Perioperative Nursing Care

• Here are some detailed study notes based on the attached text:

Perioperative Nursing

• Care involves decisions for surgery and patient transfer to the OR bed.
• Pre-op elements include pre-admission testing, admission data, forms, and diagnostic testing.
• Admission data includes gender, age, smoking/drug/alcohol history, height/weight, allergies, name, and date of birth.
• Forms consist of informed consent.
• Diagnostic testing involves blood work, vitals, X-rays, and any other tests deemed appropriate.
• Patients should understand pre-op preparations.
• Discharge planning starts at admission.
• Patient admission includes identification.
• In pre-op, verify consent, review lab data, conduct baseline assessments, insert PIVs, and insert indwelling catheters if the patient is undergoing general anesthesia.

Immediate Pre-Op Nursing

• Patients change into gowns, hair is covered, mouths are inspected, and jewelry is removed and secured.
• Pre-anesthetic medications are administered, with antibiotics peaking in the bloodstream before incision.
• Pre-operative records are maintained and patients are transported to the presurgical area.
• Pre-op warming prevents hypothermia, and family needs are attended to.

Preoperative Checklist

• Includes identification and allergy bracelets.
• Nutrition and IV status are verified.
• A pre-op checklist and appropriate forms are completed.
• Past medical history and physical exams are reviewed.
• Makeup, jewelry, dentures, and glasses/contacts are removed.
• Surgical sites are identified and marked, surgical sites are prepared, and medications are administered.

Informed Consent

• Involves a surgeon who explains the risks and benefits.
• Nurses witness the signature of consent, answer questions already answered by the surgeon, and contact the surgeon for further questions.
• Patients must be 18+ to sign, or < 17 and in need of a parent/guardian signature
• Must be mentally capable, have consented prior to sedative medication, and be awake and aware.

Time Out

• A brief pause before an invasive procedure, including surgery, to verify the patient's identity, the procedure, and the surgical site.

Respiratory Complications

• Hypoxemia is an inadequate concentration of oxygen in arterial blood due to shallow breathing.
• For Hypoxemia; monitor, notify, administer oxygen, encourage deep breathing/coughing, use incentive spirometry, and encourage ambulation.
• Assess for restlessness, dyspnea, diaphoresis, tachycardia, hypertension, and cyanosis.
• Also assess peripheral and central (lips, face, extremities) pulse oximetry.

Atelectasis

• Collapsed alveoli results from not deep breathing, coughing, or immobility within 1-2 days.

Pneumonia

• Develops in 3-5 days as a result of infection, aspiration, or immobility.
• Assess for dyspnea, increased respiratory rate, crackles, temperature, cough, and chest pain.
• Interventions include lung sounds, Q2 turning, deep breathing, coughing, incentive spirometry, chest physiotherapy, postural drainage, fluid, and suction.

Gastrointestinal Complications

• Constipation is the abnormal, infrequent passage of stool
• Constipation occurs when resuming a solid diet post-op and failing to pass stool in 48 hours
• Assess for absence of bowel movement, bowel distension, anorexia, headache, and nausea.
• Interventions for constipation include assessing bowel sounds, fluid intake up to 3000 mL/day, early ambulation, fiber foods, privacy, adequate time, and stool softeners/laxatives.
• Paralytic ileus is the failure of appropriate forward movement of bowel contents
• Results from anesthetic medications or manipulation of bowel during surgery.
• Assess for vomiting, abdominal distension, and absence of bowel sounds/movement/flatulence.
• Interventions include monitoring I/Os, maintaining NG tube patency, maintaining NPO until bowel sounds return, encouraging ambulation, IV fluids/parenteral nutrition, and medications to increase gastric motility/secretions.

Renal Complications

• Urinary retention is the involuntary accumulation of urine in the bladder because of loss of muscle tone 6-8 hours post-surgery.
• Urinary retention is caused by anesthetic or opioid analgesic effects.
• Assess for inability to void, restlessness, diaphoresis, lower abdominal pain, distended bladder, hypertension, and percussion sounding like a drum.
• Interventions include monitoring for voiding, assessing by palpation/bladder scan, ambulation if prescribed, and fluid intake unless contraindicated.

Intraoperative Roles

• Nurses assist patients to void and stand, provide privacy and warmth, notify HCP after noninvasive techniques, and use straight/Foley catheters.
• Circulating nurses are patient advocates who verify consent, surgical pause, monitor aseptic practice, travel through OR rooms, and are not sterile.
• Scrub nurses count sponges used during surgery, monitor hand hygiene, sterilization field, surgical instructions, and medications.

Fluid and Electrolytes

• Fluid volume deficit can be isotonic, hypertonic, or hypotonic dehydration.
• Isotonic dehydration (hypovolemia) is water + electrolytes loss.
• Hypertonic dehydration is water loss greater than electrolyte loss.
• Hypotonic dehydration is electrolyte loss greater than water loss.
• Management includes oral rehydration, IV fluids (isotonic, hypotonic for hypertonic dehydration, hypertonic for hypotonic dehydration).
• Medications include antidiarrheals, antibiotics, antiemetics, and antipyretics.
• Labs, VS and I/Os should be monitored.
• Hypokalemia is low potassium levels in the blood, caused by diuretics, excessive vomiting/diarrhea, or poor potassium intake.
• can cause muscle weakness/cramps, fatigue, constipation, and arrhythmias.
• Complications of hypokalemia include muscle weakness, respiratory failure, and cardiac arrhythmias.
• Hypocalcemia can cause muscle spasms/cramps and lead to tetany, numbness/tingling, muscle twitches/tremors, and hyperreflexia.

