Perioperative Nursing, Respi & ABG PDF

**PERIOPERATIVE NURSING** - TOTAL SURGICAL NURSING 1. **PRE-OPERATIVE** CONSENT OR I. **INFORMED CONSENT (voluntary and autonomy)** - LEGAL AGE - MENTALLY STABLE - NEAREST KIN (mother, father, eldest siblings, if married wife/husband) - PATERNALISM (emergency only. The do...

**PERIOPERATIVE NURSING** - TOTAL SURGICAL NURSING 1. **PRE-OPERATIVE** CONSENT OR I. **INFORMED CONSENT (voluntary and autonomy)** - LEGAL AGE - MENTALLY STABLE - NEAREST KIN (mother, father, eldest siblings, if married wife/husband) - PATERNALISM (emergency only. The doctor have the right to sign the consent. Principle of autonomy. ) II. **PRE-OPERATIVE TEACHING** (THE NIGHT BEFORE SURGERY) TO PREVENT POST-OP COMPLICATION. A. **DEEP BREATHING/COUGHING** EXERCISE (PREVENT PNEUMONIA) B. **LEG EXERCISE** (DEEP VEIN TRHOMBOSIS) INFLAMMATION/BLOD CLOTH. - ASSESS USING **HOMAN'S SIGNS (**lying/sitting) entension and flexion. (+) pain (blood cloth) (-) painless (/no blood cloth) C. **SPLINTTING** - Apply gentle pressure on incision site using pillow or binder. COMPLICATIONS: - DEHISCENCE (bumuka ang tahi/drainage) - Evisceration (protrusion) D. **EARLY AMBULATION** SITTING, STANDING AND WALKING TO PREVENT PNEUMONIA. **III. PRE OPERATIVE ASSESSMENT** a. **DEMOGRAPHIC** - AGE(EXTREME AGE) - GENDER(MORE COMPLI. BOYS) - CIVIL STATUS b. **MEDICAL HISTORY** - **DIABETES** - **DEHYDRATION** - **CARDIOVASCULAR** - **DISEASE** - **ALLERGIES** - **MEDICATIONS** **BIG X MEDICATIONS DURING SURGERY** **(SAAD)** - **STEROIDS (**ANTIINFLAMMATION AND IMMUNOSUPRESSANT.) It should not be stop before and after complication such as increase blood sugar and blood pressure will a rise. TEMPERATURE \-\-\-\-- INFECTION\-\-\-- CONTINUE BUT DECREASE DOSAGE. - **ANTICOAGULANT (WARFARIN)** Prevent blood cloth formation. During surgery, complication such as bleeding is expected. So, it is important to assess for negative homans sign. - **ANTIBIOTIC (ERYTHROMYCIN)** - **DIURETICS** (given e morning) **HYDROCHLOROTHIAZIDE** **C. PRE-OPERATION MEDICATION** - **ANXIOLYTIC -- DIAZEPAM** (ANTI-ANXIETY) promotes relaxation - **H2 BLOCKER- RANITIDINE** decrease secretion of hydrochloric acid. - **ANTICHOLINERGICS -- ATROPINE SULFATE** decrease gastric secretion - **ANTI-EMITIC- METACLOPRAMIDE** - **SEDATIVES- BARBITURATES** sedation/sleep - **OPOID ANALGESIC -- MORPHIN** antidote (**NARCAN/NALOXONE)** Monitor- RR Respiratory depression (adverse effect) **PURPOSE OF SURGERY** 1\. **DIAGNOSTIC**- IDENTIFY DISEASE 2\. **CURATIVE**- TREATMENT 3\. **REPAIRATIVE**- REPAIR (PLASTY) SUTURE (RHAPPY) 4\. **RECONSTRUCTIVE**- COSMETIC 5\. **PALLIATIVE**- CONTROL SYMPTOMS (**RHIZOTOMY**-NERVE ROOTS.) 1\. **EMERGENT**- immediate (life threatening) 2\. **URGENT-** (24-30 hours) 3\. **REQUIRED-** weeks/ months 4**. ELECTIVE-** should have but should have not kay di life threathening. 