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Medical 2 Surgical


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Association of Operating Room Nurses (AORN)
first nursing organization to develop structure, process, and outcome standards defined by ANA.
The standards of perioperative nursing include?
administrative practice; clinical practice; professional performance; quality improvement
client outcomes
AORN has since been changed to?
Association of Perioperative Registered Nurses
What is ambulatory surgery?
outpatient surgery, short-stay surgery, or same-day surgery
Describe PS-1 (Physical Status)?
a normal healthy client
Describe PS-2?
a client with a mild systemic disease; a 48 yo smoker needing an EDG
Describe PS-III?
a client with a severe systemic disease that limits activity but is not incapacitating;
43 yo asthmatic 280 lb needs EDG
Describe PS-IV?
a client with a severe systemic disease that is a constant threat to life; 54 yo renal dialysis pt needing colonoscopy
Describe PS-V?
a moribund client who is not expected to survive 24 hours with/without the operation; ejected MVA victim needing cranial, abdominal, and thoracic injury
Describe PS-VI?
a client declared brain dead whose organs are being removed for donor purpose
Describe E?
Emergency operation
What are the characteristics of a PS-1 which is a normal healthy client?
No physiological, biological, organic disturbance
ex: 24 yo male needing repair of facial laceration
What are the characteristics of a PS-II which is a client with a mild systemic disease?
Cardiovascular disease with minimal restriction on activity
What are the characteristics of a PS-III which is a client with severe systemic disease that limits activity but is not incapacitating
Hypertension, obesity, diabetes mellitus
What are the characteristics of a PS-IV which is a client with a severe systemic disease that is a constant threat to life?
CV or pulmonary disease that limits activity; severe diabetes with systemic complications; history of myocardial infarction, angina pectoris, or poorly controlled HTN
What are the characteristics of a PS-V which is a moribund client not expected to survive 24 hours with/without operation?
Severe cardiac, pulmonary, renal, hepatic, or endocrine dysfunction
What are the characteristics of a PS-VI which is a client declared brain dead whose organs are being removed for donor purpose?
clients may have a wide variety of dysfunctions that are being managed to optimize blood flow to the heart and organs (e.g., aggressive fluid replacement and blood pressure medications)
What are the characteristics of E which is emergency operation?
Surgery is done as a last recourse of resuscitative effort; major multisystem or cerebral trauma, ruptured aneurysm, or large pulmonary embolus
Assessment for surgical procedures are (18 fond campers)?
alcohol ingestion
client expectations
diagnostic screening
emotional health
family support
medical history
medication history
nursing history
perceptions of surgery
physical exam
preoperative pain
previous surgeries
risk factors
smoking habits
substance abuse and use
How does CHF affect surgical candidate?
(medical history)
there might be a further decline in cardiac function which can be thwarted
by giving IV at a slower rate or by giving a diuretic after blood transfusion
Name 6 risk factors of surgical procedures?
fluid and electrolyte imbal.
What are two major risk factors for infants undergoing surgery?
maintaining normal circulatory blood volume which makes it difficult to meet increased oxygen demands...also dehydration or overhydration depending on rate fluids are replaced
Name surgical care aspects of child's surgical care?
(seaaaa pasted)
(a, risk factors, age)
seizure treatment
excessive blood loss
airway management
age-appropriate medications
age-appropriate equipment
anesthesia recovery
seizure treatment
temperature alterations
emergence delirium
dehydration vs overhydration
How many calories per day does a patient require following surgery? (a, risk factors, nutrition)
1500 kcal/day, esp. vitamins A and C, and zinc which facilitate wound healing
How does malnutrition in a surgical patient affect healing? (a, risk factors, nutrition)
anesthesia tolerance poor
nitrogen balance negative
blood clotting mechanisms
wound healing poor
multiple organ failure
(potential for poor)
How does obesity (bariatric) affect surgical risks? (a, risk factors, obesity)
reduces ventilatory and cardiac function
What diseases are common in obese patients?
diabetes mellitus
What conditions are commonly seen in bariatric patients?
