PCA

Patient controlled analgesic

Nursing responsibilies of a PCA

- check to see how many times ptnt. presses pump

-if to many times- contact dr.- let him know actions arnt effective

Ablative

• Describes a procedure involving procedure removing tissue or a body part.
• OR distruction of its function

Prevenitive surgery

(examples)

•  surgery to prevent complications
• when get both breasts removed when only need one to prevent spread of cancer
• takeing out appendix if abdomen already open

Diagnostic surgery

• To diagnose a problem
• Not sure exactly what is going on

Exploratory surgery

• Cut open to explore
• To discover cause of disease/reason 4 pain
• E.G. Laberotomy

Curative Surgery

• Removal of tissue to prevent/stop/cure disease

Palliative surgery

• Removal of tissue to releive pain/obstruction

Reconstructive surgery

• Also cosmetic or restorative surgery
• used to correct deformities/genetic deffects/body&facial improvement

 Different kinds of surgery

1. Preventive
2. Diagnostic
3. Exploratory
4. Curative
5. palliative
6. reconstructive/cosmetic

Different kinds of anesthesia

1. General anesthesia
2. Local anesthesia
3. spinal anesthesia

General Anasthesia

• Loss of sensation/consciousness/reflexes
• By IV or inhalation

Local Anesthesia

• Numbing a piece
• Loss of sensation to body region
• infection of local agent

spinal anesthesia

• intrathecal injection in L4 or L5
• Effects spinal nerves

Adjunct agents

• initially for each patient
• ?

Conscious sedation

• Not totally under- use of hypnosis/acupunture

Primary intention

• Ideal
• Wound is approximated
• Crust/scab joins wound together

Secondary intention

• Wound edges far apart(cannot be brought close)
• Loss of alot of tissue
• Granulation tissue fills in open area

Tertiary intention

• Would kept open and healing delayed on purpose due to infection
• To facilitate cleaning and healing from in to out

What does potassium regulate?

• Muscle function --> expecially the heart
• Maintains fluid balance
• trasmission of nerve impulses
• Osmosis
• Cell metabolism

S&S of PE

• Dyspnea
• restlessness
• tachycardia                     (DRTCC)
• Chest pain
• cyanosis

Paperwork involved with surgery

• Surgical consent or operative permit
• Needs to be signed- involves risks and possible risks
• If adult confused- family must sign
• if ptnt. doenst understand- refer to dr. 

S&S of internal hemmorage

• hypotension 
• Increasing pain                        (HIITE)
• increasing abdm. girth
• tachy cardie
• echymosis around incision

Thrombophlebitis

S&S

Intervention

• blood clot
• Heat, redness, pain, edema
• Use ted hose and keep moving legs

Defenition of shock

• fatal condition
• When inadequate O₂ available to tissues
• Usaully occurs suddenly

Shock develops from:

• ↓ Blood Vol.
• Heart/pump failure
• Massive vasodialation of peripheral vessels

Symptoms of shock

• ↓
  • Cardiac output
  • BP
  • unrine OP
  • gas exchange in lungs
  • O₂ in blood (hypoxemia)
  • "    " tissues(hypoxia)
• ↑
  • fluid retention
  • CO₂ in blood
• Rapid/shallow respirations
• Skin= pale/cold/clammy
• organ failure

Hypovolemic shock

• Decrease in volume of fluid
• Mainly intravascular(bleeding out)
• Caused by
  • Trauma
  • surgery
  • fluid shift
  • diaretics
  • Pooling of fluid from allergic reaction
  • post partum
  • burns

Arterial bleed

Pulses/squirt w/ HR

Vascular bleed

• Free flow bleed

S&S of hypovalemic shock

• Rapid breathing
• Increased HR
• cold/calmmy skin
• hypoxemia                  (RICHHD)
• hypoxia
• deacreased BP

Distributive shock

• Inadequate volume R/T movement of fluid away from intravascular compartment
• vasodialation

Kinds of distributive shock

• Neurogenic shock
• Septic shock
• Anaphylactice shock

Neurogenic shock

• Malfunction of autonomic nervous system
• Injury to major motor center in madulla of brain

Causes of neurogenic shock

• Spinal chord/head injury
• Opioid/tranquilizer OD
• general anesthetic

(need to treat cause of it)

Septic shock

• Also toxic shock
• Overwhelming bacterical infection
• Gram - Massive dialation 2° to bacterial endotoxins

Endotoxins

-Waste bacteria puts out

treatment of septic shock

• ID organism
• Do culture/sensitivity
• treat with antibiotic

Anaphylactic shock

• Sudden severe allergic reaction
• Histamine released-->causes vasodialation
• Bronchus constricts-->obstructs airway-------------->wheezing--->stridor
• Rash

