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LPM.

Psychosocial Assessment d. Patient verbally confirms the surgical


1. Assess situational changes/ assess procedure and the surgical site
behavior
2. Concerns with unknown 3. Pre-op medications
3. Concern with body image Sedatives/ tranquilizers: 15-20
4. Past experience mins. Prior to sx; to reduce anxiety,
5. Knowledge deficit ease of anesthesia
- Ativan- bendodiapine
Watch out for: - Flumazenil- antidote for
1. Signs of threat to life bendoziapine
- Suicide, suicidal thoughts, Narcotic analgesics
uselessness - Morphine sulfate
2. Signs of depression - Narcan- Naloxone
- Feeling of hopelessness Anti-cholinergics: reduce pulmonary
- Anhedonia- inability to feel irritation
pleasure - Decreased pulmonary/bronchial
- Pessimism- being negative secretions
NOTE: Not all signs of suicide are - Atropine sulfate
obvious
Anti-emetic: control episode of N/V:
3. Signs of anxiety
30 mins. before end of surgery to
- Insomnia, SOB, increased BP, HR
reduce gastric irritability
- Metoclopramide
Culturally competent care
- Diazepam
BASIS: Transculturally nursing by Madeleine
H2 receptor antagonists/ PP2
Leininger
a. Cultural competence and language - Decreased gastric secretions
competence - Omeprazole
b. Open to racial and cultural - Famotidine
differences and how to address Neuroleptic analgesic
them - Anti-psychotic
c. Friendly and respectful treatment - Induces general feeling of
of all patients calmness
d. Signs, poster, information are - Haldol
translated
Medications and antidote
Nursing management of pre-op client: 1. Acetaminophen- NAC
2. Benzodiazepine- Flumazaenin
1. Pre-op teaching 3. Coumadine/Warfarin- Vit. K
a. Information 4. Digitalis- Digivide
- What will happen, when will it 5. Heparin- Protamine Sulfate
happen, what will the patient 6. MgSO4- anticonvulsant- Calcium
experience, what do we expect Gluconate
from the client to enhance recovery 7. Penicillin- Epinephrine
b. Psychosocial support to reduce anxiety 8. Aspirin- Sodium bicarbonate
c. Role of client and support people in
the 3 phases Hazardous to Surgery
d. Skills training, moving, coughing, DBE, 1. Certain antibiotics
splinting 2. Anti-depressants
3. Phenothiazine
2. Final preparation for surgery 4. Diuretics
a. Personal belongings are identified and 5. Steroids
secured 6. Anti-coagulants
b. Jewelry is removed
c. Dentures are removed, labeled, nail Bleeding precautions:
polish is removed R- Razor Electrical
LPM.
A- Aspirin - Increased incidence of post op
N- Needles, Small Gauge confusion
D- Decrease needle sticks - Harder time orienting
I- Injury protect from - Increased incidence of delirium
- Increased sensitivity to anesthetic
Observe for: Hematuria, Epistaxis, Gingival agents
bleeding, Bruising Neurons in brain- decreased
Implement when: Using coagulants, liver neurotransmitters slower > overall
diseases, decreased platelets, using slower > less blood circulation to
thrombolytic, hemophilia brain
-------------------------------------------------------- Delayed response/reflex
Thrombolytic- break/ lysis of blood clots like Older brains shrink 15%
RTPA is only given to ischemia/ infarction if
hemorrhagic will not be given 4. Renal System
Anti-thrombotic- slows down clotting of - Renal blood flow declines 1.5%/yr.
blood - Renal clearance reduced
Anti-coagulants- prevents clumping and
blood clot 5. Gastrointestinal
- Decreased intestinal motility
Gerontological Consideration - Decreased liver blood flow
1. Cardiovascular - Delayed gastric emptying (min. of
- Coronary flow decreases 2 hrs.)
- HR decreases - Decreased liver size at age 70
- Response to stress decreases 6. Musculoskeletal
- Peripheral vascular decreases - Decreased mass tone strength
- Cardiac output decreases - Decreased bone density
- Endocardium becomes fibrotic - Bladder control, bowel control
(thickens due to scar formation and - Hypothermia- decreased adipose
