Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
NP2:Perioperative
Test 3; Prof. Hutton
| Question | Answer |
|---|---|
| Members of surgical team | Charge Nurse (runs board), Manager, Educator, RNFA (RN first assist "right-hand man of surgeon"), Scrub, Circulator (RN), ULP |
| Definition of RN in OR | A nurse who idenitifies the physiological, psychological and sociological needs of teh OR patient in order to restore or maintain the health and welfare of that patient before, during and after surgery! |
| Circulators duties | Collects pre-op pt. info.Verify consent.Set up OR.gather supplies;equipment.Open instrument;supplies.Anticipate and meets needs of surgeion, anesthesia, and scrub.Monitor blood loss with anesthesia.Identify;assess pt in order to ensure saftey.Plan;coordin |
| Scrub Tech duties | Assist in gathering supplies, equipment and helping set-up OR room. Set-up and maintain the sterile field, hands supplies and instruments to surgeon, keeps count of sponges, sharps, supplies and instruments, monitors sterile technique |
| Intraoperative | Perioperative Initial assessment |
| Psychological Assessment | Review critical pt. data first, Identify and address anxiety and fear, Teach about OR activities, clarify misunderstandings, Ask questions about facts and feeling, Provide privacy, Dicuss expectations, Assist in maintaining an attitude of hope |
| Sociocultural and Spiritual Assessment: Be Aware of | Personal space and modesty, Eye contact and touch, Pain management, Birth and death rituals, Family relationships, Religious orientation (Must accomadate pt. preferencs to best abilities) |
| Developmental Assessment | Fluid and electrolyte balance, Body temperature, Pain, Anxiety |
| To reduce anxiety | Give pre-op tour, Describe roles of OR team, Allow children to play iwth OR medical equipment, Allow child to bring favorite security object, Address fear of mutilation or punishment, Address fear of being put to sleep |
| Unrestricted area | can wear street clothes; front desk, locker room |
| Semi-restricted area | scrubs and hats required, staff and pt's only |
| Restricted area | where surgical procedures are performed, scrubs, hats and masks required; actual OR and sub-sterile room |
| Commandments of Surgical Aspesis | Always face sterile field, Keep 12 inches from sterile field, Check package integrity, Do not lean over field when opening packages, Do not splash fluids when dispensing, Everyone in room monitors each other for the maintenance of the sterile field |
| Patient OR Positioning | Main purpose is to provide optimum exposure and access to the operative site |
| Hair removal should be done | in the pre-op area with clippers, start where incision will be made and move out in circular motion, Move from clean to dirty |
| OR skin prep | should last 5 minutes, CV/Orthropedic preps should last 10 minutes. After reaching the prep area edges, a new sponge dipped in the antiseptic should be used beginning at the proposed incision site and working to the edges again, repeat atleast x3 |
| Grounding pads must be placed | on muscle such as butt, leg, arm |
| General anesthesia | reversinle, unconscious sate characterized by amnesia (no memory), analgesia (no pain), depression;loss of reflexes, muscle relaxation, and homeostasis or manipulation of physciological functions |
| Regional anesthesia | reversible loss of sensation and;or movement when a local anesthetic is injected to block or anesthetize nerve fibers (Spinals, Epidurals, Caudals or Major peripheral blocks) |
| Local anesthesia | the surgical site is injected with a anesthetic, such as lidocaine, into the SQ tissue in order to depress the superficial peripheral nerves |
| An epidural (caudal block) goes into | fatty tissue and is dose dependent, may loose sensation but not movement |
| Side effects of an epidural and subarachnoid are | headache, decrease bp dt activation of sympathetic system |
| In Phase 1 recovery from regional anesthesia must make sure | pt. gets sensation back and voids |
| In Phase 2 recovery from regional anesthesia must make sure pt. | gets sensation, movement, and voids |
| Conscious sedation | state of reduced consciousness which allows performance of unpleasant procedures while perserving airway reflexes and the ability to respond to verbal commands |
| Stages of general anesthesia | Indroduction: begins with administration of anesthetic agents to the positioning of the pt. Maintenance: from positioning until the surgical incision is closed. Emergence: from the time the pt begins to "wake up" until the pt is transferred to the PACU |
| During induction and emergence you | shut-up! |
