Surgical Nursing Responsibilities and Anesthesia

Adult Health 4 - Exam 1 Study Notes

• Kahoot Topics: Calcium Channel Blockers, ACE Inhibitors (-PRIL), Chest Tubes, Chapter 17: Fluid and Electrolyte Balances, Chapter 18 - Preoperative Care, Chapter 19 - Intraoperative Care, Chapter 20 - Postoperative Care, Chapter 21 - Emergency and Disaster Nursing, Chapter 26 - Burns, Chapter 28 - Supporting Ventilation, Chapter 44 - Nutrition Problems, Chapter 67 - Musculoskeletal Trauma and Orthopedic Surgery
• Carbon Monoxide (CO) Poisoning: Symptoms range from dizziness and headache to unconsciousness and death. CO has a much higher affinity for hemoglobin than oxygen. Administering 100% oxygen is crucial. Myocardial injury can occur frequently.
• Pseudocholinesterase Deficiency: Individuals with this deficiency have decreased ability to metabolize succinylcholine and mivacurium.
• Sudden Vital Sign Changes: Assess blood pressure manually, check lines for kinks, and verify oxygen and IV access.
• End-tidal CO2 Monitors: Used for rapid verification of endotracheal tube (ETT) placement.
• Ineffective Cough: Causes may include muscle weakness, impaired chest mobility, increased mucus viscosity, and ciliary dysfunction. Intubation may be required if airway protection is compromised
• Smoke and Soot Inhalation: Common injuries causing respiratory difficulty.
• Burn Patient Care: Early enteral nutrition improves outcomes.
• Nutritional Goals: Nutritional goals may not be met due to weight loss, elevated glucose, or overhydration/dehydration in burn patients. Monitor triglycerides and triglycerides during lipid administration.
• Parenteral Nutrition (TPN/Lipids): Medications aren't administered via the TPN/lipid lines. Risks include hyperglycemia, infection, and volume overload. Monitor glucose levels.
• Ventricular Tachycardia: Rapid, life-threatening dysrhythmia originating from an ectopic focus in ventricles.
• Captopril: May cause hyperkalemia, angioedema, cough, renal insufficiency, flushing. Should be taken 1 hour before meals.
• Wound Care & Patients with Burns: Wear appropriate protective equipment, like gowns, masks, and gloves, when entering the room. Maintaining a minimum of 30 mL urine output per hour for a burn patient is key.
• Chest Tube Placement & Care Pneumothorax/Hemothorax - air/blood in the pleural space causes partial/full lung collapse. Signs of hemothorax include respiratory distress, tachypnea, dullness to percussion. Excess fluid from pulmonary contusions can interfere with gas transfer, leading to hypoxia. DVT risk factors include family history, immobility, and in-dwelling catheters.
• Chest Tube Complications: Drainage stops in first 24 hours, large amounts of drainage, cloudy drainage indicates infection. Lorazepam is used for anxiety and panic disorders. Hyperkalemia can cause cardiac arrest if severe.
• Premature Ventricular Contractions (PVCs): Caused by an ectopic pacemaker in the ventricle, often seen in mass casualty events.
• Cardioversion: Administer anesthesia if time permits.
• Digoxin and Potassium: Patients with heart failure may need a Digoxin and potassium regimen - not the primary or first-line treatment.
• Hyperkalemia: Signs include abdominal cramping, diarrhea, vomiting, confusion, fatigue, irregular pulse.
• Hypokalemia: Signs include muscle weakness, cramps, paresthesias, decreased reflexes, tetany.
• Acid-Base Imbalances: Recognize the imbalances and the different causes of respiratory and metabolic acidosis and alkalosis.
• Fluid and Electrolyte Imbalances: Understand both deficits and excesses.
• Intubation: Crucial step for patients at risk for airway compromise.
• CO Toxicity: Use pulse CO oximetry for detection.
• Chest Tubes: Continuous bubbling in the suction chamber of a wet-suction system usually indicates a leak. Tidaling is the rise and fall of fluid in the water-seal chamber with breathing. Continuous bubbling in the water-seal chamber suggests a lung leak.
• Burn Injuries: Classification (superficial/deep); rule of nines. Fluid resuscitation formulas are crucial to survival.
• Burn Pain Management: Pain-rating tools, multimodal approaches (use of opioids, NSAIDs, and adjuvant analgesics), nonpharmacologic therapies.
• Hypertrophic Scarring: Prevent with methods like pressure garments and active ROM.
• Postoperative Care: Focus on airway, breathing, circulation (ABCs), wound care, and pain management.
• Fluid Resuscitation: Follow the American Burn Association (ABA) formulas for calculating fluid requirements.
• Anesthesia: Recognize various types, associated drugs, and interventions. Patient teaching should include avoiding aspirin given with ACE inhibitors.
• Surgical Procedures Different suffix meanings relating to removal of body parts, incisions, or repairs.
• Patient Preparation for Surgery: Including patient history, assessment for allergies and current medications.
• Postoperative Care Include considerations for patients post surgical procedure.
• Tracheostomy Knowledge of normal parameters needed for care such as tidaling, suctioning, and use of sterile technique.
• Special Considerations: Recognize considerations regarding obesity, patients with allergies to latex and patients with pre-existing medical conditions.
• Patient Safety: Review medications and ensure they are administered appropriately, and check for any allergies.