sclerosis -> uncontrolled hypertension tissues
- Myocardium hypertrophy (due to
overwork) 7. Integumentary
- Changes in the valve rings - Decreased elasticity
- Changes in the heart valve (fibrosis - Decreased lean body mass
and calcification) - Decreased subcutaneous fat
- Decreased sebaceous gland:
2. Respiratory System xerosis: extreme drying of skin
- Static lung volumes - Decreased temperature control
a. TLC+RV+FRC+VC
- Pulmonary static recoil decreases Psychosocial consideration
- Sensitivity of the airway receptors 1. Level of anxiety
decreases 2. Coping ability
- The older, lung tissue becomes 3. Support systems
smaller and rigid
- Lungs= less elastic, early airway
closure
Insufficient basilar inflation Levels of Anxiety and S/S
Lesser lung expansion 1. Mild
Decreased ability to expel foreign/ Alert, more aware of environment;
accumulated matter attention focused on environment and
RV is decreased immediate events
VC is decreased- greatest volume Restless; irritable; wakeful; reports of
of air insomnia
Motivated to deal with existing
3. Nervous System problems in this state
LPM.
Anesthesia-conduction room: turban
2. Moderate and scrub shoes
perception narrower; concentration
increased; able to ignore distractions 3. Protective zone
in dealing voice quivers/change pitch. Outside clean zone
trembling; increased pulse/respirations Administration offices of OR supplies
Waiting area
3. Severe PACU
Range of perception is reduced; All administration office; space
anxiety interferes with effective entered before we change, waiting are
functioning for patient before surgery
Preoccupied with feeling of
discomfort/sense of impending doom 4. Disposal zone
Increased pulse/respirations with - Gown and instruments used
reports of dizziness, tingling - Room for operating debris
sensations, headache and so forth
Flow of supplies: from cleanest to dirtiest
4. Panic Always from clean core area thru the
Ability to concentrate is disrupted; OR to the peripheral corridor.
behavior ois disintegrated; client Sorted material should not re-enter
distorts the situation and does not the clean core area. (soiled linen and
have realistic perceptions of what is trash)
happening. Client may be
experiencing terror or confusion or be Ventilation
unable to speak or move. - Aids in the control of infection by
minimizing microbial contamination
Intraoperative - OR: temp between 68 to 73
degrees F (20-23 degrees C)
1. Physical environment - Relative humidity of 30-60%
Safety: No risk for infection, fire, explosion
and chemical and electrical hazards. Emergency signals
Convenient: well devised traffic patterns, - Every surgical suite should have an
material handling systems, disposal system, emergency signal system that can
well dispersed clean unidirectional be activated inside each OR
ventilation system - A light should appear outside the
2. Traffic flow door of the room involved
Traffic patterns in the surgical suite: Follows
a four-zone designation of areas within the OR Department compromises:
surgical suite 1. Restroom
2. Changing rooms
4 Zones of traffic in the OR: 3. Teaching rooms
4. Storage
1. Sterile zone a.k.a. central aseptic 5. Reception areas
area 6. An operating suite/ or theatre
Restricted area
Actual operation theatre An operating theatre
Aseptic condition-tissue 1. One fixing unit of a department
Handling of sterile equipment 2. Anesthetic room
Requires full aseptic condition 3. Clean prep room
4. Scrub up area
2. Clean zone/ semi restricted area 5. Operating theatre
Around/ outside of sterile zone 6. Sluice room- disposals/reuse
Preparing of instruments 7. Exit bay- passage out of the or
Lab gown
LPM.
Clean and dirty Greek: anesthesis = negative sensation
- All journeys within the department Analgesia- absence of pain
area made from clean to dirty Anesthesia- total loss of sensation/partial,
areas with or without consciousness

