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M6 Op PT/Wound Manag

phase 2 test 3 'operative patient care/wound management'

Define Anesthesia loss of sensation, w/o pain
Embolus free-floating blood clot
Infarct blood clot that blocks an artery
Informed Consent educate pt about and they understand the procedure, why they need it, and agree
Intraoperative care during surgery
Perioperative care throughout entire surgical procedure
Preoperative care prior to surgery
Thrombus deep blood clot that stays in one spot
M6 responsible for getting informed consent? no, but is responsible for making sure it's signed
Pre-Operative Patient Care review peroperative lab and diagnostic studies review the client's health history and prep for surgery assess physical needs assess psychological needs assess cultural needs client followed physician's orders
Pre-Operative Patient Teaching Done 1-2 days prior to surgery
What is taught in pre-operative patient teaching? leg position use of side rails splinting frequency coughing exercises
Turning Improves: venous return respiratory function gastrointestinal peristalsis
What coughing exercises do removal of retained mucus from resp tract
Deep Breathing Exercises __________ helps expand collapsed lungs and prevent postoperative pneumonia and atelectasis done 5-10 times/hr
Incentive Spirometry used to encourage deep breathing and prevent atelectasis instruct in proper technique 10 times/day during each waking hour for first 5 days *except immediately before and after meals
Leg Exercises helps prevent circulatory problems 'gas pains' must be individualized repeat 1-2 times hour
Early Ambulation helps patient breathe deeply stimulates circulation urine retention constipation abdominal distention appetite sleep helps people feel less helpless
Pain Management normal part of surgical experience area of major concern for patient and family ordered by physician and admin by nurse usually prn pt ask for meds before severe bowel sounds in 4 quads before admin
LPN can give IV morphine push? NO!!!!!
Antiembolism Stockings Homan's sign apply stockings in supine position abdominal surgeries most at risk pitting edema peripheral cyanosis
Sequential Compression Devices place sleeve under pt's leg with fuller portion at top ensure there are no wrinkles or creases attach tubing to SCD after both sleeves applied assess client periodically
Preparing Patient for Surgery prepare pt's chart using surgical checklist/preoperative checklist assure completion of SF 522
SF 522 Request for Administration of Anesthesia and for Performance of Operations and other Procedures
GI Preparation NPO after midnight bowel cleanser may be ordered
Skin Preparation shower hair removal
Morning of Surgery complete morning care visit with family record vital signs check proper ID band is on pt check preoperative consent forms are signed and medical records are in order recheck accuracy of surgical checklist administer preoperative meds pt's safety s
Intra-Operative Nursing Care Includes ID pt verbally, nonverbally personal contact awareness of the potential for harm recognition of susceptibility to injury strict adherence to principles of positioning and asepsis
3 Types of Anesthesia general regional local
Half Life amount of time required for 1/2 of medication to be metabolized
Amnesia not remembering
Analgesia pain relievers
Autonomic Stability sympathetic and parasympathetic medications to control VS
Muscle Relaxation calm and rested, muscles not tensed
Anesthesia Made Possible in _____ 1840s
General Anesthesia used for major procedures results in - immobile, quiet person, unable to recall procedure Admin by inhalation agents or IV anesthestics
3 Stages of General Anesthesia induction maintenance emergence
Adverse Effects of General Anesthesia malignant hyperthermia uncommon but potentially fatal signs: rapid rise in temp, tachycardia, tachypnea, muscle rigidity increased risk: children, adolescents and those with skeletal or muscular abnormalities
Clinical Uses of Moderate Sedation procedures requiring moderate (conscious) sedation preoperative sedation doesn't necessarily cause complete loss of consciousness
Reversal Agents for Moderate Sedation naloxone - narcotics romazicon/flumazenil - benzodiazepines anticholinesterases - reverses effects of neuromuscular blocking agents
