Peri-Op
Preferred method for surgical site hair removal
What are Electric Clippers?
HA, sweating, shaky, tachycardia, lightheadedness, confusion, memory lapses, numbness of the lips and tongue, slurred speech, impaired coordination, emotional changes, irrational/combative behavior, double vision, drowsiness are manifestations of this
Hypoglycemia
Name 2 drug classes/diseases that are often allowed with a sip of water when the patient is NPO before surgery
-Cardiac disease - beta blockers
-Respiratory disease/meds
-Seizure meds - midazolam
-Hypertension
This medication stimulates the beta cells to secrete insulin, may improve binding between insulin and insulin receptors, or increase the number of insulin receptors.
Second-generation sulfonylureas - Glyburide/glipizide
This is when there is a protrusion of organs through the surgical incision
Evisceration
A patient states they have a food allergy to bananas - the nurse would be concerned about this because
The patient may also have a latex allergy or may have issues with products that contain latex
"Morning hyperglycemia" characterized by normal glucose levels until 3am then hyperglycemia in the AM/waking hours
Dawn Phenomenon
Name 2 ways the nurse can educate the patient to promote optimal lung expansion after surgery
-Sitting position to enhance lung expansion
-C&DB technique - breathe deeply, exhale through the mouth, take a short breath, cough deeply in the lungs
-Splinting
This muscle relaxant is the drug of choice to treat malignant hyperthermia
Dantrolene
"morning hyperglycemia" characterized by normal or elevated glucose levels at bedtime, hypoglycemia in the early morning hours (2-3am), and hyperglycemia in the AM/waking hours
Somogyi Effect
The Patient's autonomous decision about whether to undergo a surgical procedure.
What is Informed Consent?
A patient who presents in DKA may present with elevated glucose levels, dehydration, acidosis, electrolyte loss, fruity breath, and this rapid, deep breathing used to rid the body of CO2
Kussmaul's breathing/respirations
Name 3 ways the nurse might educate the diabetic patient to help decrease their risk for complications related to diabetes
Macrovascular complications - smoking cessation, control blood glucose levels, control triglyceride levels
Microvascular complications - annual eye exams, control glucose levels, HTN, prevention or vigorous treatment of UTIs, avoid nephrotoxic medications/contrast, adjustment of medications as kidney function changes, low sodium & low protein diet
Neuropathies - check feet everyday
Inhibits the production of glucose by the liver, increases the body tissue sensitivity to insulin, and decreases hepatic synthesis of cholesterol
Biguanides - Metformin
Diabetes can increase the patient's risk for SSI - the nurse would expect this order in a post op patient
Frequent monitoring of glucose levels
Name 3 reasons that bowel surgeries require bowel prep
-bowel surgeries only
-night before/morning of
-enema/laxative
-minimizes risk of colon injury
-improves visualization of bowel
-reduces number of intestinal bacteria
-decreases risk for contamination of peritoneum
Name 3 clinical manifestations of metabolic syndrome
-Insulin resistance
-Increased fasting glucose
-Elevated cholesterol
-Increased risk for cardiovascular disease
-Abdominal obesity
-HTN
-Chronic inflammation
Name 3 intraoperative nursing interventions
slide 31 powerpoint
Give 3 examples specific examples of how the nurse might treat hypoglycemia, <70, in a conscious patient
15g fast-acting, simple carbs
-4oz juice
-4oz regular soda
-1 tablespoon sugar/honey/syrup
-hard candies
3-4 glucose tablets
1 dose of glucose jelly
The nurse is reviewing a patient's pre-op labs. The H&H is 14.5&42, K - 4.2, BUN - 35, and creatinine - 2.1. The nurse's next action would be
Note that the BUN and creatinine are abnormally high and communicate the results to the surgeon/surgery team
Name 3 aspects of the physical exam that the nurse would assess a pre-op patient for and what is the importance
page 11 powerpoint
What are the SICK day rules for diabetic patients
slide 33 powerpoint
Name 3 patient education points related to diabetic foot care/hygiene
-Trim nails straight across
-Wash feet daily - lukewarm water, gentle soap, dry well
-Do not soak
-Inspect feet daily with a mirror
-Wear well-fitted shoes
-Do not walk barefoot
-Buy shoes later in the day - when feet are more swollen
-Wear breathable socks - white, cotton
This class of drugs can affect the surgical experience. They should be tapered to discontinuation, can cause skin changes/affect wound healing, increase glucose levels
Corticosteriods
The nurse is caring for a patient in PACU. The patient's vitals signs 1 hour ago were BP 130/90 HR 88 O2 98% T 98.9. The patient's vital signs now are 110/60 HR 82 O2 98% T 98.7. The nurse would anticipate what action next
Notify the surgeon