perioperative nursing care
nursing care given before(pre-operative, during (intraoperaive, and after(postoperative) surgery.
association of perioperative registered nurses
formerly association of operating room nurses, formed to gain knowledge of surgical principles and explore methods to improve nursing care of surgical patients.
ambulatory surgery
outpatient surgery, same day surgery, short stay surgery
cholecystectomy
gallbladder removal
laproscopic
involves minimally invasive techniques with small incisions using scopes and cameras.
benefits of ambulatory surgery
anesthetic drugs metabolize quicker, shorter operative times, faster recovery time, elimination of hospital stay, reduction in possibility of HAI.
patients with high risks concerning anesthesisa
patients who are volume depleted or who have poor cardiac function.
classification of surgery
seriousness, urgency, purpose
american society of anesthsiologists
provides guidelines for perioperative management and evaluation of process and outcomes.
abalative
excision or removal of diseased body part
palliative
relieves or reduces disease symptoms, not a cure
moribund
a patient who is not expected to survive without the operaton
preoperative education
promotes structured, standards, satisfaction, prevention, decreased anxiety levels.
clinical judgement
includes assessment, analyzing, then decide implications
patient centered care
includes principles of EBP-Priorities are airway, pain, infection, discharge
Physical status classification
Ranges from P1-P6. P1 being a normal healthy patient and P6 a brain dead patient.
bleeding disorders(thrombocytopenia, hemophilia)
increase risk of hemorrhage before and after surgery.
diabetes melitus
increases susceptibility to infection and impairs wound healing
heart disease
general anesthetic agents depress cardiac function
obstructive sleep apnea
increased risk of airway obstruction after surgery
upper respiratory infection
increased respiratory complications during surgery
liver disease
alters metabolism and elimination of drugs administered during surgery
medication history includes...
prescriptions, OTC medications herbal substances
allergies include...
drugs, latex, food, contact, sensitiity
Major surgical procedure
involves extensive reconstruction or alteration. ex. coronary artery bypass
Minor surgical procedure
minimal alteration in body parts. ex. cataract extraction
Elective surgical procedure
patients choice, not essential. ex. plastics
Urgent surgical procedure
necessary for patients health. ex excision of tumor
Emergency surgical procedure
must be done immediately to save patients life. ex perforated appendix
Diagnostic surgical procedure
surgical exploration that confirms diagnoses. ex. exploratory laporotomy
Reconstructive surgical procedure
restores function or apearance
Constructive surgical procedure
restores congenital function lost. ex cleft palate
Cosmetic surgical procedure
improves personal procedure. ex. rhinoplasty
Preoperative holding area(PSCU)
initiate IV, conscious sedation, admission to operating room
obesity
increases surgical risk by reducing ventilatory and cardiac function
after surgery a patient needs
1500 kcal/day and protein, vitamin A and C, and zinc for wound healing.
induction of anesthsia
induction-drug administered
maintenance- appropriate levels maintained
emergence- the patient comes out from anesthsia
regional anesthsia
can paralyze patient ex. epidurals in pregnant women
local anesthesia
ex. numbing an area with lidocaine
conscious sedation
semi-awake, patient should be able to answer you
postoperative phase
post anesthesia care unit, two phase, first phase reovery, second stage hand off or home
aldrete score
postanesthesia recovery score
malignant hyperthermia
hereditary condition in which certain anesthetics (e.g., halothane) cause high body temperatures and muscle rigidity
obstructive sleep apnea
obstruction of airway during sleep
low basal metabolic rate in older adults
can cause reduced total oxygen consumption.
potentiate
means to enhance action of
antibiotics
potentiate anesthetic agents, can cause respiratory depression
antidysrythmics
can impair cardic contraction during anesthesia
anticoagulants
alter clotting, discontinue 48 hours before surgery
anticonvulsants
alter metabolism of anesthetic agents
antihypertensives
when combined with anesthetics can cause bradycardia, and hyotension
corticosteroids
amounts increase during and before surgery because prolonged use reduces the body's ability to cause stress.