Cardiovascular Conditions

• Coronary artery disease is the narrowing or obstruction of coronary arteries due to atherosclerosis.
• Causes decreased perfusion of myocardial tissue and inadequate myocardial oxygen supply.
• CAD leads to hypertension, angina, dysrhythmias, myocardial infarction, heart failure, and death.
• Modifiable risk factors include BMI >30, diabetes, hypertension, alcohol, high LDL/low HDL, and tobacco.
• Non-modifiable factors include age >65 and genetic predisposition/family history.
• Clinical manifestations include asymptomatic early phase, chest pain, dyspnea, syncope, cough/hemoptysis, palpitations, and fatigue.
• Diagnostic testing includes electrocardiograms (ischemia = ST depression, infarction = ST elevation), lipid profiles (elevated cholesterol), stress tests, and cardiac catheterization.
• Prevention and treatment include tobacco cessation, hypertension management, diet (low calorie/sodium/cholesterol/fat, increased fiber), diabetes control (lifestyle, exercise, medications), stress reduction, reduced alcohol, and pharmacological management.

Hypertension

• A chronic condition is characterized by elevated blood pressure in the arteries.
• Measured using systolic and diastolic pressure; normal is around 120/80.
• Severe complications can arise, such as heart and kidney disease, and stroke.
• Can be primary, secondary, or malignant.
• Age, genetics, lifestyle, medical conditions, and medications contribute to hypertension development.
• Stages: usually asymptomatic, treatment focuses on reducing end-organ damage, implementing lifestyle changes for 1-3 months before medication.
• Includes healthy, elevated, stage 1, stage 2, and hypertensive crisis.
• Healthy is systolic less than 120 and diastolic less than 80.
• Elevated is systolic 120-129 and diastolic less than 80.
• Stage 1 is systolic 130-139 and diastolic 80-89.
• Stage 2 is systolic 140 or higher and diastolic 90 or higher.
• Hypertensive crisis is systolic over 180 and diastolic over 120.
• Types
• Primary has no single cause (idiopathic) and accounts for 90-95% of cases. -Risk factors include aging, family history, African American race, and sedentary lifestyle.
• Secondary is the result of other conditions and accounts for 5-10% of cases.
  • Precipitating conditions include cardiovascular, renal, endocrine diseases, pregnancy, and medications.
• assessment includes history (family history, current medications, perception of disease), signs and symptoms (of hypertension, dietary pattern, visual changes, neurological assessment, lab tests), and physical exam. Physical exams involves obtaining 2 BP on both arms (supine and standing), comparing to priors, and weighing.

Raynaud's Disease

• Defined by blanching, cyanosis during vasoconstriction, numbness/tingling/swelling/coldness at the affected site, and reddened tissue when relieved.
• Interventions include monitoring pulses/skin integrity, administering vasodilators/CCBs, and identifying/avoiding triggers.
• Patients should encourage warm clothing/socks, warm (not hot) water use, smoking cessation, and extra precautions to avoid injuries.

Respiratory System

• Atelectasis is the collapse of alveoli and can be acute or chronic, encompassing broad physiologic changes.
• Can occur if there is obstructive (e.g foreign bodies, tumor) or nonobstructive conditions with reduced ventilation.
• Higher incidence in post-op patients, the lungs can show CXR findings.
• Manifestations involve dyspnea, cough, hypoxemia, decreased breath sounds/crackles, tachycardia, tachypnea, and diminished/absent sounds.
• Large amounts lung are affected include marked respiratory distress, tachycardia, tachypnea, pleural pain, and central cyanosis.
• Prevention/management includes frequent turning, early ambulation, lung volume expansion, and coughing.
• If these aren't effective, positive end-expiratory pressure can be used.

Tuberculosis

• Highly contagious communicable disease caused by M. tuberculosis, transmitted via airborne exposure.
• Exudative response leads to pneumonitis and granulomas.
• Insidious onset means clients might be unaware for some time. Bacteria forms lesions that are encapsulated causing a scar, if there is no full encapsulation, cause and immune response. Active phase infections can cause ruptures and spread necrotic tissue. Individuals with recent BCG vaccines, need to have chest x-rays. Risk includes young children, elders, drinking unpasteurized milk, the homeless, low socioeconomic group, minority, refuge, contact diagnosed people, living in prisons, malnutrition, immune dysfunction. Manifestations has 2 phases that cause fever to cough, see primary or advanced manifestations. Testing include TB test but positive is not mean active and quantiFERON.

Emphysema

• Dilatation or destruction of parenchyma, tissue destruction, mild hypoxemia, severe constant dyspnea, mild cough, "pink puffer", tachypneic, diminished breath sounds, and meet nutritional requirements

Musculoskeletal Complications

• Types of fractures include: closed/simple, open/compound/complex, and intra-articular.

