Medical Surgical - Emergency and Disaster Nursing

Disaster
↳
any man-made & natural event that causes :
natural

⑧ overwhelms e community natural-occuring

② impairs e community manmade

&
requires outside assistance made by man

volcanic natural flash floods natural-chronic

-

war-man made * PBQ Spread comm disease

-
.

terrorism -
man made -

acute ↳ natural

tsunami-natural -
acute

* chronic - slow progressive

acuto - sudden

Phases of disaster mgt:

① Mitigation long term prep
,
.

focus :
risk reduction

eg
:
creation : laws Allocation
.
o budget
② preparedness -
short ferm prep
I focus
.

bracing
eg . Public Announcement way , way ,

"nine nine six ako"

sick also
, ,

③ Response -> Activities done during and immediately after PD 996 -

Immunization

cy . Search & Rescue , relief

operation PD -
Presidential Degree

④ Recovery + bring back e community to pre-disaster status 70 -

Executive Order

eg Rehab.

, rebuilding

Legal basis
① PD 1566 ->
strengthening disaster response level 7 -

severe
↳ agency Council) level e
- Mustered
:

NDCC /National Disaster Coordinating

② RA 10121 -D risk reduction Lef

↳ agency NDRRM

mandatory training
:

: gor't officials
↳ integrated in E curriculum
↳ price ceiling
↳ budget :

21
⑤ RAT160 in times

The gorgorder
disaster
National gort gives power to 164 of

-
 Emergency response
* PBQ & Activate Emergency Preparedness Plan
↳ & diff scenarios diff plan ·

② Go to e scene

Ambulance immune
I
↳ + -> to traffic rules

Team :

/ Headman ->
leader o I team

~ First Aiders
~Tridge - 1st o respond

~ Lifters
~ Logistics I gamit crowd control -

~ Documentation
& PBaU Driver
③ Establish a

The when
that I scene is safe you arrive scene

APBQ Golden:

Rule :
Jafts = Responder - PARITY !
④ Triage A
In prioritization o victims (pt .
1
* PBA bioethical principle utilitarianism :

↳ the greatest good for I greatest number

* Types : Triage

e
Field Triage
① NATO Triage (North Atlantic Treaty Org) * PBA 1st Aid
:
:

I
9 .

Minimal - minor injuries eg cuts minor burns

.
, ,in-soft tissue
/sports related
injury
injuries
b .

Delayed -
delayed for 1-2 hrs/med cond .

eg .
fracture HPN ,

c .
Immediate - life threatening eg massive
.
bleeding /burns
d .
Expectant -
less likely to survive eg .
cardiac/respi .
arrest

②A START (Simple Triage and Rapid Treatment)

↳
Algorithm :

start where you stand

↓
go to i nearest victim

ASSX :
ask if * able to walk - YES
*
walking wounded) # ex area

↓
NO
I
bleeding All
DepositionAraNo
Assx :
-> No->

+E
Assx :
RR + abU -
/ ↳ move to the nearest victim
⑱ 12-30
after tugging
↓
⑱
↓
Assy CRT :

/Pulse -ab +D
>35e0s
#
⑱
time , place , person
↓orientation
confused/disoriented
:

Asx Lo0(mental
:
-
unable to follow command
↓
oriented Inherent /able
to
follow command to low
ERriaghitary Trige i

a Emergent litethreated
C .

Non-urgent to minor cases/OPD

for e

* ② Reverse Triage
I look identify minor cases

L Purpose free :

up hospital beds
*
⑧ ESI (Emergency Severity Index)
Algorithm

chnicalsx-S
Assy : Severe Ell leve
·

*
needs life saving intervention

j
Assy NO a

I
:
->

↓
*
TES
↓ #TI Lul E
Assx :
AYered LOW YES

ESI Levi 1 ↓
F
NO
non e
Severe distress
- YES
Assa
*
:

↓
ASSA . No .
oner I
resources needed &
- NO
↓ ↓
IN YES
ESI Lul Many->Alsa .
Danger zone vitals
-

↓ /HR >100bpn =

No danger vifals -RR =

>20bpn
↓ /02 Sat =

< 92 %

# SI Level I

⑤ Primary &
Secondary AssX .