Local or Regional Anesthesia loss of sensation in a specific area of body no loss of consciousness usually patient is sedated 2 major categories: central, peripheral
Central Anesthesia spinal epidural
Peripheral Anesthesia nerve block infiltration anesthesia topical anesthesia
Spinal Anesthesia intrathecal/subarachnoid anesthetic agent is delivered to the subarachonoid space proper patient position significant complication from SAB is headache
Epidural local anesthetic delivered to the epidural space located between dura and overlying connective tissue commonly used in labor and delivery
Nerve Block done under ultrasound by anethesiolgist can be single shot or infusion post-op pain
Infiltration Anesthesia put into specific and numbs area around 1 tiny nerve, vasoconstriction
Topical Anesthesia eye drops hemmorroid cream cytocanespry
Intra-Operative Patient Care in Moderate/Conscious Sedation reduce fear and anxiety quick recovery requires careful monitoring routinely used for procedures that don't require complete anesthesia
Common Agents used in Moderate Sedation opioids sedatives/benzodiazepines combinations of medications
Monitoring Patient Receiving Conscious Sedation identify baseline information and risk factors continuous monitoring by RN during procedure post procedure assessment: discharge instructions
Members of Surgical Team surgeon anesthesiologist anesthetist scrub nurse circulating nurse
Surgical Risk Factors and Potential Complications infection - catheters, drains, surgical wound burns hypothermia hyperthermia bleeding/hemorrhage pressure sores trauma injuries
Immediate Post-operative Phase airway breathing consciousness circulation system review
How Often Vital Signs Take in PACU minimum every 15 minutes
Spinal Anesthesia Used For lower abdominal pelvic procedures lower extremity procedures urology procedures surgical obsterics
Risks for Spinal Anesthesia migration: drug, amount, pt position vasodilation/decrease in BP respiratory paralysis
Post Anesthesia Patient Care for Spinal Anesthesia monitor vitals 3-5 minutes level of consciousness level of anesthesia physical assessment proper position
Most Important VS for PT of Spinal Anesthesia respiratory rate and BP
Potential Postoperative Complications N/V aspiration hypothermia/hyperthermia laryngospasm hypoxia hemorrhage pain hypovolemic shock decreased/absent urine output increase/decrease IV input
Documentation of Postoperative Phase Assessment ID patient time patient arrived LOC safety measures VS type of anesthesia given type of procedure meds pre/post-op surgeon output IV's drains dressing discharge/exudate wound packs EBL pain rating O2 Sat nursing staff sig & initials
Ways to Prevent Postoperative Respiratory Problems mobility secretion clearance deep breathing and coughing exercises splint analgesics breath sounds incentive spirometer
Circulation in the Later Postoperative Period move legs frequently and do leg exercises don't use pillows under knees avoid pressure to lower extremities use antiembolism stockings ambulate as ordered heparin SCD
Incision Care in Later Postoperative Period observe for drainage-reinforce if necessary accurate measurement of drainage dehiscence evisceration - 3 days - 2 weeks post op
When to give pain medications in post-op patient every 3-4 hours as needed before pain becomes severe
Devices that can be used to control pain PCA TENS
Length of Time Patient Needs to Recuperate from Surgery Depends on physical and mental prep type and magnitude of surgical procedure
When prep for discharge begins during the preoperative period
The major goals of nursing managements are prevention and detection of complications prevent injury regain independence patient education
Pain medication should be timed in relation to? activities
Recovery Period begins when the pt arrives in the hospital room or a postsurgical unit and full activity is resumed
Define Pulmonary Embolism obstruction of 1+ arterioles originating in venous system
S&S of PE sharp, stabbing chest pain cyanosis anxiety profuse diaphoresis rapid, irregular pulse dyspnea, tachypnea
Nursing Interventions for PE administer O2 have pt sit in upright position reassure and comfort pt monitor VS, EKG, ABGs administer analgesics as ordered initiation of thrombolytic therapy notify charge nurse STAT