Cardiogenic shock

• Heart unable to pump enough blood to cells
• Pump failure
• mortality rate 80%-90%

Cardiogenic shock caused by

• MI
• Or heart failure

treatment of cardiogenic shock:

• O₂
• CPR
• Bedrest
• mechanical support/venilation
• Transplant-only hope to survive

Obstructive shock

• Mechanical obstruction to flow of blood
• Causes:
  • tension of pneumothorax
  • cardiac tampanode
  • Increase abdm. pressure

Brain: failure R/T shock

• Brain survives for 4 min w/o resp.
• Cells begin to dye
• Decrease in glucose/O_2-->would see: decrease LOC

Kidneys Failure: R/T shock

• Low BP-->damage to capallaries in kidneys-->acute tubular necrosis
• would see: decreased UOP< 20cc/hr
• urea/creatine build up in blood(toxic waste)

Gastro-intestinal failure R/T shock

• Decrease blood flow to GI track-->damage/kills tissue
• would see :Develop GI bleeding

Liver Failure R/T Shock

• Kidny fails soon after liver fails
• Prolonged vasoconstriction-->kidney damage
• build up of wastes-->Would see Jaundice/acidosis

Lungs failure R/T shock

• Decrease/increase in pulmonary capillary blood flow-->pulmonary edema
• Decrease in surfactent-->alveolar colapse
• would see:massive atelectasis,dyspnea,hypovenilation,

Adult respiratory distress syndrom

(R/T shock)

• AKA shock lung
• from  Severe illness or injury
• would see hypoxia/hypoxemia

Drug therapy for shock

• Vasopressors( all vasoconstrictors)
  • Dopamine
  • Levophed
  • epinephrine
•  (also monitor BP every few min)

Respiratory complications of surgery

• Pneumonia
• actilectisus

Pneumonia

• caused From:
  • not coughing/deep breathing
  • aspirating
  • prior resp. compromisation
  • immobility
    • causes fluid in lungs

S&S of pneumonia

• Increased temp
• ronchi
• rails
• dyspnea                (IRRDCP)
• coughing
• Purrulent(green/yello) or rusty sputum

Ronchi

Coarse crackles

Rails

Fine crackles

Interventions to pneumonia

• Rest
• ambulation
• semi-fowlers
• Increase O₂
• Coughing/deep breathing
• IS

Actilectisus

• Incomplete expansion or collapse of alveoli in lung
• R/T hypovenilation & increased secretion

S&S Of actilectisus

• Dyspnea
• Deminshed breath sounds
• rales
• restlessness                                (DDRACC)
• aprehention of breathing
• cyanosis

Intervention to actilectisus

• Postural drainage(beating)
• Chest tube
• ambulation
• pain meds

Paralitc ileus

• R/T surgery comp.
• part of bowl becomes paralized

S&S of paralitic Ileus

• No bowel sounds
• abdm. distention from stool/gas
• "     " pain                                 (NAAV)
• vomiting that smells like stool

Intervention of paralytic ileus

• NG tube in stomach
• NPO
• Exploratory surgery
• help w/moving
• Encourage fluids
• High fiber
• Rectal tubes/supository/enema

Assessment of fresh post op phase

• Monitor vital signs
• risk for aspiration
• Ineffective airway clearance(Resp Obstruction Most common problem)
• Inneffective breathing pattern(rate,depth,ryth)
• Defficient fluid volume
• risk for injury
• Disturbed sensory perception
• acute pain

Central nervous sys. asses. stages of waking from surgery

1. =Wake up
2. =Response to touch/sound
3. =drowsy
4. =awake /unoriented
5. =awake&oriented

PACU discharge criteria

• Stable vital signs
• SaO_{2 .} 90%
• Awake-baseline level of consciousness
• resp. not depressed
• bleeding controlled

things to do in post op

•  should void 8-10 hrs after surgery
• check resp. first 24-48 hrs
• get up and moving in 1st 12 hrs if possible
• take vital signs
• abserve pain level

Some complications that can occur

• hemmorrahage
• thrombophlebitis
• infection
• dehisence
• evaseration
• paralytic ileus
• pneumonia
• atilectisus

Intervention fo nausea/vomiting

• Meds
• gingerale
• crackers
• reposition

Intervention for thirst when NPO

• Swabs
• suck on washcloth
• icechips

Diet for post-op

• clear fluids-->if hear bowel sounds and has no nausia-->then full liquids-->If passing flatus-->advance to soft diet