(a, risk factors, obesity)
How does obesity affect wound healing?
fatty tissue structure contains a poor blood supply which slows delivery of nutrients, antibodies, and enzymes; thick adipose layer also hard to suture and susceptible to dehiscence
Complications from previous surgeries include? (a, previous surgeries)
motion sickness and
nausea and vomiting
which increase the risk for aspiration
The patient's perception and understanding of surgery may induce? (a, P&U)
True or False? All meds (herbal too) are discontinued postoperatively unless doctor orders? (a, medications)
It is critical to assess what type of allergies in surgical patients? (a, allergies)
contact (ex. tape, ointments, solutions)
What postoperative care is important to smokers and ALL
preop teaching programs?
(a, smoking habits)
deep breathing exercises which include:
"huff" coughing diaphragmatic breathing incentive spirometry positive expiratory pressure
leg exercises
How does alcohol affect surgical healing? (a, alcohol ingestion)
increases anesthetic needs due to cross-tolerance;
poor wound healing due to malnourishment; at risk for liver disease, portal hypertension, esophageal varices; delirium tremens
Review of emotional health of surgical patient may reveal that patient feels?
fear, anxiousness and powerlessness
How does self-concept affect surgical outome? (a, self-concept)
hinders ability to adapt to stress of surgery and aggravates feelings of guilt or inadequacy
What types of surgery can affect body image, mainly sexuality? (a, emotional health)
breast removal
prostate gland removal
When assessing emotional health of surgical patient, determine? (3)
body image
coping resources
What is the body's physiological response to surgical stress?
activation of endocrine system results in release of hormones and catecholamines (epinephrine, NE) which increases blood pressure, heart rate, and respiration; platelet aggregation also occurs
Physical exam for surgery should include?
general survey
head and neck
thorax and lungs
heart and vascular system
neurological status
The surgical nursing assessment should complement?
surgeon's and anesthesia provider's assessment
The surgical nursing assessment should include the following? (hav light nn)
general survey
The surgical nurse should take baseline preoperative vital signs and compare with post-operative vital signs?
to rule out fluid and electrolyte imbalance
When assessing head and neck, the nurse should inspect soft palate and nasal sinuses for?
Palpate for cervical lymph node enlargement to rule out possibility of?
local or systemic infection
Inspect jugular veins for distention to?
rule out excess fluid buildup in circulatory system or failure of heart to contract efficiently
Note oral mucosa, identifying
loose or capped teeth as they may be?
dislodged during endotracheal intubation.
Inspect skin before surgical procedure to?
discern increased risk of skin tears after lying for hours or sliding on OR table.
If surgical nurse auscultates wheezing preoperatively, the patient may be at risk for further airway narrowing due to?
certain anesthetics which cause laryngeal muscle spasm...notify doctor.
Acceptable capillary fill occurs in?
less than 2 seconds
Assess abdomen for?
regular bowel movements?
color and consistency of
If client is to receive spinal anesthesia, nurse should assess?
gross motor function and strength preoperatively. Nurse needs to be aware that client will only return to pre-op strength.
What is a complete blood count?
peripheral venous sample of blood measuring
What conditions might a CBC reveal? (bio)
blood volume low
oxygenation problems
(surgeon may order replacement)
Normal rbc count in men?
4.7 - 6.1 million/mm3
Normal rbc in women?
4.2 - 5.4 million/mm3
Normal hemoglobin in men?
14 - 18 g/100 ml
Normal hemoglobin in women?
12 - 16 g/100 ml
Normal hematocrit in men?
42% - 52%
Normal hematocrit in women?
37% - 47%
Normal white blood count in adults and children older than 2 years?
5,000 - 10,000 /mm3
Serum electrolytes include?
bicarbonate (HCO3-)
chloride (Cl)
potassium (K)
sodium (Na)
Normal range for bicarbonate (HC03-)?