OR personnel 1. Blocks transmission of nerve impulse


- Enter thru changing rooms 2. Suppress reflexes
- Once attired can go to clean zone 3. Promotes muscle relaxation
- From clean/scrub area to or 4. Controlled level of consciousness
- Decreased level of consciousness
Patients
- Other areas/tools 6 levels of consciousness
- Anesthetic room- anes machine 1. Clouded consciousness
- OR table - Decreased ability to focus
- Operating lights - Wakefulness, still oriented
- Swab rack 2. Confusion
- Swab board - Disoriented in time, place, person
- X-ray screens 3. Lethargy
- Rubbish, bins, linen, bins, swab - Severe drowsiness, arouse by
bins moderate stimulation
- RR 4. Obtunded
- Severe drowsiness, cannot be fully
Surgical team aroused
1. Surgeon 5. Stupors
2. Anesthesiologist - Vigorous, repeated, painful
3. Nurses stimulation
a. Scrub- sterile 6. Coma
b. Circulating- non-sterile - Not responsive to stimulation
4. OR technologist/technician
- V/s documentation now allowed
- Checking of docx Factors influencing dosage and type
- Additional supplies 1. Type and duration of procedure
- Skin prep 2. Area of the body being operated on
3. Urgency of procedure
Nursing roles: 4. Options of management of post op
1. Staff education pain
2. Client/family teaching 5. How long it has been since the client
3. Support and reassurance had ate any liquids or any medications
4. Control of the environment 6. Client position for the surgical
5. Provision of resources procedure
6. Maintenance of asepsis
7. Monitoring physiologic and Types of anesthesia
psychologic status 1. General anesthesia
- Blocks awareness center in the
Surgical asepsis brain so that amnesia, analgesia,
1. Ensure sterility hypnosis and relaxation occur
2. Alert of breaks Route: IV/inhalation via LMA/ET; IV infusion
a. volatile liquid anesthetics
Other methods of sterilization of - Administered; breathing mask, ET
instruments tube, LMA
1. Infrared Ex. Isoflurane, sevoflurane
2. Boiling - Always mixed with oxygen
3. Soaking b. laryngeal mask airway- inflation

Anesthesia Advantage of GA
LPM.
1. Patient is unconscious 1. Spinal anesthesia/ sub arachnoid
2. Cardiac and respiratory functions is blocks: 1.5-3.5 Ml/5 mins.
regulated 2. Epidural anesthesia- 20-30 mins 5-10
3. Can be adjusted according to age, mL
length of operation and physical 3. Peripheral nerve block
status 3.1Femoral nerve block
Disadvantage 3.2Brachial plexus nerve block
1. Depression of respiratory and 4. Bier block IV regional anesthesia
circulatory system, medullary
depression Monitored anesthesia care
1. Minimal
Stages of GA 2. Moderate
1. Analgesia/ induction stage 3. Deep
- With pain, drowsy 4. General anesthesia
2. Excitement
- Hyperalert, nausea, vomiting,
increased HR Spinal anesthesia: Nsg. Responsibilities
3. Pt is still conscious 1. Drug study of involved medications
- Surgical, anesthesia stage - Lidocaine- antidote: Lipid emulsion
-v/s returns normal 2. Patient assessment
4. Medullary depression - Continuous heart rate, rhythm,
- Decreased HR, decreased BP pulse ox monitoring
- Level of anesthesia
Complications of GA - Motor function and sensation
1. Overdose return
2. Hypoventilation- decreased RR,
shallow breathing Complications:
3. Malignant hyperthermia/hyperflexia- 1. Hypotension
rare 2. Bradycardia
4. R/t intubation 3. Urine retention
4. Postural puncture headache
Regional anesthesia 5. Back pain
Interrupts transmission of sensory
nerve impulses from a specific area Reminders:
or region 1. Safety
Motor function may/may not be 2. Simultaneous placement of feet to
affected prevent dislocation of hip
Does not lose consciousness 3. Always apply knee/arm straps/pads
4. Arms should not be more than 90
Gag reflex-intact
degrees
Supplemented with
5. Prepare and apply cautery pad before
sedatives/opioids surgical skin prep
Types of RA