RNFA 1
- ANS-Surgical hemorrhage
1913 from the National Fire Protection Association (NFPA) Committee on Safety to Life.
The Life Safety Code is commonly referred to as "the Code," and it addresses features
necessary to minimize danger to life from the effects of fire, including smoke, heat, and toxic
gases. The Code covers electrical, fuel-gas, mechanical, plumbing, and energy factors, and
encompasses the environment of care. Fire prevention and understanding of the fire triangle are
critical components of fire safety. The fire triangle consists of heat, fuel, and an oxidizer. Each
member of the surgical team controls a part of the triangle:
the surgeon, heat
the nurse, fuels
the anesthesia professional, oxidizers
If oxygen, heat, or fuel is removed, the risk of fire is lessened. 29
In the OR suite, there are combustible materials including drapes, towels, plastics, sponges,
sheets, and paper. High-energy heat ignition devices, such as electrosurgi - ANS-Life Safety
Code
A visual identification of many potential causes of a problem - ANS-Fishbone diagram
Abnormally low white blood cell count - ANS-Leukopenia 1
Agranulocytes (mononuclear cells) are lymphocytes and monocytes; their increased cell counts
reflect
lymphocytes—viral infection, leukemia, hepatitis, tuberculosis, pertussis
monocytes—bacterial infection, colitis, protozoan infection, malaria, tuberculosis, bacterial
endocarditis - ANS-Agranulocytes
Alexander's Care of the Patient in Surgery 15th Edition
Pages 1132-1159
Alexander's Care of the Patient in Surgery 16th Edition
Pages 1119-1145 - ANS-interventional radiology
an immune response where particles such as bacteria are targeted for destruction by an
immune cell known as a phagocyte- identifying the invading particle to the phagocyte -
ANS-opsonization
Anticoagulation
Patients with chronic AF and prosthetic heart valves often take anticoagulation therapy.
Coumadin therapy should be discontinued 4 to 5 days before elective surgery. Patients at high
risk for thromboembolic events include those with prosthetic valves in the mitral position, AF
,associated with mitral valve disease, and a history of thromboembolism. Such patients should
be admitted for transition from warfarin anticoagulation to IV heparin treatment. Outpatient
therapy with preoperative enoxaparin in place of conventional unfractionated IV heparin may
employed. Patients with highly thrombotic valves, two prosthetic heart valves, or recent arterial
embolism should be considered for standard IV heparin therapy perioperatively.27,30,33 -
ANS-anticoagulant AND THE SURGICAL PATIENT
are at high risk for a perioperative cardiac event; intermediate risk post-MI for a perioperative
cardiac event can last from 6 weeks to 3 months. If the MI is complicated by arrhythmias or
ventricular dysfunction, the patient remains at intermediate risk for a perioperative cardiac event
for longer than 3 months. In a patient who is status post-MI for 3 months without complications,
it is not necessary to delay surgery.1 - ANS-Patients who have had an MI within the past 6
weeks
Aspirin should be discontinued 2 weeks before surgery.
NSAIDs should be discontinued at least 5 half-lives (of the particular NSAID) before surgery.4
Both aspirin and NSAIDs can be restarted 1 day after surgery if necessary.
Nonaspirin and non-NSAID pain relievers can be used for postoperative pain. - ANS-aspirin and
nsaids and surgery
Bipolar cautery is unlikely to disable the pacemaker or initiate an arrhythmia.2 -
ANS-electrocautery and the pacemaker
Cardiac arrhythmias
Cardiac arrhythmias contribute to postoperative morbidity and mortality. The most common atrial
arrhythmia after surgery is atrial fibrillation (AF); the most difficult to manage is atrial flutter. Atrial
fibrillation is a significant arrhythmia because a fibrillating atrium reduces preload (ie, LV filling)
and subsequently reduces cardiac output. Patients may receive amiodarone preoperatively
because this drug has demonstrated a reduction in the development of postoperative AF.29
When a patient exhibits either atrial flutter or paroxysmal atrial tachycardia in the postoperative
period, rapid atrial pacing is the recommended treatment. If these arrhythmias persist, the
patient is often referred to an electrophysiologist for diagnosis and treatment.29
Postoperative ventricular arrhythmias range from occasional premature beats to multiple
sequential premature beats, to nonsustained to occasional bou - ANS-cardiac arrhythmia
Cardiac output and cardiac index
Cardiac output refers to the amount of blood in liters that is ejected by the left ventricle (LV) per
minute. Cardiac output is determined by
preload (ie, the amount of venous blood returning to the heart)
afterload (ie, the pressure faced by the LV during ejection)
myocardial contractility (ie, the force of ventricular contraction)
heart rate (ie, the number of heart beats per minute)
, In patients undergoing a "normal" postoperative recovery, no special measures are needed to
manipulate the components of the heart rate. Patients with impaired or inadequate cardiac
performance require manipulation of one or more of these components. Interventions may be
pharmacologic or use mechanical devices to augment contractility (eg, intra-aortic balloon
pump, ventricular assist device).28
Cardiac index refers to the cardiac output per square meter of the patient's body surface area.
The cardiac - ANS-Cardiac output equation AND CARDIAC INDEX
Cardiac53
Bradycardia—decrease in heart rate is generally caused by parasympathetic effect from direct
pressure on the vagus nerve.
Gas embolism—monitoring indicators will suggest hemodynamic instability and a drop in
ETCO2 levels. A sudden decrease in systolic blood pressure, desaturation, dysrhythmias, and
cyanosis are symptoms of a venous gas embolism. The abdomen should be flooded with
normal saline solution. The patient should be returned to a supine position.
DVT—appropriate DVT prophylaxis should be provided to all surgical patients, including
antiembolitic stockings, sequential compression devices, and heparin therapy if indicated.
Lengthy procedures, the lithotomy position, or any surgical position that cause the patients' legs
to pool blood or compromises venous return presents greater risk.56
MI—occurrence of intraoperative or postoperative MI in non-cardiac related surgery is very low.
However, the RNFA - ANS-anesthesia AND THE SURGICAL PATIENT
Complications of positioning
Compression neuropathies—ulnar, peroneal nerves. Using padding over elbows avoids
pressure on the posterior popliteal fossa.
Anterior tibial compartment syndrome—caused by pressure on the anterior compartment of the
leg and may be associated with positioning devices requiring padding to avoid compression of
the tissue. An orthopedic emergency that may require emergent fasciotomy.
Pressure on the eye—corneal abrasions, damage to the anterior chamber
Cervical spine injuries during positioning as a result of relaxed muscles under anesthesia -
ANS-POSITIONING COMPLICATIONS
Describe how trauma care has evolved over the years
Discuss emergency medical services and how pre-hospital care is delivered
Explain the differences among the four levels of trauma centers
Explain what is meant by the biomechanics of trauma
Discuss the CNOR/RNFA implementations for trauma patients
Explain what is meant by "critical incident stress debriefing"
Describe the common types of trauma surgical procedures and the perioperative nursing
implications
Alexander's Care of the Patient in Surgery 15th Edition
Pages 1104-1131