21 - 28 mEq/L
Normal range for chloride (Cl)?
98 - 106 mEq/L
(chloride is feverish)
Normal range for potassium (K)?
3.5 - 5.0 mEq/L
Normal range for sodium (Na)?
136 - 145 mEq/L
Imbalanced serum electrolytes may indicate need for?
IV fluid replacement preoperatively. Use peripheral venous sample of blood
Coagulation studies include?
APTT - activated partial
thromboplastin time
INR - International
Normalized Ratio
PT - prothrombin time
(These values reveal clients at risk for bleeding tendencies and thrombus formation)
Normal PT level?
11 - 12.5 seconds
Normal INR level?
0.76 - 1.27
Normal APTT level?
30-40 seconds
Normal platelet level?
150,000 - 400,000 /mm3
Serum creatinine measures?
ability of kidneys to excrete creatinine, by-product of muscle metabolism, assesses renal function
An elevated creatinine can indicate?
renal failure
Normal serum creatinine level for men?
0.6 - 1.2 mg/100 ml
Normal serum creatinine level for women?
0.5 - 1.1 mg/100 ml
Normal blood urea nitrogen (BUN level)?
10 - 20 mg/100 ml
BUN measures?
ability of kidneys to excrete urea and nitrogen indicates renal function
An elevated BUN may indicate?
dehydrated client; preop IV fluid replacement may be needed
(normal BUN 7-20 mg/dl
Normal fasting glucose level?
70 - 105 mg/100 ml
A glucose check may be acquired by?
finger stick or peripheral blood sample; treat abnormal levels pre-op and post-op
Common diagnostic studies for hepatic disease?
coagulation studies
liver enzymes (ex: AST)
alkaline phosphatase
Common diagnostic studies for diuretics include?
Common diagnostic studies for steroids include?
Common diagnostic studies for anticoagulants include?
coagulation studies
Common diagnostic studies for cardiovascular disease include?
Common diagnostic studies for pulmonary disease include?
Common diagnostic studies for CNS disease are?
WBC count
Common nursing diagnoses relevant to surgical client?
acute pain
deficient knowledge (specify)
delayed surgical recovery
disturbed body image
disturbed sleep pattern
impaired physical mobility
impaired skin integrity
ineffective airway clearance
ineffective breathing pattern
ineffective coping
risk for deficient fluid
risk for imbalanced body temp
risk for infection
risk for latex allergy
risk for perioperative-
positioning injury
Critical thinking assessment for surgical clients include?
coping skills
physical exam
pre-op dx tests
previous surgical experience

client's previous experience
with surgery
physical exam focused on
client's history and
planned surgery
results of preoperative
diagnostic tests
Critical thinking planning for surgical clients include?
pre-op instructions for
client and family
consult other hcp's
provide coping therapies
risk reduction therapies
Planning phase of the nursing process includes? (3)
continuity of care
goals and outcomes
setting priorities
In the PLANNING phase, OUTCOMES established for each goal of care provide?
In the PLANNING phase, setting PRIORITIES requires?
clinical judgment to prioritizing nursing diagnoses and interventions based on the assessed unique needs of each client.
In the PLANNING phase, CONTINUITY OF CARE for surgical patients mean?
guiding the patient pre-op and post-op
In the IMPLEMENTATION process for surgical intervention, the nurse provides?
a complete understanding of surgery and prepares client physically and psychologically
IMPLEMENTATION for surgical clients involves? (6)
acute care
health promotion
informed consent
physical preparation
preoperative teaching
preparation on day of surgery
It's the __________ responsibility to explain the surgical procedure and obtain the informed consent.
