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Surg (Wes)


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What is routinely checked after surgery that is affected by hemorrhage?
Hemoglobin and Hematocrit
What are the normal hemoglobin levels?
F: 12-16 g/dl

M: 14-18 g/dl
What are the normal hematocrit levels?
F: 37-47%

M: 42-54%
What is the normal range for bicarbonate in blood?
22-26 mEq/L
What is the normal range for CO2 in venous blood?
22-30 mEq/L
What is the normal range for O2 saturation?
What is ABLATIVE surgery?
removal of a diseased part
What is PALLIATIVE surgery?
reduces intensity of a disease
What are the three levels of surgery regarding urgency?
1. Elective (optional), 2. Urgent (must be done soon), 3. Emergent (must be done immediately)
What are the purposes of anesthesia?
Block nerve impulse, suppress reflex, relax muscles, achieve a controlled level of unconsciousness
When is sterile technique used?
In any procedure that compromises skin integrity or that involves contact with mucus membranes
What are the four stages of anesthesia?
1. Analgesia and sedation 2. Excitement, delirium 3. Operative level 4. DANGER, code
What is the main concern for a patient that has been administered Pentothal?
Respiratory and cardiac depression, VS are to be monitored until drug is eliminated
What is the main safety concern for a patient under the influence of Ketamine?
Possible fall, safety measures or Valium is used to control effects
What are important concerns for a patient under the influence of Ativan or Valium?
Respiratory depression, apnea
Which opioid should not be used for elderly patients?
Demerol. Alternatives: Fentanyl, morphine
What is a high concern for patients on opioids?
Respiratory depression
What are three common neg side effects in surgery?
1. Bleeding 2. Fluid & electrolyte imbalance (due to the large amount of IV fluids administered) 3. Inflammation
What are some red flags in a patient's history when heading into surgery?
ALLERGIES, Hypo/hyperthermia, hypo/hypertension, Hypovolemic shock, Renal failure, Electrolyte imbalances, Dysrhythmias, Chronic heart failure, Paralytic ileus, Acute urinary retention, DVT, Pulmonary embolism, Atelectasis, Pneumonia, Laryngeal edema, GI bleeding, Anemia
What is the normal range for PT (prothrombin time) and what is its significance?
11-12.5 seconds, how quickly a clot is formed on a wound, used to measure the effects of anticoagulants (Heparin, Coumadin)
What are post surgery vital signs compared with?
pre surgery vital signs (baseline)
What are main areas of post op assessment?
Vital signs (esp. respirations), Integrity of surgical area (any bleeding?), Neuro, Comfort level, IV fluid status (30cc/hr is standard), I&O, once stabilized assess for readiness for discharge
In post op, how often are vital signs monitored?
every 15mins x 4
every 30mins x 4
every 1hr x 2
every 4hr x 24-48hr
How would you prevent dehiscence of a wound?
Move patient carefully, instruct them to move carefully, use a pillow for pressure support of a wound in case of coughing
Describe two general types of drains.
1. Gravity - fluid flows freely from surgical site (Penrose, T-tube)
2. Closed wound drainage systems - fluid is extracted by means of a pump (Hemovac, Jackson-Pratt)
What are Montgomery straps?
Used for frequent dressing changes, prevent skin irritation from frequent tape removal
What are some factors that contribute to poor wound healing and infection?
Malnutrition, inhibited circulation
What are some special considerations for an obese patient undergoing surgery?
- Decreased ventilatory and cardiac function
- Poor wound healing due to low blood circulation in fatty tissue
- Greater chance of evisceration (external exposure of organs through incision)
What are the physiologic reasons for surgical complications in patients with COPD or that smoke?
- Cilia and membranes hypoactive
- Lining of airways hypertrophied
- Alveoli less compliant
What are some surgical complications in patients with diabetes, heart disease, liver and renal disease?
- Diabetes - impaired wound healing, glucose levels
- Heart disease - anesthetics depress cardiac function, healing requires increased cardiac output
- Liver/Renal - elimination and excretion of drugs
What is the normal pH of blood?
What would a urine output of less than 30cc/hr indicate?
Kidney complications
Post op GI and excretory assessments?
- Abdominal distention
- Paralytic ileus
- Nausea and vomiting (very common)
- Urinary retention
- Urinary tract infection
How often should NG drainage be assessed?
every not alter NG tube without order from surgeon
How many days after surgery will ineffective wound healing be able to be observed?
5-10 days
When does pain level usually reach peak after surgery?
2nd day (patient more active, alert)
What are some interventions for impaired gas exchange?
- Airway maintenance
- Position patient on side or turn head to prevent aspiration
- Breathing exercises
- Encourage mobilization asap
What are the reasons for a drain?
- Provides exit route for air, blood, and bile
- Prevents deep infections and abscess formation
A couple treatments for potential or present wound infection?
Antibiotics, irrigation
Some teaching points in avoiding infection after discharge?
- Regular dressing care
- Proper nutrition
- Meds
- Progressive increase in activity level
- Use of proper body mechanics
Some diagnoses for post op?
- Impaired physical mobility
- Impaired skin integrity
- Disturbed body image
When setting priorities for treatment what is the standard reference?
Treatments that prevent DVT?
- Leg excercises
- TED stockings
- Early ambulation
- Positioning
- Anticoagulants
- Fluid intake
What is the greatest risk after surgery for an infant?
Dehydration (hypothermia is also a large risk)
What are some important factors to consider when gathering data preop?
- Age
- Current meds, drugs
- Medical history, CARDIAC and PULMONARY
- Previous surgery and anesthesia (complications?)
- Blood donations
- Discharge planning
What are some preop lab assessments?
- Urinalysis
- Blood type and crossmatch
- H&H
- PT
- Electrolyte levels
- Pregnancy test
- Chest x-ray
What is the nurse's role regarding teaching preop?
1. Clarify facts and dispel myths the client or family may have about surgery
2. Tell the patient what to expect for post op
The client is to be NPO for __ to __ hrs before surgery.
Name some herbs that affect BP.
Garlic, Motherwort, Feverfew (important not to overlook in preop assessment)

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