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PERIOPERATIVE CARE, Infants
at increased risk for surgical…
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Infants
- at increased risk for surgical complications
- focus of helping to adapt to extrauterine life
- special care related to respirations
- checking in with parents is also very important
Children
- assessment to ensure that child's development stage makes sense for the procedure
- keeping family involved and educating the child on the procedure to their best limits of their understanding
- keeping the child as comfortable and relaxed as possible; providing reassurance to them and their parents that their are going to be taken care of
- promoting comfort and safety during postop
Pregnant women
- unique situation with numerous special concerns
- place the woman in the left lateral recumbent position when in surgery to promote cardiac output
- fetal monitoring throughout the whole perioperative process
Older Adults
- increased risk for developing pressure ulcers; must take extra measures for the positioning
- at increased risk for surgical complications during intra and post op so paying close attention to these fields
- being aware of previous surgery or medical conditions is very important
Preop
- teaching: nature/length of procedure, recovery time, what medications they should or shouldn't be taking, pain control, tips to stay calm and reduce anxieties, etc.
- preparing for surgery
- performing necessary assessments
Postop
- staying alert and monitoring for risks and complications that could have come from surgery
- administering medications as ordered to help aid in pain or other surgical recovery aspects
- using clean technique to change any wounds dressings
- proper maintenance of IV lines
- using the Aldrete Score
- education on proper nutrition and its role in aiding with wound healing
- education on limits within activity and movement
Intraop
- constant monitoring of surgical environment and patient
- interventions and therapies will vary with the different types of procedures
- providing padding to prevent skin breakdown and work towards comfort
- application of airway monitors for anesthesia
- providing proper documentation
Preop
- Data collection assessment: allergies, previous surgeries, personal or family history with anesthesia, NPO status, VTE/prophylaxis
- Culture
- communication abilities
- drug and alcohol use
- physical examination
- psychosocial assessment
- nutritional assessment
- pain assessment
- medication review
- prep of surgical site: clipping hair, cast removal, shower
Intraop
- assess for any s/sx of change within to the patient to ensure they are staying safe
- vitals signs
- oxygen and CO2 levels to ensure staying safe
- nurse is only advocate for patient when they are in surgical process; must keep constant assessment to ensure they are staying safe and healthy
- assess for any complications
Postop
- airway patency
- ability to move post anesthesia
- cardiovascular status
- skin assessment
- fluid status
- operation site status
- pain, nause, and vomiting
safety
- bowel sounds
Assessment
- consistent and constant assessment to ensure patient is staying safe during operation
- compare assessments to baseline to notice any changes
Comfort
- premedication as needed so patient is comfortable and relaxed during operation
- discomfort can lead to higher anxiety and stress which could lead to complications
Infection
- during operation infection is a risk
- follow proper infection control protocols to ensure safety
- education on wound care post operation
Perfusion
- blood loss and/or transfusion are common during operations
- being aware of s/sx of excessive blood loss
- risk related to decreased perfusion
Oxygenation
- respirations and oxygen levels can be affected by sedation given for operations
- closely monitoring to ensure patient is safe
Stress and coping
- patients are often stressed for operations
- elevated levels of stress can cause complications
- doing best to keep patient calm and reducing anxieties
PT/PTT
- prothrombin time and partial thromboplastin time taken to see how long it will take the patients blood to clot
- important to know if client is at bleeding risk and if it is worth it to before the operation or not
Capnography
- shows the CO2 levels in exhaled breaths
- used during surgery to make sure patient is getting proper levels of ventilation
- keeps patient oxygen levels in a safe range
CBC
- main focus on Hct, Hgb, RBC, and platelets
- used to measure blood cell count to monitor blood loss and to see if a transfusion is at all needed
Potassium levels
- potassium plays a major role in muscle and nerve activity
- hypo/hyper levels can be signs of numerous complications
ECG
- done to check the cardiac rhythm of a patient
- done before major surgeries to tell if the patient's heart will be able to withstand surgery
- neuromuscular blockers interfere with nicotinic receptor activation
- sustained contraction of skeletal muscles is due to repetitive activation of nicotinic receptors
- succinylcholine keeps the end-plate from repolarization
- neuromuscular blockers do not reduce consciousness or pain
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- respiratory depression is a major adverse effect
includes: atracurium, cisatracurium, mivacurium, pancuronium, rocuronium, succinylcholine, and vecuronium
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therapeutic goal: muscle relaxation during surgery and other procedures, all given via IV
Possible adverse effects: apnea, hypotension, malignant hyperthermia, hyperkalemia, muscle pain
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