Health promotion activities during preop phase focus on?
health maintenance
prevention of complications
support of possible rehab
needs postop
A nurse pre-warns (reduces anxiety) client that he may have a sore throat following surgery due to? (preoperative teaching)
endotracheal tube
A nurse pre-warns (reduces anxiety) client that he may have sensations of blurred vision postop due to? (preoperative teaching)
ointment being placed in client's eyes to prevent corneal damage
Understanding of the surgical experience includes the following? (8 preoperative teaching)
Client cites:
feelings regarding surgery
postop activity resumption
pain relief measures
postop monitoring & therapies
postop unit & location of
family during surgery &
reasons for preop instruct.
surgical procedures & postop
time of surgery
When giving preop instructions concerning breathing, the nurse should?
allow pt practice
return to re-evaluate
patient's success
Equipment needed when demonstrating post-op exercises are?
pillow or wrapped blanket
incentive spirometer
positive expiratory pressure
(PEP) device and nose clip
The pillow used when demonstrating postop exercises is used to?
splint surgical incisions during coughing
When assessing client's risk for postop respiratory complications, review medical history for?
chest wall movement
chronic pulmonary conditions
ex: emphysema, asthma
history of smoking
presence of reduced hgb
Why does general anesthesia predispose client to respiratory problems?
because lungs are not fully
inflated during surgery..
cough reflex is suppressed..
mucus collects in airway
Postop, patient may have trouble coughing and deep breathing because?
there is reduced lung volume due to general anesthetic
Postop, patient is at greater risk to develop?
respiratory complications if other chronic lung conditions are present
Smoking damages?
ciliary clearance
increases mucus secretions
Reduced hemoglobin level can lead to?
inadequate oxygenation
Preop, nurse should get a baseline chest expansion measurement to?
compare postop measurement with
Older clients, active cancer patients, and clients immobilized for more than 3 days are most at risk for?
DVTs or thrombus formation
Signs of thrombus formation may include?
localized tenderness along
distribution of venous
swollen calf or thigh
calf swelling more than 3 cm
compared with other leg
pitting edema
collateral superficial veins
For thrombus formation to occur, there must be simultaneous? This event may occur following general anesthesia.
vein trauma
venous stasis
True or false? Positive Homan's sign indicates DVT?
When teaching diaphragmatic breathing, have client hold slow, deep breath for?
3 counts, exhale slowly, and repeat 3 to 5 times...patient to take 10 slow, deep breaths every hr while awake during postop period until mobile
To perform incentive spirometry or positive expiratory pressure therapy, have patient sit in which position?
semi-Fowler's or high Fowler's position
"Huff" coughing or forced expiratory technique when using PEP therapy accomplishes what?
promotes bronchial hygiene by increased expectoration of secretions
When done appropriately ((with fingers (splint/support) or pillow over incision)), controlled coughing exercises will cause incisional injury? True of false
Practicing turning exercises
reduces risk of vascular and pulmonary complications
Preop leg exercises are done by?
rotating each ankle alternating with dorsiflexion and plantar flexion of both feet in supine position
If in pain, patient may request pain medication 30 minutes before postop exercises. True or false?
A client may receive the following preop to relieve anxiety and promote sleep?
Restoril (temazepam)-
Xanax (alprazolam)-anxiolytic
Routine procedures surgical nurse provides in preparation for a day of surgery are? (10)
administering preop meds documentation
eliminating wrong site and
wrong procedure surgery
hair and cosmetics
latex sensitivity/allergy
performing special procedures
preparing bowel and bladder
removal of prosthesis
vital signs
safeguarding valuables
If patient has been NPO before surgery, mouth may be dry. Nurse may offer?
mouthwash and toothpaste and
water and instruct patient
not to swallow
preop meds which may cause
An indwelling catheter may be placed in the pre-op client just before surgery if?
surgery is long
incision is in lower abdomen
Essential documentation that must be in chart before client goes to OR?
pertinent laboratory results
preoperative checklist
current client documentation
Preop or "on call" meds are given AFTER consent form signed and are used to treat?