• Clinical manifestations include: loss of function, deformity, shortening, crepitus, edema, and ecchymosis.

• Assessment involves health history, comorbidities, pain, VS, respiratory status, LOC and s/s, neurovascular assessment, bowel assessment, I/O, and skin condition.

• Management focuses on immobilizing, covering, reducing (realignment of the bone) the impacted area.

  • Includes performing reductions (closed, open, delayed,), and external or internal fixation.

• Nursing interventions must maintain extremity elevation, monitor neurovascular compromise and normal elimination.

• Risk factors include: age >40, bone loss, tobacco use, comorbidities, corticosteroids, NSAIDs, trauma, inadequate immobilization.

• Other factors include: malignancy, malalignment, pre-mature weight bearing, and AVN.

• Osteomalacia, inadequate mineralization can cause deficiency in: activated vitamin and softened bones.

  • Can be from inadequate sun-light, calcium abosorbtion, GI disorders, malnutrition.
  • Look for bone demineralization, fracture compression, low calcium levels and low phosphorus levels. -Bone Biopsy is is demineralized, cartilaginous bone.
    • Manage with more calcium, vitamin D, exposure to sun light and surgery

Joint disorders

• Septic arthritis: Infected joint, perform cultures, aspiration.

  - Main risk: older age, diabetes, IV drug use, alcoholism, history.
  - Interventions include: broad spectrum anitoibitics, prevent infections
  

Osteoarthritis

• Breakdown of cartilage on both joints due to degeneration.
• More often older age, has to do with female and labor activities
• Assessment: functional impairment, some stiffness
• Interventions Rest, decrease pain and stiffness, compression, and medication

Osteoperosis and management

• Resoprtion of bones but thinning the tissue to fracture.
• Risk small frame, female gender, steroid
• Can also see compression features and DXA testing may be help with levels.
• Regular excercises and weight lifting will help stimulate bone mineral density

Upper GI Disoders

• Peptic Ulcer Diease: This is ulceration in portions exposed to gastric secretions.

• Interverventions: Diet, Vital signs and medication, no spicy food

Total parenteral nutrition

• Helps patients with their veins, the solution contains Amino Acids, glucose and lytes.
• Can only be given for patients who have a functional GI tract.
• PPN can administered while TVN must use a central like PICC
• Always validate before admiistering and be warry for phlebitis
• Monitor Liver and functions

Ostomies

• Gastroesophaeal Reflux Disease: Reflux from the contents of duodenal to esophogus.

  • caused by pyloric stenosis and bad sphrincters.

• Nursing: small amounts and educate the patient

• Diarrhea: Rapid gastric into intestinse, causes N/V assess the patients, and educate thm to eat sugar free.

• Neuro: Myathensia gravis and and caused bad muscle fatigue, there no interuption in the nervis junction.

• Monitor muscles

Strokes

• Caused by disruptions in the brain. The two main causes: Ischemic (blocked artery) & Hemmorrhegic (ruptured artery) Intervention depends on stroke types (monitor and support with PT)

Stroke

• Ischemic and Hemorrahagic: Both present very similar and have similar treatment

##Endocrine Disorders

• Diabetes Insipidus - Hyposecratation of ADH that can lead to dehydration and lots pee
• Interventions : Monitor vs and fluids and lytes

  • Hyperthyroidism

      - Hyposecretion hormone and weight loss, manage the heart/VS
    

##Adrenal Glands (Cushing)

• Adrenal: caused by cortisol productions, monitor with weights and VS. Also look for labs for sodiumm, potassium and calcium.

Other Issues (Hypoparthyoroidsm)

• Monitor for CAT for seizures, anxiety.
• Calcium with magnesium and vit d supplements.

Heps and Pancreais

• Hepatitis A*

• Poor hand hygeine, fecal to oral, symtompatic but no chronic, monitor vs and manage

• Hepatitis-B

• body fluids exchange that be chronic, look for liver function, offer alpha agents.

• Pancreatitis: Is self of digestion of glands enzyme, caused high mortality, check pain with medication

• Cholestitics: Inflammation when in the gallbladder, check for pain, tenderness to right quadrant and meds

  • Liver: Accumlation of fluid in body, Hepatic can also get the toxins

• Jaundice: Overhelm with bodies over time or lack of detox the bilirubin.

Oncology

• Treatment is palliative more improve and relief

• Appitetie is important, also know the low platelets and follow guidelines
• Preventions as well for infections and lymphedmas in body Immunne :HIV/AIDS

• CD4 is important and we dont want to lose thses counts, there other bad bloods will attack you
• Test : HIV antibodies and treat

OA and RA

• OA is degenerative disease that not bilaterial and stiffness for 30 minutes. RA is inflam and bilaterial for extended that destroys the other areas, joints, also autoimmmune

• can cause inflammation and fatigue with lab checks.

• Treatment*:NSaids meds and reduce with rest
• In order to perserve function*: Mobility is important and use light excercise

I hope this helps let me know if you want me to refine any part.