5\. **OPTIONAL**- patients preference (cosmetics) **GAS** **1. O2-** green **2. AIR**- yellow **3. NITROUS OXIDE**- euphoria (blue) **VOLATILE LIQUID** - HALOTHANE (BP-HYPOTHENSION) - ISOFLURANE -- RESPIRATORY DEPRESSION (RR) - ENFLURANE - RESPIRATORY DEPRESSION (RR) **ANESTHESIA (DEPRESSANT)** -ALL DOWN TARGET- sensory, motor, autonomic A. GENERAL (major surgeries) - INHALATION (ET TUBE) - IV - OPOID ANALGESIC- FENTANYL - MUSCLE RELAXANT- SUCCINYLCHOLINE - MUSCLE PARALYSIS - TIG A BODY. LOW BLOOD, LOW OXY - PRODUCE LACTIC - CAUSE PAIN - MUSCLE PARALYSIS - INCREASE TEMP - MALIGNANT HYPERTHERMIA (1-2/ 5 MIN) - GIVE MUSCLE RELAXANT (DANTROLENE SODIUM) IF RISK PA LANG... - RISK FOR PULSE- 150 UP - REGIDITY - ANESTHETIC AGENT - DIAZEPAM- ANXIOLYTIC - MIDAZOLAM- HYPNOTICS (EFFECTIVE) - PROFOPOL- SEDATION (MILKY) - BEVITAL -- RECTAL HECAPS. B. REGIONAL (NERVES) - LIDOCAINE - BUPIVACAINE - PROCAINE - LOCAL- (to affected area) - EPIDURAL - SPINAL -- Subdural L4 L5 (risk for spinal headache) - Conscious- IV sedation. **STAGES OF ANESTHESIA** - **INDUCTION-** give anesthesia - **EXCITEMENT-** hyperflex safety - **SURGICAL AMNESIA-** unconscious last to lost hearing. - **DANGER / EXHAUSTION-** RISK FOR RESPIRATORY DEPRESSION. CHECK CONSCIOUSENESS. **MEMBERS OF OR TEAM** - **SURGEON-** captain of the ship - **ASSISTANT SURGEON-** provide support - **SCRUB NURSE-** sterile member (maintain sterility) - **PATIENT-** center of sterile field - **CIRCULATING NURSE-** clean nurse/ monitoring/ documentation - **ANETHESIOLOGIST-** patient centered. Endure PT to RR wit CN. **PRIORITIES IN INTRAOPERATIVE** - SEVERE THE PATIENT- AIRWAY & SAFETY - ADMINISTRATION OF ANESTHESIA - HEMODYNAMIC STATUS (TEMP- 20-24 & HUMIDITY- 30-60%) **IV. POST-OPERATIVE (RR- LAST FOLLOW-UP CHECK-UP)** **A. PATIENT MONITORING** - Every 15 minutes for 1^st^ hour - Every 30 minutes for next hour - Every 4 hours **B. Monitor for post-operative complications** - **INFECTION -- after** 5 days fever - **DEHYDRATION-** IMMEDIATE FEVER **DURING SURGERY** - Prepare 2 bags. Expect 1000ml of blood loss. - Gauge 18 **C. Nutrition** - **PROTEIN (WOUND HEALING)** - **VIT C (ANTIOXIDANT REPAIR CELL)** - **VIT K (PREVENT BLEEDING)** **D. Diet** - **NPO** - **If there is a presence of GAG reflex and flatus, ready to eat.** - **Clear liquid (broth)** - **Full Liquid (milk and palp)** - **Soft diet ( lugaw, tinapay)** - **DAT** **E. WOUND CLOSURE** **3 TYPES OF SUTURE** 1\. PRIMARY- IMMEDIATE 2\. SECONDARY- GRANULATION (production of new cell 0 scar formation. Possible discharges: - SEROUS- liquid, clear - Sanguineous- blood, red bleeding - CEROSANGUINEOUS- pinkish - PURULENT- yellow, pus indicate Infection. 3\. Tertiary- delayed suturing, deep scar, if my faulty suture. **RESPIRATORY SYSTEM** - GAS EXCHANGE & ELIMINATION OF TOXIC) **UPPER RESPIRATORY TRACT (passage way)** - **NASAL CAVITY-** filter ad humidified air - **PHARYNX-** connects nasal to larynx - **LARYNX-** voice box **LOWER RESPIRATORY TRACT** (gas exchange) - **TRACHEA-** passage way of oxy & carbon - **PRIMARY BRONCHI** - **LUNGS-** GAS EXHANGE - **ALVEOLI-** surfactant, can exhale, inhale - **CAPILLARRIES-** gas exchange **NORMAL BREATHE SOUND** - **BRONCHIAL (**HIGH PITCH SOUND)- SA MAY SPINE BABAW - **BRONCHOVESICULAR-** (MODERATE NOT TO LOD NOT TO LOW) - **VESICULAR-** (llow pitch sound) base of lungs. **ABNORMAL BREATHE SOUNDS (ADVENTESIOS SOUND)** - **WHEEZING-** high pitch musical sound (exhalation) (ASTHMA) - **BRONCHOCONSTRICTION --** small airway - **BRONCHODILATOR-** lumaki ang airway - **STRIDOR --** low pitch sounds (inhalation) - **LARYNGOSPASM** - **CROUP DISEASE** - **RONCHI-** snoring - **OBSTRUCTIVE SLEEP APNEA** - **CRACKLES-** fluid in lungs - **Pulmonary edema** - **Pneumonia** - **FRICTION RUB** - **PERICARDITIS (PERICARDIUM)** **CHEST DEFORMITIES** - **BARELCHEST --** over inflation - **2:1 --** mas Malaki ang transverse amd likod sang chest. - 1:2 normal - COPD - **FUNNEL CHEST --** depressed sternum - **inward protrusions** - **Marfan syndrome- connective tissue hereditary.