amount of anesthesia
risk of n & v and resultant
respiratory tract secretions
Products that may contain latex and which surgical candidate may be allergic to include?
adhesive tape
disposable electrodes
endotracheal tube cuffs
IV tubing
protection sheets
rubber stoppers on bottles
and vials
ventilator equipment
Localized signs and symptoms of latex allergy?
anything from flat or raised
red patches to
vesicular, scaling, or
bleeding eruptions
acute dermatitis
rhinitis and/or rhinorrhea
Life threatening symptoms of latex allergy include?
focal or generalized
mucus hypersecretion
(compromises respiratory
vasodilation compounded
by increased capillary
permeability leading to
circulatory collapse and
Define "Time Out"?
conducted just before surgery whereby all team members are present and client is again identified along with indelibly marked side and site of surgery
The qualification of a circulating nurse MUST be?
an RN
In the nursing process, EVALUATION for surgery includes?
Ask if the client's
expectations are being
Evaluate the client's
knowledge of surgical
procedure and planned
postop care
Have the client demonstrate
postop exercises
Observe behaviors or
nonverbal expressions of
anxiety or fear
What does the circulating nurse do?
Assists surgeon & surgical
team by operating non-
sterile equipment,
provides additional
supplies, verifies sponge
and instrument counts and
maintains accurate and
complete written records
Assists with endotracheal
intubation and blood
Establishes & implements
intraop plan of care
Evaluates the care
Monitors sterile technique
and safe OR
Provides for continuity of
care postop
Reviews preop assessment
The qualifications of a scrub nurse may be?
licensed practical nurse
surgical technician
What does the scrub nurse do?
maintains sterile field
during surgical procedure
assists with applying sterile
hands surgeon instruments
counts sponges and instru-
Four types of anesthesia used in the OR are?
Define general anesthesia?
an immobile, quiet client who doesn't recall surgical procedure
The 3 phases of anesthesia?
General anesthesia is called for when?
control of ANS
muscle relaxation
Define induction?
includes administration of agents and endotracheal intubation
Define maintenance?
includes positioning the client
Define emergence?
anesthetics are decreased and client begins to awaken
Define palliative surgery?
reduces intensity of disease; performed to relieve symptoms of a disease process, but does not cure; makes the client more comfortable
ex: colostomy
nerve root resection
tumor debulking
Define cosmetic surgery?
reconstructs the skin and underlying structures; can be elective, urgent, or emergent; performed primarily to alter or enhance personal appearance
ex: liposuction
revision of scars
Surgical procedures are categorized according to? (5)
anatomic location
degree of risk
extent of surgery
reason for surgery
urgency of procedure
Reasons for surgery include?
Urgency of surgery? (3)
Degree of risk of surgery?
Extent of surgery?
Define diagnostic surgery?
performed to determine the origin and cause of a disorder or the cell type for cancer
ex: breast biopsy
exploratory laparotomy
Define curative surgery?
performed to resolve a health problem by repairing or removing the cause
ex: laparascopic
Define restorative/reconstructive surgery?
restores function; performed to improve a client's functional ability
ex: total knee replacement
finger reimplantation
Define elective surgery?
planned for correction of a nonacute problem
ex: cataract removal
<hernia repair>
total joint replacement
Define urgent?
<necessary, but not necessarily emergency> requires prompt intervention; may be life threatening if treatment is delayed more than 24-48 hrs
ex: acute cholecystitis
bladder obstruction
bone fracture
eye injury
intestinal obstruction
kidney or ureteral
<removal of gallbladder>
Define emergent?
