Inpatient- staying at hospital, Outpatient/Ambulatory- goes home

SCIP 1: Prophylactic antibiotic received within 1 hr prior to incision, SCIP 9: Urinary catheter removed on POD 1 or POD 2, SCIP 10: Surgery patients with perioperative temperture management

Nature of treatment, Risks, Opportunity for questions, Benefits, Alrernatives

True

Chief complaint, Health history, Previous surgeries and illnesses, Prior to admission medications, Allergies, Previous reactions to anesthetics

Physical Assessment, Psychosocial info, Lab data, Diagnostics

Cardiac Medications: Betablockers (may be stopped or not), Insulin (may be stopped or not), Respiratory medications (bring to hospital), Anticoagulants (stopped 10-14 days prior), Vitamins/Herbal preparations (stopped 1 week prior), Aspirin (stopped 1 week prior), NSAIDS (stopped 4 days prior or out??)

CBC- Depends on type of surgery and chance for bleeding out, Type and screen- To match blood, Electrolytes/Glucose- If taking diuretics, BUN/Creatinine- If kidney problems, Urine HCG- For all girls to determine if pregnant, Clotting Studies- For PT, PH, INR, for if you take anticoagulants

Chest X-ray (for pneumonia), EKG (rhythm)

Fears and anxieties, Pre-Op routines: CHG, bath, NPO, Labs, IV, Coughing, splinting deep breathing, Turning, Incentive Spirometer, Lower extremity exercises, Sequential compression devices/TED hose

Early Ambulation (Walk 4 times a day for 20 minutes), Pain management

Bowel preparation, Skin preparation, Vascular preparation (for IV access, central line)

Sedatives/hypnotics, Anxiolytics, Analgesics, Antocholinergics (used to dry up secretions), Antiemetics (prevent nausea and vomiting), Antibiotics (within 1 hr of incision, Prophylytic)

Anxiety, Knowledge Deficit, Anticipatory Greiving

Patient ID, EHR review, Advance Directive/No CPR orders, Surgical consent, Allergies/Reactions to Anethetics or Transfusions, Lab/Diagnostics, Medical History, Physical exam findings

Diagnostic (biopsy), Curative (gallbladder removal), Restorative (shoulder), Cosmetic (mole)

Elective (set date and time), Urgent (gallbladder attack), Emergent (accident)

Simple, Radical (takes organ + more, breast + muscle tissue), Minially invasive

Surgeon, Anesthetist (prescribes), Nurse Anesthetist (gives), Circulating Nurse (doing lab/outside stuff/getting blood), Scrub Nurse (prep skin), Surgical Tech

Site of the Operation, Age and Size of the patient, Type of anesthetic uses, Mobility issues, NO pretzel positions

Desired effects, Maintaining Physiologic Function

Reversible loss of consciousness, Intravenous/inhalation agents

Blocks multiple peripheral nerves and reduces sensation in a specific body region, Spinal/Epidural

Loss of sensation around an incision, wound or lesion, Topical or local infiltration

Inhalation Agents: Nitrous oxide (N2O), Desflurane (suprane), Enfluane (ethrane), Halothane (fluthane), Isoflurane (forane), Sevoflurane (ultane), Intravenous Agents: Non-barbituates: Droperidol (inapsine), Etomidate (amidate), Ketamine (ketalar), Propofol (Diprivan)- has less side effects fast onset and reversed fast, Intravenous Agents: Barbituates: Methohexital (brevital)

Analgesia and Sedation (relaxation), Patient is drowsy/dizzy/amnesic , Reduced sensation to pain/hearing exaggerated

Excitement, Delerium, Regular or irregular breathing/loss of consciousness, Loss of eyelid reflex, Increased muscle tone/involuntary movement, Laryngospasm or vomiting May occur (aspiration)

(Operative Anesthesia, Surgical Anesthesia), Generalized muscle relaxation , Jaw is relaxed, Breathing is quiet and regular, Patient cannot hear, Loss of reflexes/depression of vital functions, Sensations to pain are lost

(Danger), Depression of vital functions, Respiratory muscles are paralyzed/apnea occurs, Pupils are fixed and dilated

Uses: When clinical situations require muscle paralysis, Medications: Succinylcholine (anectine), Atracurium (tracrium), Cisatracurium (nimbex), Mivacurium (mivacron), Vecuronium (norcuron), Pancuronium (pavulon)

idk yet will come back to.

Neostigmine Methylsulfate

Inhalation agents and Neuromuscular Blockers, Succinylcholine

Increased serum calcium, Increased serum potassium, Increased metabolic rate, Can lead to acidosis, Cardiac Dysrhythmias, Fever

Incraesed ETCO2, Decrease in O2 saturation, Tachycardia

Dantrolene sodium -skeletal muscle relaxant, IV fluids saline and insulin, Sodium Bicarbonate maybe??

R/T anesthesia agent, Incorrect delivery method, Systemic absorption, Overdose

CNS stimulation -intial stress response, CNS and cardiac depression -hypotension, and bradycardia

Open airway/Oxygen, Notify surgeon ASAP, Fast acting barbiturate

“Conscious sedation”, IV delievery, Sedative, hypotic, opioids, Amnesic action is short, Agents: Amidate, Versed, Sublimaze, Diprivan, Morphine

Potential for injury related to improper perioperative positioning, Potential for infection due to invasive procedures, Decreased gas exchange due to anesthesia, pain and reduced respiratory effort

Proper positioning, Padding of operating room table, Assess for interference with circulation and breathing (cap. refill), Assess for anatomic alignment (no pretzel shape), Protection of skeletal and neuromuscular structures, Consider comfort, safety, and dignity, Accurate instrument counts before and after surgery

Assess for risk of infection, Maintain aseptic technique throughout the procedure, Providing prescribed skin preparation, Keep traffic to a minimum, Provide antibiotic prophylaxis, Pre and Intra-op skin preparation, Apply proper dressings

Continuous monitoring during the procedure every 5 minutes, Breathing, Circulation, Cardiac rhythms, Blood pressure, Heart Rate

Anesthesia provided without complications, Vital signs within normal limits post procedure, Patient free from signs/symptoms of hypoventilation/post op pneumonia

BP increases, Peripheral circulation decreases, Cardiac output decreases

Vital capacity decreases, Lung eleasticity decreases

Blood flow to kidneys decrease, Ability to excrete waste/glomerular filteration decreases

Reaction time slower, Ability to adjust to changes slower, Cognitive ability slower

Increase in incidence of deformities related to osteoporosis

Decrease in subcutaneous fat, Increase risk for damage, Impaired skin healing, Increase risk for infection