Define Pneumonia inflammation of alveoli as a result of an infectious process or foreign material
Causes of Pneumonia aspiration infection depressed cough reflex dehydration immobilization increased secretions from anesthesia
S&S of Pneumonia elevated temperature chills crackles or wheezes on auscultation dyspnea chest pain productive cough
Nursing Interventions for Pneumonia semi-fowler's admin O2 maintain nutritional and fluid status encourage turning, coughing, deep breathing frequent oral hygiene teach proper disposal of tissue and sputum provide for rest & comfort provide emotional support
How to Manage/Minimize Risk of Phlebitis/Thromosis leg exercises every 2 hours or more frequently elastic stockings or bandages (remove at least 1-2 times per day) asses skin temp, color, and capillary refill
Hiccups singultus caused by uncontrolled contraction of diaphragm and rapid closure of the glottis place gentle pressure over eyelids rebreathe into a paper bag administer medications as ordered
Nursing Concerns and Interventions - Nutrition monitor I&O maintain IV fluids assess for dehydration and wight loss provide oral hygiene before and after meals monitor diet tolerance encourage pt to sit upright for meals encourage family participation as necessary
Nursing Concerns and Interventions - Nausea and Vomiting maintain clean environment provide frequent oral hygiene encourage sips of liquids at frequent intervals administer medications as ordered
Types of Open Wounds abrasions avulsions lacerations amputations punctures bite
Type of Closed Wounds contusion crush injury
Crush Injuries Seen Most in farming accidents
Phases of Wound Healing hemostasis inflammatory reconstruction maturation
Hemostasis termination of bleeding
Inflammation initial increase in blood elements water flow out of blood vessel and into vascular space
Reconstruction collagen formation occurs
Maturation 3rd week to 2 years post injury
Types of Primary Would Healing primary intention secondary intention tertiary (delayed primary) intention
Wound Complications abscess adhesion cellulitis dehiscence evisceration extravasations hematoma
Bleeding can be caused by ________ slipped suture dislodged clot coagulation problem trauma
S&S of Internal Bleeding dressing may remain dry increase thirst restlessness rapid, thready pulse decreased BP decreased urinary output cool clammy skin abdomen rigid and distended hypovolemic shock
Difference Between Dehiscence and Evisceration evisceration organs protrude through surgical opening
S&S of Infection purulent (pus) drainage fever tenderness pain edema elevated WBC positive wound culture
Factors that Impair Wound Healing extent of injury type of injury age nutritional status obesity impaired oxygenation smoking drugs diabetes mellitus radiation wound stress
Sutures Remain in Usually _____ 7-10 days
Serous Drainage clear
Sanguineous red with clear streaks
Serosanguineous pink, watery
Purulent brown, yellow, green
Open Drains drainage passes through an open-ended tube into a receptacle or out onto the dressing Penrose drain
Closed/Suction Drains self-contained suction units more efficient than open drains creating vacuum or negative pressure prevents environmental contaminants
Jackon-Pratt Drain used when small amounts (100-200 mL) of drainage anticipated
Hemovac Drain system used for larger amounts (up to 500 mL) of drainage
Antibiotic treatment of bacterial infection slow/retards growth of bacteria
Bactericidal kills bacteria
Bacteriostatic slows/retards growth of bacteria
Colonization bacteria grows and multiplies in a wound
Definitive Theory know what bacteria it is and what will work against it
Empiric Therapy physician decides on what treatment to use without C&S
Prophylactic Antibiotic Therapy treating prior to procedure to prevent infection
Subtherapeutic not getting adequate dosage, etc
Superinfection infection that occurs when antibiotics knock down natural flora
Syngeristic Effect 2+ drugs work together in order to achieve greater effect than individually
Gram Positive stain purple thick cell wall outer capsule
Gram Negative stain red complex cell wall structure more difficult to treat