NOW! requires immediate intervention because of life-threatening consequences
ex: AAA
compound fracture
gunshot or stab wound
<repair of perforated
severe bleeding
Define minor surgery?
procedure without significant risk; often done with local anesthesia
cataract extraction
implantation of a venous
access device (VAD)
incision and drainage
muscle biopsy
Define major surgery?
procedure of greater risk, usually longer and more extensive than a minor procedure
ex: CAB
colon resection
lymph node dissection
mitral valve replacement
pancreas transplant
Define simple surgery?
only the most overtly affected areas involved in the surgery
ex: simple/partial
Define radical surgery?
extensive surgery beyond the area obviously involved; is directed at finding a root cause
ex: radical hysterectomy
radical prostatectomy
A diabetic client may need a more extensive bowel preparation because?
of decreased intestinal motility
Problems from anesthesia occur most commonly in what body system?
cardiovascular due to hemodynamic changes and response to anesthesia possibly resulting in MI
<Surgical risk factors of the aged's cardiovascular system include?>
<decreased cardiac output
decreased peripheral
increased blood pressure>
<Nursing interventions and rationales for the aged's cardiovascular system are?>
<1) Determine normal activity levels and note when the client tires...knowing limits helps prevent fatigue

2) Monitor vital signs, peripheral pulses, and capillary refill....having baseline data helps detect deviations>
<Surgical risk factors of the aged's respiratory system include?>
<reduced vital capacity
loss of lung elasticity
decreased oxygenation of
<Nursing interventions and rationales for the aged's respiratory system are?>
<1) teach coughing and deep breathing exercises...
pulmonary exercises help prevent pulmonary complications

2) monitor respirations and breathing effort...having baseline data helps detect deviations>
<Surgical risk factors of the aged's renal/urinary system include?>
<decline in glomerular
filtration rate
decreased blood flow to
nocturia common
reduced ability to excrete
waste products>
<Nursing interventions and rationales for aged's renal
and urinary system are?>
<1) assess overall hydration and monitor I & O...ongoing assessment helps detect fluid and electrolyte imbalances and decreased renal function

2) assist frequently with toileting needs, especially at night....frequent toileting helps prevent incontinence and falls>
Risk factors of the aged's neurologic system include?
<decreased ability to adjust
to changes in surroundings
sensory deficits
slower reaction time>
<Nursing interventions and rationales for the aged's neurological system are?>
<1) orient client to surroundings

2) allow extra time for teaching client

3) provide for client's safety individualized preop teaching plan is developed on the basis of the client's orientation and neurologic deficits and safety measures help prevent falls and injury>
<Risk factors of the aged's musculoskeletal system are?>
<Increased incidence of deformities related to osteoporosis or arthritis>
<Nursing interventions and rationales of the aged's musculoskeletal system are?>
<1) assess the client's mobility...interventions help prevent complications of immobility

2) teach turning and positioning; encourage ambulation; place on fall precautions, if indicated measures help prevent injury>
Name 7 routine preop meds?
Nursing interventions for preop antidysrhthmic meds?
obtain baseline ECG
assess peripheral circulation
Nursing interventions for preop antihypertensives?
assess for hypotension during transfer and turning
Nursing interventions for preop corticosteroids?
continue steroid therapy
during surgery
assess for signs of
assess for subtle signs of
infection and bleeding
monitor wound healing,
support incision area
with binders, and splint
wound when client is
turning, coughing, and
deep breathing
Nursing interventions for preop anticoagulants?
monitor coagulation studies
monitor signs of bleeding
gradually d/c 24-48 hours
before surgery
have an antidote for warfarin
ex: vitamin K for heparin
protamine sulfate for
warfarin sodium
Nursing interventions for
antiseizure meds?
assess for seizures
pad siderails of bed
place suction equipment
at bedside
Nursing interventions for glaucoma meds?
check with physician about
d/c'ing Humorsol at least 2
weeks before surgery
monitor respiratory status
and cardiac output
assess for increased intra-
ocular pressure
Nursing interventions for antidiabetic agent?
monitor serum glucose levels
administer antibiotics and other intermittent meds in NS
instead of dextrose , or as facility prescribes
Define autologous donations?
patient donates 2-4 units of own blood up to 5 weeks before surgery, hgb greater than 11 g/dl, and doctor's recommendation;
last donation can't be made within 72 hours before surgery
Define directed blood donation?
family and friends donate blood exclusively for patient
Red blood cell stimulation can be accomplished with?
epoetin alpha
ex: Epogen
supplemental iron
folic acid
vitamin B12
vitamin C
Specific considerations when planning care for the older preop client includes?