| Last sensation to leave and first to come back is | hearing |
| What agents are given during conscious sedation? | Amensic (Midazolam "Versed), Analgesic (Morphine) and Sedative |
| Balanced anesthesia is the use of combining | IV anesthetics, analgesics, amnesics and inhalation drugs to achieve unconciousness, skeletal muscle relaxation, pain relief and physiological homeostasis |
| Complications of anesthesia include | Anaphylactic reactions, Malignant hyperthermia, Hypotension, Fluid volume and electrolye imbalance,Hypothermia, Hypoventilation, Airway obstruction, Loss of sensation and;or movement,Hematoma, Infection, Tissue trauma, Inability to void, Drug toxicity |
| Malignant Hyperthermia is a pharmacogenetic disease that effects the | skeletal muscular system at the level of calcium transfer in the muscle cell |
| Malignant Hyperthermia is percipitated by the administration of | volatile inhalation agents and depolarizing muscle relaxants |
| Malighnant Hyperthermia occurs | rarely but is deadly |
| Notify anesthesia of hx of | high fever 24 hrs post anesthesia or death |
| Malignant Hyperthermia is associated with | other neuromuscular disorders and is genetic |
| Malignant Hyperthermia results in | muscle rigidity, tachycardia, hypermetabolic state and increased body temperture |
| Signs of Malignant Hyperthermia include | Hypercarbia (retaining air), respirations slow and shallow, high fever during general anesthesia or 24 hrs post |
| Treatment of Malignant Hyperthermia includes | Dantrolene, cold IVF, ice packs, and possibly ice NG lavages, ice rectal lavages |
| Post Anesthesia Recovery Assessment | focus on respiratory status, CV status, pain level, and type of anesthesia give, temperture, control of nausea and vomiting |
| S and S of ineffective airway clearance | snoring, nasal flaring, use of acessory muscles, intercostal retractions |
| Causes of ineffective airway clearance | tongue occluding the pharynx |
| Treatment of ineffective airway clearance | chin lift; jaw thrust, stimulate pt to cough and DB, insert oral airway, intubation |
| S and S of ineffective breathing pattern | CO2 > 45, extreme sedation, decreased RR, shallow resp, HR and BP elevated or depressed |
| Causes of ineffective breathing pattern | residual effects of anesthesia, pain, obesity, supine position, HO poor circutlatory perfusion |
| Treatment of ineffective breathing pattern | stimulate pt to take DB, O2, elevate HOB, place in lateral positon, provide pain relief, assess for hypovolemia and replace with appropriate fluid *must decide if can wait for anesthesia to wear off or intubate |
| Alteration in tissue perfusion: Hypotension | BP < 20% of baseline |
| Causes of hypotension | hemorrhage, hypovolemia, MI, embolism or drugs |
| Treatment of hyptotension | fluid replacement, vasoconstriction medications, elevate pt legs, monitor VS and IO's |
| Aleration in tissue perfusion: Hypertension | BP > 160 |
| Causes of hypertension | pain, anxiety, full bladder, pulmonary edema |
| Treatment of hypertension | treat cause and give quick acting antihypertensives (IV) |
| In order to treat acute pain must know | what anesthetics and analgesics were given in OR |
| Top pain meds used | Sublimaze (Fentanyl), Hydromorphane (Dilaudid, Morphine |
| Sublimaze | Fentanyl; Major CNS depression, used as supplement to general anesthesia, given for severe pain and thrashing around, acts quickly and wears off quickly |
| Hydromorphone | Dilaudid; CNS depression, used for moderate to severe pain, takes longer to wear off |
| Naloxone | Narcan; reverses fentanyl, morphine, and dilaudid |
| Alteration in body temperature < 95 F causes | bradycardia and shallow respirations |
| Who is more susceptible for body temperature < 95 F? | Elderly and Children |
| Goal temperature post-precedure | <97 F |
| S and S of temperature < 95 F | shivering which increases O2 demand; demerol is drug of choice to stop shivering |
| Body temperature < 95 F may lead to | hypotension, metabolic acidosis, and cardiac dysrhythmias |
| Comfort and Safety of pt with temperature < 95 F | adjust pain med dose and assess RR frequently, touch and reposition, stay at bedside if pt is fearful |
| S and S of Emergence Delirium | strong, non-purposeful movements, crying, verbalizing or moaning and unable to follow commands, confusion, combative |
| Causes of Emergence Delirium | certain anesthetic agents, hx of anxiety, substance abuse, hypoxemia, children |
| Treatment of Emergence Delirium | stay with pt, reassure pt, pull curtains around bed, dim lights, make sure pt is oxygenated well and pain is under control, usually last 10-15 minutes |
Created by:
stilsl
Popular Nursing sets