⑰ Trauma AssX . DCAPBTIS ⑧ Comprehensive LOU Assx .

(60s)
I eformity Highest 15

↳
->

3
ontusion -> bruise Lowest ->

↓
brasions
Puncture Best eye Best Verbal Best Motor

Burns
enderness -

pain upon palpation

opening Response
SponTOTONo
Response
OCIIN
response
OL WiFi En
Laceration 5-Oriented time G-Obeys Command
->
punit Hear 4 -

Spontaneous person

Swelling 3 -
To verbal commands 4-Confused 5-localizes Pain
③ SAMPLE Hx to pain stimulus 3-Inappropriate Words 4-withdraws
from

i
pain

S-SISX
-

No response 2 -
Incrompehensible 3- Ab En
A Allergies
- -> medications 1 -
NO Response 2- Ab Exterebration

M-Medication
1 -
NO Response
. Hi
I -last Oral
Med
Intake
E- Events that lead to condition
 ⑥ First Aid (ERMgt
⑦ Hemorrhage (Massive Bleedings
S/Sx : (Hypotachy tachy) S1SX :
Internal Bleeding
It BP ~ Hema temesis
~

~Y
F
Al

RR
3 regardless it
internal /External
↓ Hemoptisis
↓ Hematuria
↓ Pallor ~ Melena
↓ LOC/Restlessness ~ Hematochizia
Of Risk for Aypovolemic ~ contusions Ittematoma
~Epistaxis
First Aid :

VASIX .
Site : bleeding
~ & GOLD Standard s
Apply direct pressure
↓ If bleeding persists Apply -
pressure on proximal blood vessels
~40s Modified Trendelenburg
:
or R :

O compression : diaphragm
~ A Amputation ->
part ->
place inside plastic (riplork) ->
place inside cold -> A transport
wrapped in cloth (body part) surfaced container i pt .

~ A Epistaxis -> pos : huperflex ineck R: O aspiration

In apply pressure on nose bridge
In apply cold compress -> vasoconstriction

~ transport E victim

ER Mgt
~ Admin .
Oz
~Admin IVF-NSS
~Admin B5
A Emergency blood type -Type O
~ Repair -
either suture or surgical

B Fractures

S/SX :. A Deformity ER MGH :

~Pain ~Immobilize -
-
casting
-

beglass
~Swelling 1 Traction
-

SYetal
/Shorter (limb) Le Fixators

/cases :
pulselessness ~ Admin .

pain medication
First Aid :

~A Gold standard -
Immobilization

I Pinge
↳ manual
~A Pulseless ->
reposition
~ Apply cold compress

~ Transport
 ⑧ FBAO (Foreign Body Airway Obstruction)
* common cause :
Adult -
Food
children -
small toys
SISX VDOB
:

~ A Universal Sign Clutching :

i neck

1 Apprehension /Restlessness
~ Inability to talk -> full obstruction
~ Able to talk ->
partial obstruction
~change in color

↓ 10C

ER Mgt :

First Aid ~* Full Obst Tracheostomy

->

~ ASK it in need o help ~ Surgical Removal -> Endoscopic

1 Ask to cough forcefully ~Admin 02
~A Heimlich Mannever / Chest or Abd thrust .

~Open Airway * PBA

:

Infants -
Back Slaps
~Remove FB -> finger sweep Adult ↳ Heimlich Mannever

/POS Recovery 40s (side lying)

:

/ Transport

⑪ Anaphylaxis
↳ severe hypersensitivity ran

cause
:

allergens -
medications

As too mical s

slx /A DOB 20 broncho constriction

:

~ swelling - danger sign face/lips

:

~ Redness
~ Itchiness
~ Urticaria (Hives)
First Aid :
Remove allergen
~ head filt chin lett
a
open airway
I
,

jaw thrust &- mas better, no spinal movement

~ AssX : medications
~Remove constrictive clothing
~ Transport
ER mgt : ~Admin Epi DOC) -

bronchodilation
I vasoconstriction -to decrease rate of inflammation
~ Admin 02

~ Severe Indotracheal/tracheostomy Intubation

:

