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Alanine aminotransferase (ALT)
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Aspartate aminotransferase (AST)
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Pre-op
1510 Pre-operative
| Question | Answer |
|---|---|
| Alanine aminotransferase (ALT) | Males: 10-40 U/LFemales: 7-35 U/L |
| Aspartate aminotransferase (AST) | Male: 15-40 U/LFemale: 13-35 U/L |
| Lactate dehydrogenase (LDH) | 90-156 U/L |
| Total bilirubin (TBIL) | 0.3 – 1.2 mg/dL |
| PT/INR | Prothrombin time/international normalized ratioPT: 10 13 secINR 2.0-3.0 |
| PTT | Partial thromboplastin timePTT 60-70 sec.APTT 30-45 sec. |
| Pre-op blood glucose range is | 65-99 mg/dl |
| What is hCG | Human chorionic gonadtropin |
| What does hCG indicate? | >5 IU/L indicates positive pregnancy test. |
| Dalmane (flurazepam) Restoril (temazepam) | Benzodiazepines; Sedative/Hypnotics Used for insomniaRoute: POUsual dose: 15-30mg at HSSide Effects: Dizziness, lethargy, blurred vision, paradoxical excitation in someImplement fall precautions |
| Surgery Nurisng Diagnoses | Deficient Knowledge (Surgery)AnxietyAnticipatory GrievingDisturbed Sleep PatternIneffective Coping |
| Deficient Knowledge (Surgery, Post-Op Exercises | Evaluate patient’s readiness to learn.Involve family members/significant others/caregivers in pre-operative teaching.Provide handout, “Preventing Pneumonia in 4 Easy Steps,” on 01/15/2010.Provide video, “Early Ambulation and Me,” on 01/16/2010. |
| Anxiety | identify and limit, discontinue, or be aware of the use of any stimulants such as caffeine, nicotine, theyophylline, terbutaline…….negative effects of caffeine on anxiety this shift.Provide backrub PRN anxiety. (Relaxation techniques…guided imagery) |
| Anticipatory Grieving | Use open-ended questions to allow for patient expression of grief,Refer patient and family to spiritual counseling |
| Disturbed Sleep Pattern | Organize/schedule procedures prior to 2100.Limit nighttime fluids to prevent voiding.Limit intake of caffeinated drinks after 1400. |
| Ineffective Coping | Use verbal/nonverbal therapeutic communication techniques.Encourage to identify stressors.Encourage to identify areas of personal strength |
| Hypertonic Solutions | Dextrose 5% in 0.9% Sodium Chloride (D5NS)Dextrose 5% in 0.45% Sodium Chloride (D5½NS)Dextrose 5% in Lactated Ringer’s (D5LR)Dextrose 10% in Water (D10W) |
| Avoid hypertonic solutions for which conditions? | pts with kidney and heart disease. |
| MOA for hypertonic solutions is what? | Pull fluid from the cells (intracellular space, puts it in vascular space, expanding vascular volume) |
| Hypotonic Solutions | 0.45% NaCl (½NS)0.33% NaCl (1/3NS) |
| MOA for hypotonic solutions is? | used to provide free water, treat cellular dehydration |
| Avoid hypotonic solutions for which conditions? | pts at risk for ICP (CVA, head trauma, neurosugergery) or third space fluid shift (burns trauma, low serum protein: malnutrition, liver disease) |
| Volume Expanders | DextranComposed of chains of sugar moleculesPlasmaA blood componentAlbuminA blood proteinHetastarch & PentastarchComposed of large molecules made up of smaller sugar molecules – hold water in the vessels |
| Atropine (atropine sulfate): | IM, IV, subcut, PO: 0.4-0.6 mg given 30-60 min pre-op: Anticholinergics |
| Robinul (glycopyrrolate): | IM only in pre-op – 4.4mcg/kg (not to exceed 0.1 mg) given 30-60 min pre-op: Anticholinergics |
| Anticholinergics MOA | Reduce salivation and respiratory secretions thus preventing aspiration during surgery, prevent bradycardia |
| Anticholinergics AE | Side effects: nausea, facial rash, flushing, blurred vision, dilated pupils, urinary retention, elevated pulse, orthostatic hypotension, |
| Valium (diazepam) | PO, IM, IV, PR Usual dose 2 – 20 mg: Sedative/Hypnotics, Benzodiazepines |
| Versed (midazolam) | PO, IM, IVUsual dose IV: 1 mg initially, titrated to patient’s sedation required, total dosage > 4 mg rare; PO 5-10 mg: Sedative/Hypnotics, Benzodiazepines |
| Sedative/Hypnotics, Benzodiazepines MOA | Decreases anxiety, provides sedation/amnesia for the surgery or diagnostic test |
| Sedative/Hypnotics, Benzodiazepines AE | Side Effects: drowsiness, dizziness, headaches, dry mouth, blurred vision |
| Pre-Op Patient Safety Goals | Improve the accuracy of patient IDImprove the effectiveness of communication among caregivers Reduce the risk of health care associated infections Accurately and completely reconcile meds across the continuum of care |
| Documentation | Informed consent should be placed in designated area of chartEnsure pre-op checklist is completed and on chart; All pre-op care, including assessments, interventions, evaluationsMedications; Do not forget patient education |
| Antibiotics in the mycin drug group (Erythromycin) | May cause respiratory paralysis when combined with certain muscle relaxants used during surgery. |
| Anticoagulants (Warfarin [Coumadin], Aspirin) | May precipitate hemorrhage. |
| Diuretics (Hydrochlorothiazide or HCTZ [HydroDIURIL]) | May cause electrolyte imbalances resulting in respiratory depression from the anesthesia. |
| Tranquilizers (includes minor tranqs: benzodiazepines such as diazepam [Valium] and sedative/hypnotics, such as flurazepam [Dalmane] & temazepam [Restoril]) | May increase the hypotensive effect of the anesthetic agent, thus contributing to shock. |
| Adrenal steroids (Prednisone [Deltasone]) | Abrupt withdrawal may cause cardiovascular collapse in long-term users. |
| Phenothiazines (Chlorpromazine [Thorazine]) | IV infusion may be required to guard against seizure activity during surgery |
| Insulin | May be infused as a drip during surgery to offset effects of anesthesia on this drug |
| Antiseizure medications | IV infusion may be required to guard against seizure activity during surgery |
| Monoamine Oxidase (MAO) Inhibitors (Phenelzine sulfate [Nardil]) | Abrupt withdrawal may cause cardiovascular collapse in long-term users. |
| Thyroid hormones (Levothryoxine sodium [Synthroid, Levothyroid]) | IV administration may be necessary postoperatively to prevent thyrotoxicosis. |
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