Sulfonamides primary bacteriostatic interferes with PABA often used to treat UTI and burns
Examples of Sulfonamides sulfisoxasole sulfamethizole mafenide (Sulfamylon) - burns silver sulfadiazine (Silvadene) trimethoprim and sulfamethoxazole (Bactrim)
Adverse Reactions of Sulfonamides Agranulocytosis Thrombocytopenia Aplastic anemia Anoxeria N/V/D Abdominal pain Stomatitis – inflammation of the mouth Crystalluria – crystle formation in urine Leukopenia Uticaria, pruritus Steven-Johnson Syndrome
Interactions of Sulfonamides Increased action of anticoagulants Bone marrow suppression with administration of methotrexate Decreased metabolism of oral hypoglycemic drugs (Orinase)
PT and Family Teaching for Sulfonamides Take as prescribed Take drug on an empty stomach Take with full glass of water Complete the full course Drink at least 8-10 oz. glasses of water a day Keep all follow-up appointments *Sulfasalazine may cause skin or urine to turn orange - yellow col
Classifications and Examples of Penicillins Natural – penicillin G and V Penicillinase resistant – dicloxacillin Aminopenicillins – ampicillin, amoxicillin Extended-spectrum – piperacillin B-Lactamase Inhibitor – Augmentin, Unasyn
Uses of Penicillins UTI’s intra-abdominal infections, meningitis gonorrhea, syphilis respiratory infections
Adverse Reactions of Penicillins Mild nausea Vomiting Diarrhea Sore tongue or mouth (glostitis) Fever Pain at injection site
PT Allergic to Penicillin Most Likely Also Allergic to cephalosporins
Pseudomembranous Colitis causative org. C syphlasil, abd cramping & pain, bloody stool
Interactions of Penicillins May interfere with effectiveness of birth control pills Decrease effectiveness when administered with tetracyclines May increase bleeding risk when taken with anticoagulants Penicillins should be given 1 hour before or 2 hours after meals
Patient and Family Teaching for Penicillin Similar to Sulfonamides To reduce risk of superinfection, take yogurt or buttermilk (keep flora in gut) Women should consider additional contraceptive measures
Generation of Cephlosporins best against gram positive. Gram negative first third
First-Generation of Cephalosporins cefadroxil (Duricef) cefazolin (Ancef)
Second-Generation of Cephalosporins cefaclor (Ceclor, Ceclor CD) cefotetan (Cefotan) cefoxitin (Mefoxin)
Third-Generation of Cephalosporins cefixime (Suprax) cefoperazone (Cefobid) ceftriaxone (Rocephin)
Adverse Reactions of Cephalosporins N/V/D Pruritis, urticaria HA Dizziness Stevens-Johnson syndrome Nephrotoxicity
Interactions of Cephalosporins Risk of nephrotoxicity (increased toxic levels in kidneys) increases when administered with aminoglycosides May increase bleeding risk when taken with anticoagulants Most cephalosporins may be taken without regard to food
PT and Family Teaching of Cephalosporins Similar to penicillins Avoid drinking alcohol when taking and for 3 - 7 days after completing therapy
Use of Tetracyclines and Macrolides cholera, Rocky Mountain spotted fever, typhus and some skin and soft tissue infection (acne) in which penicillin is contraindicated
Adverse Reactions of Tetracyclines and Macrolides N/V/D Epigastric distress Stomatitis photosensitivity
Contraindications of Tetracyclines and Macrolides children under 9 pregnant
Interactions of Tetracyclines and Macrolides Antacids impair absorption Increase effects of anticoagulants and digoxin Decreases effectiveness of oral contraceptives
PT and Family Teaching of Tetracyclines and Macrolides given on an empty stomach with few exceptions and are not to be taken with dairy products Avoid exposure to the sun or any type of tanning
Fluoroquinolones ciprofloxacin (Cipro) levofloxacin (Levaquin) gatifloxacin (Tequin)
Uses of Fluoroquinolones and Aminoglycosides Lower respiratory infections Skin infections UTI’s STD’s
Adverse Reactions of Fluoroquinolones and Aminoglycosides Nausea Diarrhea HA Abdominal pain or discomfort Dizziness Photosensitivity Superinfection / pseudomembranous colitis
Interactions of Fluoroquinolones and Aminoglycosides taken with cimetidine may interfere with elimination risk of seizures when taken with NSAID’s nephrotoxicity if admin with a cephalosporin risk of ototoxicity if admin with a loop diuretic risk of neurotoxicity if admin soon after general anesthetics