~Antihistamine >
-
SE : + 102
 & Hyperventilation ⑧ Poison Ingestion
↳ deep rapid breathing solids usually
Non-corrosive
-

cause : /Asthmatic Attack (acute) corrosive - highly acidic /basic

~ Anxiety S/X V :

or Loss of Consciousness
~Pain ~ DOB
First Aid :

/Ask pt to calm down ~ change in VIs

~ A Breathe into a paper bag ~ corrosive oral burns
R: to regulate rhythm red circumoral region
* O Resp . Alkalosis / Foaming : mouth

/ Transport
ER Mgt
:

/ Admin . O2 -> Rebreather mask First Aid :

/ Open Airway
↓ correct e cause ~ call for help/poison control

↓ pos O side lying

:
R: delay absorption in e intestine

1 Home Remedies
⑧.
Snake bites
(raw) encapsulates
venomous
at egg whites i
poison
non venomous -

i Ipecac Syrup
bite marks.. Activated charcoal absorbs
Fang Rounded -
impurities
head Triangular /Diamond Rounded * c . +
induce vomitting
pupil Eliptical Rounded wo
* Never induce romitting if corrosive

color uniform multi ~ Transport

First Aid : ER MGA :

/ X suck e venom ~Administer O2

~ calm Down ! ~ Gastric Lavager/suction

~ Pos :

Upright Do not move o

to ~ Admin .
E Antidote
~ Wash wound J H20 speed circulation
~ WHO - tourniquet
DOH - &x tourniquet

~ transport
ER MgH :
~ Admin . 02 a capture : snake it
~ Admin . Anti venin (antivenom) possible !
* perform skin test !

↳ dilute in NSS

In WOF anaphylaxis:

↳ Bedside Epinephrine :
 ④ Beesting ① Jellyfish Sting ⑥ sting ray sting
First Aid : First Aid :
First Aid :

~Remove Stinger ~ APBa Wash I :

vinegar ↓A PBa Warm H20

* PBQH Scrape off ! (Acetic Acid) ~WOF Anaphylaxis
:

~Wash ~wash
~ WOF Anaphylaxis VWOF Anaphylaxis
:
:

-> ⑧ bee attack

↓ Stay still
~ Avoid colorful clothing
~ Avoid Scents

⑰ Burns
Types of burns:
⑧ Thermal + most common
acia
② chemical
Xenity was abalala
base

③ Electrical - most lethal

④ Radiation - e .

g sunburn
.

Degree of burns in other books 40 burns

:

① Superficial burns (1st degree) deep -> dermis

② Partial thickness burns (2nd degree) partial i Kalahati ng dermis

③ Full thickness (3rd degree)

-20 so

Affected area Epidermis Epidermist Dermis fr Epi until beyond Dermis

.

pain mild-moderato moderate -

severe
painless--nasunog nadin nerves
~nagbabalat

Unique slex redness +

desquamation blisters
+

weeping
↓
nagtutubig
char formation - in
tutong
wound healing 5-7 days 2-3 Wks none

Potassium in , Sodium Out

Stages of burns PiSO

① Emergent Stage - aka Fluid Accumulation Stage
:
inside culls -

potassium

124 -
48 % ↳ 120 move from IVC to ISS
lababligd Sodium
Lo
intravascular interstitial
naca
A D ↳Bp
-
Planning
Hypovolemia Herkalemia
-

PAR if it
-
,
, weak thready pulse-hypo requires cognition
② fast s weak its the answer

a pindRemobilizationstate yung
not
Amte Stage
13-4 days) excess Hao , Thing hi board exam : Psychiatric
↳
↳ A20 moves back to NC bottle ->
glass bottle
ho Hypervolemia
-
-> diuresis /Polyuria, Aokalemia bath -> nakalublub owarm
③ Recovery stage +>
Normalize - day

* Acid-base imbalance -> Metabolic Acidosis

(burnis
 Reseten
First Aid :
~ A Burning -> Protocol -
continecontra-time
Evacuate
de ee
~ STOP ! DROP ! ROLL ! ->
Log rolling
~Open : airway jaw thrust-vasoconstriction
I temporary
->

