Inability to metabolize drugs
Increases risk of bleeding
Liver damage can alter surgical outcomes because of (2) things
Anesthesia less effective
Require more meds
Surgical outcomes for patients with drug abuse (2)
Pre-admission testing
Past medical history
Drug allergies
In the preoperative phase, 3 things should be done for assessment
reduce anxiety
*Interventions should be in place in the preoperative phase to
Notify the doc
*Patient teaching in the preoperative phase you should asses level of knowledge concerning procedure, if they dont understand..
witness
*RN/LPNs sign the consent form to
Analgesics/anti-anxiety (sedation and anxiety)
Antiemetic (N/V)
Anticholinergic (dry secretions)
Antibiotic
*4 As pre op meds
Local anesthetic
*type of anesthetic where the patient does not lose consciousness
Enema
In the preoperative phase to prep for surgery, you might need to shower, scrub, shave, douche or give
Vomiting and aspiration
before surgery patient is to be placed on NPO to prevent
The procedure
Alternative treatment
Risks
Benefits
In the preoperative phase the MD must inform the patient of (4) things before meds are given and before consent is signed
Intraoperative phase
What phase is preformed during surgery
Circulating nurse (RN)
What kind of nurse manages the surgery case, oversees aseptic technique and ensures the room is set up and supplies are ready
Motor function returns before sensory
*When anesthesia wears off...
Malignant Hyperthermia
*severe reaction that occurs to particular medications used during general anesthesia
Increased Temp, Pulse and metabolic rate
Decreased BP
Cyanosis
Muscle rigidity
s/s for Malignant hyperthermia (6)
Cool temp with ice packs or iced saline IV
100% O2
2 nursing interventions for Malignant hyperthermia besides meds
Shock (monitor for symptoms)
Post operative complication that could be caused by drugs or hypovolemia
Hypoxia
Post operative phase because of drugs and anesthesia, monitor patient for depression of respirations, which can lead to
Atelectasis
Respiratory complication after surgery where there is a partial or complete collapse of a lung
gas exchange
pneumonia
Atelectasis impairs what?
and can lead to what?
Dehiscence
*Post op wound complication where margins separate
Evisceration
*Post op wound complication where organs protrude thru an open wound
Cover with NS dressing and then apply dry dressing
Notify surgeon right away
2 things to do when there is an evisceration
decreased peristalsis
In the post op phase, pain meds, anesthesia or eating too soon can cause GI disturbances like
Abdominal distension
Absent bowel sounds
Pain
S/S of decreased peristalsis
Early and frequent ambulation
Treatment for decreased peristalsis
Paralytic ileus
*Absence of peristalsis leads to server abdominal distension causing respiratory issues. This could cause incisional strain.
N/G tube to suction
Treatment for paralytic ileus
Urinary retention (along with drugs making it difficult to void)
Dehydration & blood loss can cause
Thrombophlebitis
Immobility after surgery can lead to
PE (if clot dislodges)
Thrombolphlebitis can lead to
Ambulation
Leg exercises
Ankle rotation, pointing/flexing
3 interventions to prevent thrombolphlebitis besides ted hose
15 mins
In the PACU (post-anesthesia care unit) vitals should be done every
LOC
In the PACU nurse should assess neuro function by checking
Adequate nutrition
Dressings
In the PACU nurse should assess skin color, temp and moisture for (2)
Bowel sounds
Distention
In the PACU nurse should assess abdomen for (2)
color (circulation)
Edema
Homans sign (DVT)
In the PACU nurse should assess extremities for (3)
Ablative
Remove diseased tissue or correct defects
Constructive procedure
Restores function lost d/t congenital defect (Cleft lip)
Liver and kidney function
Elderly respond differently to drugs due to age related changes in (2)
poor wound healing and
greater chance of infection
Surgery outcome on patients that are underweight or malnourished have (2)
Longer surgery
Respiratory problems
Slower wound healing
Takes longer to wake up from anesthesia (because it remains in adipose tissue longer)
Surgical outcomes for obese patient (4)
Blood volume and urine output
Fluid and electrolyte balance is needed for surgery for (2)
NSAIDS
ASA
Anticoagulant
Ginkgo and Ginseng
*Drugs held 7-10 days prior to OR
Cardiac arrhythmias
Fluid and electrolyte imbalances could cause
liver damage
Alcohol abuse cab alter surgical outcomes because of
When vital signs are stable (off admission baseline)
When can post op patient discharge from PACU
decrease metabolism by the liver
Elderly require lower doses of pain medication d/t
penrose and T tube
Wound care- Passive movement of fluids from wound to dressing (2)
JP and Hemovac
Wound care- Suction with negative pressure (active) (2)
Sanguineous
(sangria)
bright red drainage
Serosanguineous
pinkish drainage
serous
straw colored and clear
Vitamin C
Increase protein
zinc
*Nutritional support after surgery (3)
Gag reflex
bowel sounds
Post op asses two things
Ambulation
Incentive spirometry
*After surgery, to prevent respiratory complications, and peristalsis
30 cc
Post op check for bladder distention. How much should pt void an hour?
6-8 hours after removed
After post op cath is removed, pt should void within what time