  - pain

  - alterations of ADL

  -body image
• reasons for surgery


  - diagnostic

  - cosmetic

  -palliative
• urgency of surgery


  - elective( you're choice)

  - emergent

  -urgent
• surgical risk


  age

  nutrition status

  fluid and electrolyte balance

  general health status

  medications
• immediate pre-op


  -baseline vital signs

  - oral care

  - remove dentures, loose teeth

  - remove cosmetics, hair pins etc

  - check name band

  - ask patient to void
• anti-anxiety pre op meds

  diazepam
• sedative pre op


  midazolam
• analgesic pre op


  morphine sulfate
• AntiCholinegic drugs


  dries up oral secretions for anesthesia visualization

  -atropine sulfate

  - glycopyrrolate (robinul)
• h2 receptor antagonist


  used for pt with increase nausea/vomitting even w/ NPO

  axid

  Tagamet
• inadvertent hypothermia


  can be due to surgery

  use warm blankets

  warm Iv fluids ad blood products
• ASA classifications


  ASA I > A normal healthy patient

  
  

  ASA II > Mild systemic disease, may or may not need dental modifications (well-controlled NIDDM, asthma, epilepsy, stage I hypertension, healthy pregnancy)

  
  

  ASA III > Moderate to severe disease, but not incapacitated, likely requires dental modifications (well-controlled IDDM, stage II hypertension, CHF, AIDS, COPD)

  
  

  ASA IV > Severe systemic disease that is incapacitating & life threatening (severe CHF or COPD, kidney or liver failure)

  5- not expected to survive without surgery

  
  

  6-brain dead
• anesthetic agents


  barbiturates-ending in "tal"

  - thiopental

  -methohexital
• Non-Barbiturate Anesthetics


  propofol
• disassociative agent


  ketamine
• inhalation agent anesthetics (ending in "ane")

  -nitrous oxide

  - halothane

  - isoflurane

  -sevoflurane

  -desflurane
• opiods


  fentanyl

  morphine

  hydromorphone

  alfentanyl
• opioid antagonist


  naloxone( narcan)
• Benzodiazepines( end in zeplam or zolam)


  sedation and amnesia meds

  
  

  
  

  diazepam (valium)

  midazolam (versed)

  lorazepam (ativan)
• benzodiapine antagonist ( reversable)

  flumazenil
• general anethesia potential complications ( uncontrolled breathing)

  CNS

  - emergence( coming to) delirium- post anesthesia wake up

  - delayed emergence- not waking up post anesthesia
• cardiovascular


  hypotension

  dysthymias

  MI
• hypothermia


  core temp less than 95
• malignant hyperthermia


  A hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs.

  
  

  
  

  lab test- caffeine, halothane contracture test
• malignant hyperthermia reversing agent

  dantrolene
• MH triggering agents


  -inhalation agents: halothane, enflurane, isoflurane, desflurane, sevoflurane

  -depolarizing muscle relaxant: succinylcholine
• MH S/S


  muscle rigidity

  tachycardia and dysrhythmias

  cutaneous changes

  tachypnea

  pyrexia (fever)( quickly)
• MH crisis treatment


  administer 100% O2

  STOP anesthesia

  administer dantrolene
• esthers reginal anesthetic agents

  cocaine

  procaine

  tetracaine

  chloroprocaine
• amides reginal
• MAC anesthesia


  minor anesthesia

  CAN BREATHE ON THEIR OWN
• incentive spirometer


  medical device to encourage patients to breathe deeply to prevent atelectasis after surgery
• Postop care Cardiovasular system

  vital signs

  pulses

  skin temperature

  o2

  dressings/ bleeding re-enforce

  thrombophlebitis
• neurological POST OP


  AO x3

  motor/sensory

  verbal commands
• renal/urinary


  < 30 cc per hour
• GI


  nausea/ vomitting

  decrease Bowel sounds

  n'g tube allows heeling of GI tract