~ pour cool 120 over burns -

It pain
~ Do not apply any chemicals ->
gate
- irritant

~ cover = burns I damp towel/cloth -> moist protected & di mag dikit dikit
~ Transport
ER/Hosp Mgt :

& ABC -> Admin 02 Admin :

1st 80 -50 %

In 9'
M
grule
Fluid Replacement of
2nd 80 -
25 %

↓
Parkland Formula :
4mIx TBSAx w+(kg) 3rd 80 -
25 %
Par mL

* PBQ NF
:
choice

↳PLR/LRS ① T kg
R :

correct e met acidosis

·

9 +
9 +
18 2t
② Admin .
Antibiotics ② 3410 Celly
DOO Materide Acetate (Sulfamylon) APBQ SIE 9+4 142
n
:
-> 5
pain
:

severe
:
.

↳ deep eschar penetration Ma A -

madaming aray 8

other :

Ag Nitrate ⑤ 64
kg Say
Ag Sulfadiazine 4 .
5 +

45
.
+

9+4 5 .

2978 15780
③ Admin .

Analgesics 1485 24980

DOC Morphine S04
:

WOF
:

Resp Depression
.
panit OBP
* Airway Burns -

Meperidine ACI (Demerol)

④ Admin Prophylaxis
. Tetanus

⑤ Gastric Decompression -> O Ulcers (curling's )

④ Grafting
a) Homograft (Allograft) -> from human

b) Heterograft (Xenograft) -
from animals (pigs)
2) Autograft -> from self
a) Syngenic graft ->
from twin
Bls updates
↳ every 1
years update
& Priority C-A-B
:

il

② Tagline
:

Push hard and fast"

"Work on your knees"
8 Activity :

chest Compressions -> 30 Aside note

↳ Rescue breathing 2 rescuers infant

:
+ 2

2
in fant-> finger tech 15 :
2 .

④ Compressions :

~ Rate 100 120bpm :

-

/ Placement lower half :

sternum

~ Depth A at least 2 inches

:
-

C -
1 5-2 inches
.

I- I inch

5
⑧ cycles
:

⑥ Order/ sequence
~Establish unresponsiveness
~ check for pulse & breathing
~ Activate Ens

~ start Compressions
 Medical - Surgical: Peri-Op Nursing
Peri-op nsg.
↳ application : usg to entire surgical exp.

Phases: * PBG start end

Pre-Op D upon decision to

upon transfer to

undergo surgery OR table

Intra-op ORtable upon tranfer to

PACU
Post-OP PAM A Full Recovery 1020F) optimum level : functioning

Categories of surgery
⑰ According Purpose to

① Ablative - "to remove"" ectomy"

② Diagnostic to identify problem
-

⑧ Palliative to relieve slox-

Ccolostomy) -

④ Constructive to create ->

⑤ Reconstructive - to "repair" dapat nasira -

④ Transplant to replace mal/non faning organ

->

LA post transplant - steroid therapy/immuno suppression therapy

R :

O rejection
⑬ According to surgery
① Emergent -> at once !

② Urgent delayed for 24

·
->

O Required -

needed but delayed wis/mos

④ Elective ->
recommended but doing so is not dangerous
not

⑦ Optional ->
It's preference (cosmetics surgery)

⑥ According to
degree = Risk .

0 Major Risks
to General/Regional Anes
L Requires admission

② Minor ↓ Risks
↳ Local Anes
Le out patient
Pre-op phase
A. Pre op assx
① Nutrition/hydration
↳ poor N & H =

poor wound healing

* PBG *
CHON- most important ->
wound healing
② Dentition
↳ dentures -> remove
R O aspiration
!

I
:

loose tooth -

refer
③ Cardiovascular status
↳ unctrolled HPN-s postpone surg !
④ Respiratory status
! desi * w
↳
smoking -> STOP

⑮ Endocrine status
↳ liver failure -
cannot metabolize anesthesia
↳ DN
In Cushing's Dx I Sugar poor wound
healing
⑥ Renal status
↳ ARF-D CII for surg .