Increased, decreased or
impairment of........
cardiopulmonary complications
chronic illness
fall with injury
mental status
self-care abilities
surgery and anesthesia stress
support systems
Define oliguria?
scant amount of urine
Surgery increases metabolic rate and depletes which vitamins and electrolytes needed for wound healing and blood clotting?
B vitamins
vitamin C
How can a surgical nurse detect poor nutritional status?
brittle nails
muscle wasting
dry or flaky skin
hair changes (dull, sparse,
decreased skin turgor
orthostatic hypotension
decreased serum protein
abnormal serum electrolyte
Define procurement for transplant?
removes an organ
Define constructive surgery?
restores function of congenital anomalies
<Anesthesia is an induced state of partial or total loss of consciousness. The purpose is to?>
<*block nerve impulse
*suppress reflexes
*promote muscle relaxation
*sometimes achieve a
controlled level of
<What happens to general anesthesia in the body?>
<*most are metabolized by the liver
*excreted by the kidneys
*interactions can occur
with other drugs that the
patient has received>
<Define general anesthesia?>
<a reversible loss of consciousness induced by inhibiting neuronal impulses in several areas of the CNS>
<General anesthesia results in?>
<*analgesia (pain relief or suppression)
*amnesia (memory loss of the surgery)
*unconsciousness and loss of muscle tone and reflexes>
<General anesthesia is used in surgery for?>
upper torso
<Stages of general anesthesia are?>
<Stage 1 analgesia & sedation
Stage 2 excitement, delirium
Stage 3 operative level
Stage 4 DANGER>
<Define Stage 1 of general anesthesia?>
<analgesia & sedation is a dizzy and drowsy feeling;
hearing is exaggerated>
<Define Stage 2 of general
<excitement and delirium; loss of consciousness to loss of eyelid reflex; irregular breathing, involuntary movements, vomiting or laryngospasm may occur>
<Define Stage 3 of general anesthesia?>
<operative level; loss of reflexes, depressing of vital functions; sensations are lost; patient can't hear; jaw relaxed>
<Define Stage 4 of general anesthesia?>
<DANGER; respiratory failure, cardiac arrest, possible>
Nursing interventions and rationales for Stage I are?
keep discussions to a minimum (hearing exaggerated);
position with safety belts;
close OR doors, dim lights,
control traffic
Nursing interventions and rationales for Stage II are?
avoid auditory and physical stimuli; protect extremities; assist anesthesiologist or CRNA with suctioning as needed
Nursing interventions and rationales for Stage III are?
assist anesthesiologist or CRNA with intubation; scrub patient skin over operative site
Nursing interventions and rationales for Stage IV are?