** - **PEGION CHEST- outward protrusions** - **Down syndrome** **UPPER RESPIRATORY DISORDERS** - **VIRAL RHINITIS** - UBO, SIPON, TRANGKASO, COMMON COLD - **OBSTRUCTIVE SLEEP APNEA** - SEASTION OF BREATHING - PATIENT IS NOT AWARE - COMMON ON OBESE & ALCHOHOLIC, SMOKING PATIENT - SNORING & APNEA - WEIGHT LOSS - CPAP(TULOY OXYGEB) - BiPAP (if magstop) - **LARYNGEAL CANCER** - HOURSENESS OF VOICE- 2 WEEKS - PERSISTENT COUGHING - SYPNEA & DYSPHAGIA **RISK FACTOR** - SMOKING, ALCOHOLISM, COPD NOTE: - ANTITUSSIVE \_STOP COUGHING REFLEX - MUCULYTIC- presence of phlegm **Management:** - CHEMOTHERAPY - RADIATION THERAPY - LARYNGECTOMY **TRAUMATIC DISEASE** - **CLOSED** - INTERNAL, NONPENETRATING, INTACTS - **STERRINGWHEEL INJURY** - **RIB FRACTURE (**3 DOWN RIBS, OAIN INHALING) - **FLAIL CHEST** (3 OR MORE RIBS) - **PARADOXICAL/ PAROXIMAL** CHEST MOVEMENT- INHALE INWARD, EXHALE OUTWARD. - **PAIN WHILE INHALING** - **RR- DOWN** - **FOR PAIN (DEVERON DRUG)** - **OPEN** - external penetrating, non intact - **STAB WOUND** - **GUNSHOT WOUND** - **HEMOTHORAX-** BLOOD IN LUNGS - **PNEUMOTHORAX-** AIR IN LUNGS (2^ND^ INTERCOSTAL SPACE TEST TUBE) **TEST TUBE THORACENTESIS** - **COLLECTION** - **WATER SEAL** - **Tideline-** water flactation (reason wala na tideline) - **Chest xray-** obstruction (no BREATH SOUND Reexpansion- with breath sound. Auscultate - **BUBBLING** - Presence of bubbles - Intermittent,/ interrupted bubbling is normal - Continuous bubbling is bad due to air leak so clamp the tube and report to physician. - **Suction** (removal) continuous bubbling is normal. - **DISCONNECTED** tube to bottle **SUBMERGED** in a bottle of **NSS.** - **DISLADGED** tube in chest, **COVER** it with **STERILE GAUZE.** **3 THINGS ON BEDSIDE IF PATIENT HAVE TEST TUBE:** - **CLAMP** - **BOTTLE OF NSS** - **STERILE GAUZE** **ABG ANALYSIS** +-----------------------+-----------------------+-----------------------+ | **PH** | **NAHCO3** | **PCO2** | | | | | | **7.35- 7.45** | **22-26** | **35-45** | +=======================+=======================+=======================+ | **ALKALINE** | **ALKALINE** | **ACIDIC** | +-----------------------+-----------------------+-----------------------+ | **ACIDIC** | **ACIDIC** | **ALKALINE** | +-----------------------+-----------------------+-----------------------+ **PH & PCO3- RESPIRATORY** **PH & NAHCO3- METABOLLIC** - **FULLY COMPENSATED** - **NORMAL PH** - **PARTIALLY COMPENSATED** - **NO NORMAL VALUE** - **UNCOMPENSATED** - **Either PCO2 & NAHCO3 IS NORMAL** **ABG ANALYSIS WITHOUT NUMERICAL VALUE** **RESPIRATORY** - **CARBON DIOXIDE MONITORING** **CO2 is RESPIRATORY ACIDOSIS** - Patient unable to breath / difficulty breathing **CO2 is RESPIRATORY ALKALOSIS** - HYPERVENTILATION - RAPID BREATHING **METABOLIC** - **POTASSIUM MONITORING** **K is METABOLIC ACIDOSIS** - **DIARRHEA** - **INJURY** - **EDEMA** **K is METABOLIC ALKALOSIS** - **DEHYDRATION** - **VOMITING**