FN Chp. 50 Care of Surgical Patients

Perioperative Nursing

nursing care given before (preoperative), during (intraoperative), and after (postoperative) surgery.

Association of PeriOperative Registered Nurses (AORN)

>was the first nursing organization to develop structure, process, & outcome standards as defined by the ANA.
>was formed to gain knowledge of surgical principles & explore methods to improve nursing care of surgical pt.

Ambulatory Surgery Centers (ASC)

>aka; outpatient surgery, short stay surgery, or same day surgery.
> more than half of elective surgery's occur on an outpatient basis.

Cholecystectomy

gallbladder removal

Drugs with Special Implications for Surgical Pt: Antibiotics

- enhances the action of anethetic agents if takin within 2 weeks before surgery.
- aminoglycosides (gentamicin, neomycin, tobramycin) may cause mild respiritory depressionfrom depressed neuromuscular transmission.

Drugs with Special Implications for Surgical Pt: Antidysrhythmics

medications (beta-blockers) can reduce cardiac contractility & impair cardiac conduction during anesthesia.

Drugs with Special Implications for Surgical Pt: Anticoagulants

medications such as warfarin or aspirin alter normal clotting factors & thus increase risk for hemorrhaging.

Drugs with Special Implications for Surgical Pt: Anticonvulsants

long-term use of certain anticonvulsants (dilantin & phenobarbital) alter metabolism of anesthetic agents.

Drugs with Special Implications for Surgical Pt: Antihypertensives

medications such as beta blockers & calcium channel blockers interact with anesthetic agents to cause bradycardia, hypotension, & impaired circulation.

Drugs with Special Implications for Surgical Pt: Corticosteroids

with prolonged use corticosteroids such as prednisone cause adrenal atrophy, which reduces the bodies ability to withstand stress.

Drugs with Special Implications for Surgical Pt: Insulin

pt need for insulin usually changes after surgery. Stress responce & IV administration of glucose solutions often increase dose requirements after surgery.

Drugs with Special Implications for Surgical Pt: Diuretics

diuretics such as furosemide (Lasix) potentiate electrolyte imbalances, particularly potassium after surgery.

Drugs with Special Implications for Surgical Pt: NSAIDs

like ibuprofen inhibit platelet aggregation & prolong bleeding time, increasing susceptibility to postoperative bleeding.

Drugs with Special Implications for Surgical Pt: Herbal Therapies

can affect platelet activity & increase the susceptibility to postoperative bleeding. Ginseng is known to increase hypoglycemia with insulin therapy.

Normal Values for: Complete Blood Count

RBC: men- 4.7 to 6.1 million/mm3
women- 4.2 to 5.4 million/ mm3
Hgb: men- 14 to 18 g/100mL
women- 12 to 16 g/100mL
Hct: men- 42% to 52%
women- 37% to 47%
WBC: > 2yrs. 5000 to 10,000/mm3

Normal Values for: Serum Electrolytes

SODIUM (Na+): 136 - 145 mEq/L
POTASSIUM (K+): 3.5 - 5 mEq/L
CHLORIDE (Cl-): 95 - 105 mEq/L
BICARBONATE (HCO-3): 22 - 26 mEq/L (arterial)
24 - 30 mEq/L (venous)

Normal Values for: Coagulation Studies

PT: 11 - 12.5 seconds
INR: 0.76 - 1.27
APTT: 30 - 40 seconds
PLATELETS: 150,000 - 400,000/ mm3

Normal Values for: Serum Creatinine

men- 0.6 - 1.2 mg/100 mL
women- 0.5 - 1.1 mg/100 mL

Normal Values for: BUN

10 - 20 mg/100mL

Normal Values for: Glucose

Fasting: 70 - 105 mg/100 mL