prepare for and assist in treatment of cardiac and/or pulmonary arrest; document occurrence in client's chart
<Administration of general anesthesia by inhalation does what?>
<causes shivering after surgery because of effects on hypothalamus;
blankets won't stop shivering, but will give comfort>
<Define nitrous oxide?>
the most commonly used agent and is usually given with oxygen; it's a colorless and odorless gas that provides analgesia>
<Explain IV anesthetic agents?>
<injected through an IV line and into diluted into blood; it remains at high enough levels in brain, kidney, and liver>
<Name 3 types of IV anesthetic injections?>
ketamine (ketalar)
propofol (diprivan)>
<How are IV anesthetic barbituates used in surgery?>
<acts on CNS; most common one is thiopental sodium (Pentothal); acts within 30 seconds; monitor vital signs continuously as it depresses breathing and cardiac function>
<How are IV anesthetic ketamine (ketalar) used in surgery?>
<a dissociative anesthetic agent (one that promotes a feeling of separation of dissociation from the environment) rapid onset of trancelike, analgesic state; often used for diagnostic and short surgical procedures);
emergence reactions are common during recovery (24hrs); may help to give patient small doses of diazepam (Valium)>
<How is Propofol (diprivan)
used in surgery?>
<a short-acting; minimal n&v; hypnosis occurs in less than 1 minute; drug eliminated rapidly and client responsive within 8 minutes after infusion ends>
<Adjuncts to general anesthesia are?>
opioid analgesics
neuromuscular blocking
<How are hypnotics used as adjuncts to general anesthesia?>
<may be used as part of IV conscious sedation for short diagnostic procedures; higher doses of medazolam can induce general anesthesia; may be used during surgery along with regional or local anesthesia>
<Name hypnotics used as adjuncts to general anesthesia?>
<benzodiazepines such as:
midazolam (Versed)
lorazepam (Ativan,
diazepam (Valium, Vivol,
<What are the effects of hypnotics as adjuncts to general anesthesia?>
muscle relaxant
<Adverse effects of hypnotics as adjuncts to general anesthesia include?>
<apnea (temporary cessation
of breathing)
respiratory depression>
<Name opiods used as adjuncts to general anesthesia?>
<fentanyl (Sublimaze)
sufentanil (Sufenta)
meperidine (Demerol)
morphinen sulfate (Statex)>
<How are opioids used as adjuncts to general anesthesia?>
<reduced dosages are used for older clients, clients with a circulatory problem (ex: heart failure) and debilitated clients)>
<What are the effects of opiods as adjuncts to general anesthesia?>
<*provides pain relief AFTER
<What is the potency relationship between Fentanyl and Morphine?>
<Fentanyl is 75 to 125 times more potent than Morphine>
<Define balanced anesthesia?>
<a combination of IV drugs and inhalation agents used to obtain specific effects>
<What is balanced anesthesia used for?> (haamr)
<to provide:
muscle relaxation
reduced reflexes with
minimal disturbance of
physiologic function>
<When is balanced anesthesia most advantageous?>
<provides safe and controlled anesthetic delivery, especially for older and high-risk clients>
<What are some balanced anesthesia combinations?>
<*thiopental for induction
*nitrous oxide for amnesia
*morphine for analgesia
*pancuronium for muscle
<What systems are affected by general anesthesia?>
skin: incision>
<Undesirable outcomes of surgery include?>
*fluid and electrolytes are
out of balance which is due
to large amounts of IV
*inflammation process>
<How does positioning put the patient at risk perioperatively?>
<*Poor body positioning puts patient at risk for pressure ulcer formation.
*Good body positioning can prevent obstruction of circulation, respiration, and nerve conduction.>
<Common surgical positions include?>
< dorsal recum. (mostcommon)
*lithotomy (mostcommon)
*prone (mostcommon)
How is padding used when positioning patients for surgery?
Circulating nurse pads, coordintes transfer to OR bed, assessing skin integrity, and adds extra padding as needed.
Factors influencing TIMING of repositioning of patient by circulating nurse on OR table?
age and size
anesthetic delivery
pain on movement if client
surgical site
Factors influencing ACTUAL position of repositioning of patient by circulating nurse
age, size, and weight
any pulmonary, skeletal, or
muscular limitations, such
as arthritis, joint
replacements, or emphysema
specific procedure being
surgeon's request
<Surgical patient's skin can be impaired. Nursing interventions for this include?>
(3 at skin level
1 at body level)
<*plastic adhesive drape
*skin closures, sutures,
staples, nonabsorbable
*insertion of drains
*application of dressing
*transfer of client from the
operating room table to a
Define absorbable sutures?
*digested over time by body enzymes
*catgut, plain gut and chromic gut are types of natural absorbable sutures
*natural and synthetic absorbable sutures are absorbed in about 2 weeks

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