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surgical pts/wound

chapter 48 & 50

antibotic use and surgery enhance the action of anesthetic agents if taken within 2 wks before surgery, mild resp depression
antidysrhythmics reduce cardiac contractility
anticoagulants d/c 48 hours prior to surgery
anticonvulsants alters metabolism of anesthetic agents
antihypertensives beta blockers and calcium channel blockers interact with anesthesia causing bradycardia, hypotension and impaired circulation. inhibts synthesis and storage of norepi in sympathetic nerve endings
corticosteroids long-term use reduces the ability of the body to withstand stress; increase dosage before and during surgery
insulin stress and IV glucose increase dosage requirements while nutritional intake decreases requirements
diuretics potentiate electrolyte imbalances (potassium) after surgery
NSAIDs prolonged bleeding time
herbals: ginger, gingko, ginseng affect platelet activity and increase susceptibility to post op bleeding; ginseng increases hypoglycemia
pts most at risk for latex allergies children with spina bifida, pts with urogenital abnormalities or spinal cord injuries, health care professionals, workers who manufacture rubber products, pts with allergy to bananas, chestnuts, kiwi
RBC men 4.7-6.1 women 4.2-5.4
Hgb men 14-18 women 12-18
Hct men 42-62% women 37-47%
WBC 5000-10000
sodium 136-145
potassium 3.5-5
chloride 95-105
HCO 22-26 arterial 24-30 venous
PT 11-12.5 sec
INR 0.76-1.27
APTT 30-40 sec
platelets 150000-400000
creatinine men 0.6-1.2 women 0.5-1.1
BUN 10-20
glucose fasting 70-105
informed consent physicians responsibility
You are the nurse in the preoperative holding area and are preparing the patient for the operating room. You completed all preliminary procedures, storing valuables, checking the preoperative checklist, and assisting the patient to the bathroom. You are preparing to perform the Universal Protocol with patient verification. When is the right time to administer the preoperative sedative? The sedative should be administered after the Universal protocol is completed because the patient must be alert and able to participate in all three portions of the process.
S&S of hemorrhage ↓BP, ↑HR and resp, thready pulse, cool, clammy, pale skin, restlessness
malignant hyperthermia genetic disorder causing complication of anesthesia
S&S of malignant hyperthermia hypercarbia, tachypnea, tachycardia, PVCs, unstable BP, cyanosis, skin mottling, muscular rigidity, hyperkalemia, elevated temp occurs late
glucose levels post op normoglycemia or <150
wound dehiscence separation of wound edges at suture line
wound evisceration protrusion of internal organs
interventions for malignant hyperthermia notify surgeon/anesthesiologist immediately, prepare to administer dantrolene sodium (Dantrium), monitor vitals frequently
pressure ulcer a localized injury to the skin and other underlying tissue, usually over a body prominence as a result of pressure and/or shear or friction
hyperemia redness
blanching hyperemia blanches when pressed on - hyperemia is transient and is an attempt to overcome the ischemia
stage 1 pressure ulcer nonblanchable; intact skin
stage 2 pressure ulcer partial-thickness skin loss or blister; shallow open ulcer
stage 3 pressure ulcer full-thickness skin loss - fat visible; may include undermining and tunneling
stage 4 pressure ulcer full-thickness tissue loss - muscle/bone visible; slough or eschar may be present
unstageable/unclassified pressure ulcer full-thickness skin or tissue loss - depth unknown; the depth is completely obscured by slough and/or eschar
slough yellow, tn, gray, green or brown; must be removed before the wound is able to heal
eschar tan, brown, black; needs to be removed before the wound can heal
suspected deep-tissue injury depth unknown; purple or maroon intact skin or blood filled blister
granulation tissue red, moist tissue composed of new blood vessels, indicates progression towards healing
wound healing by primary intention wound that is closed; surgical incision, stapled or sutured wound; healing occurs by epithelialization, heals quickly, minimal scar
wound healing by secondary intention wound edges not approximated; pressure ulcers, surgical wounds that have tissue loss; heals by granulation, contraction and epithelialization
wound healing by tertiary intention wound left open for several days and then the edges are approximated; contaminated wounds; closure is delayed until risk of infection is resolved
According to the CDC a wound is infected if purulent material drains from it even if a culture was not taken or has negative results
nursing actions for eviscerated wound place sterile towel soaked in sterile saline over the tissues, immediately contact the surgical team: this is a surgical emergency, observe for s%s of shock, prepare pt for surgery
Braden scale assesses for risk of pressure ulcers using sensory perception, moisture, activity, mobility, nutrition and friction/shear
calories 30-40 kcal/kg/day must maintain positive nitrogen balance
protein 1-1.5 g/kg/day
vitamin C 100-1000 mg/day
vitamin A 1600-2000 retinol equivalents per day
zinc 15-30 mg
fluid 30-35 mL/kg/day
signs of actual or potential nutritional problems loss of 5% of usual weight, weight less than 90% of ideal body weight, loss of 10 obs in a brief period of time
estimating amount of drainage from bandaged wound 1 g equals 1 mL of drainage
the gold standard of wound culture biopsy
proper irrigation pressure is achieved with 19 gauge needle or catheter and a 35 mL syringe - this will deliver saline to pressure ulcer at 8 psi
wet to dry saline gauze dressing for wound debridement place moistened gauze into the wound and allow the dressing to dry thoroughly before pulling the gauze that has adhered to the tissue out of the pressure ulcer.
non-selective method of debridement devitalized and viable tissues are are removed
autolytic debridement synthetic dressings over a wound to allow the eschar to be self-digested by the action of enzymes that are present in wound fluids: transparent film or hydrocolloid dressings
chemical debridement topical enzyme preparation, dakin's solution or sterile maggots. ewwwww
surgical debridement using scalpel, scissors, or other sharp instrument; indicated when pt has cellulitis or sepsis
hydrocolloid dressings complex formulations of colloids, elastomeric and adhesive components; they are adhesive and occlusive
calcium alginate dressings made from seaweed, come in sheets and rope form, do not use in dry wounds; must have secondary dressing;
Created by: nursingTSJC2013