Adverse Reactions of Fluoroquinolones and Aminoglycosides Nephrotoxicity (chephlosporins) Ototoxicity – can cause damage to cranial nerve VII, early det. may be reversed Neurotoxicity N/V Anorexia Rash Urticaria
PT and Family Teaching of Fluoroquinolones and Aminoglycosides same as other anti-infectives tendinitis, such as pain or soreness in the leg, shoulder, or back of heel ringing in the ears or difficulty hearing, numbness or tingling, and change in urine output. May be permament
Aminoglycosides gentamicin (Garamycin) neomycin (Mycifradin) streptomycin tobramycin (Nebcin) blocking a step in protein synthesis
Uses of Aminoglycosides gram negative organisms Poorly absorbed, useful in suppressing GI bacteria Bowel prep Hepatic coma – liver starts to fail and amonia levels increase
____________and aminoglycosides chemically inactivate each other and should not be physically mixed penicillins
Erythromycin may ________ hepatic metabolism of other drugs decrease
Extended-spectrum penicillins and some ___________ may increase the risk of bleeding with anticoagulants, thrombolytic agents, antiplatelet agents cephalosporins
________________absorption is decreased by antacids, bismuth subsalicylate, iron salts, sucralfate, and zinc salts Fluoroquinolone
Systemic Antifungals amphtericin B cholesteryl sulfate (Amphotec) fluconazole (Diflucan) ketoconazole (Nizoral)
Topical Antifungals butenafine (Lotrimin Ultra) clotrimazole (Lotrimin) ketoconazole (Nizoral) miconazole (Lotrimin AF, Maximum Strength Desenex / Monistat–Derm) nystatin (Mycostatin) terbinafine (Lamisil AT) tolnaftate (Tinactin)
Systemic Adverse Reactions of Antifungals headache N/V/D hypokalemia
Topical/Local Adverse Reactions of Antifungals burning, itching, local hypersensitivity reactions
PT and Family Teaching for Antifungals Proper use of medication form. Continue medication as directed for full course of therapy, even if feeling better. Report increased skin irritation or lack of therapeutic response
acyclovir Zoyirax
amantadine Symmetrel
ribavarin Virazole
Helminthiasis invasion of the body by worms
Uses of Antihelmintics pinworms roundworms hookworms whipworms
mebendazole Vermox
pyrantel Antiminth
Common Antimalarials hydroxychloroquine (Plaquenil) quinine (quinine sulfate)
How long antimalarials should be taken prior to exposure to area. After returning. 2 weeks 4 weeks
5 Categories of Non-Opioid Analgesics salicylates - Aspirin acetic acid derivatives - Toradol COX 2 inhibitors - Celebrex enolic acid derivatives - Mobic, Feldene propionic acid derivatives - Naproxen, Ibuprofen
Acetaminophen - Tylenol is/is not considered an NSAID is not
How Non-Opioids Work inhibiting the enzyme that's necessary for prostaglandin synthesis
Therapeutic Dose for Salicylates 10-20
Opioid Analgesics originated from opium poppy plant
Classifications of Opioid Analgesics memeridine-like drugs - Demerol, Fentanyl methadone-like drugs - Darvon morphine-like drugs - Morphine, Codeine, oxycodone
Opioid Antagonists Reversal Agents Naloxone (Narcan) Naltrexone (ReVia)
Reversal Agent for Benzodiazapines Romazicon (Flumazenil)
Preoperative Medications reduces anxiety, the amount of anesthetic used and respiratory tract secretions
Types of Anesthesia Medications general - Etomidate, Propofol, Fentanyl, Ketamine regional - Bupivicaine, Lidocaine, Tetracaine, Procaine moderate sedation - Demerol, Morphine, sedatives/Benzodiazapines, combinations
Steps in Suture Removals 1. verify orders 2. ID pt 3. explain procedure 4. wash hands 5. expose incision 6. discard old dressing 7. wash hands 8. open kit 9. clean/sterile gloves 10. remove staple/suture 11. report unexpected outcomes 12. document
Responsibilities of the Circulating Nurse prepare OR arrange supplies sends for PT visits PT pre-op performs/confirms assess checks med. record assists in trans pos. PT on table places conduct. pad counts instruments assist scrub nurse prepare PT skin assists in arranging table cont.
Responsibilities of Scrub Nurse hand scrub sterile gloves and gown arranges supplies checks instruments counts instruments w/ circ. nurse gowns and gloves surgeons maintain sterile field corrects aseptic tech observes progress hands instruments ID and handle specimens maintai
Created by: ealongo