> Postpone
(Acte Renal Failure)
⑦ Allergies
↳ anesthesia -
Skin Test

↳latex allergy -> condom & Ask it allergic :

~ Banana

~ Avocado
~ Kiwi
~ Chestnuts

⑧ Medications
↳
Anticoag - e .

g .

Wartarin/Heparin -

if di alam
yung gamot
-
ask it nagta take siya
Y Thrombolyti ASA)
Antipl Plasik ask it may disorders that
e
gamot
- g ng mga
. .

- eg .
.

Altaplase involve coagulation .

⑨ Psychosocial *
e -

g . is chemic stroke

↳ Most common fear :

are unknown
Mg7 RN :
- education

MD +

explain e procedure

⑩ SpirituAl
↳ Religious/ Spiritual procedure -> CT
 B. Health education
↳p When is I best time ?
~upon admission
~A the day or night before surg
~ pt . is less anxious

A educate pt on what to expect

A answer valid questions honestly
* reassurance -

therapeutic -
100 % sure

- non-therapeutic false :
reassurance

Inclusions:
① >
-
Deep breathing/coughing exercises use a splint (hug a pillow)
② Use of incentive spirometry
R 1 &2
promote lung expansion
:
->

I lung collapse
⑧
02
->
promote
facilitate elim CO2

③ Movement/mobility/exercise
* PBA :

single most effective way to % surg complication

.

↳ EARLY AMBULATION

~ promotes lung expansion

~promote circulation

~promote healing
I venous stasis +
O DVT
~ promote muscle strength
~ promotes peristalsis
④ Pain and pain mgt
I during ->
painless
↳ after ->
V pain but pain meds will be given
↳ other pain mgt method
Guided A date control theory
I eg . .
Imagery
deep breathing
C. Consent
↳ "permission"
A who obtains to
surgeon

Requisites of a valid consent

/ Legal Age (18 yo and above)
~ Sound Mind -> if there is awareness I Legal
capacity
~ Understanding
~Voluntary
Special consideration (who will give the consent)
⑧ Minor -> Parents or Real Guardian
② Emergency -
Pt - LOL

↳ relatives
Doctor
present
-
Resident
⑧ Illiterate Pt -> thumbmark /"X" mark.
-> .

④ Physically incapable o signing -> pt -> representative .

⑤ Mentally III I awareness A Voluntary -> Pt

- >

I
- .

Admission
5 awareness
-
Involuntary -> next o kin
Admission

D. Bowel prep
↳ a) NPO -> 8 or post-midnight
* AAA 80 before -

regular meals

60-soft diet
40 -

full liquid
20 -

clear liquid (water)

<20 -

WPO
B) enema -> X Routine

↳ only during bowel related except appendicitis

C) administer of antibiotics
* PBG R: #0 microorganisms in e 615

E. Administer pre-op medication

* PBQ Best time :

~ After signing consent

~60-90 mins before surgery
~ Before induction o anesthesia
Purpose - Risk for complications
:

a) Anesthesia required
↳ anxiety/ sedate
anxiolytics mild tranquilizers g"- pam"
&
e g . .
·

e .

sedatives ·

hyprotics
B) anticholinergics
↳ ↓
gastric and oral secretions ->
O aspiration
e g Atropine 504 . .

SE : Dry Mouth
C) anti emetics
↳I vomiting -> O aspiration
e g .
Metochlopramide (Reglan)
.

D) h2rb (H2 receptor blockers)

↳ O Ulceration [Cushing's Disease)
"- tidine"
e .

g .
 E) narcotics
↳ ↓ required dose i anesthesia
e g Fentanyl . .

Final Note :
~ Remove nail polish
R CRT
to
properly assess
:

1 After pre-op med :

>CBR (complete bed rest)

>provide bed pan
>Raise side rails
>Provider call bell
I -> safety

Intra Op Phase
A. Or traffic system
- OR is divided =
R Ocontamination
:

A) unrestricted area
↳ waiting area

In attire :

anything
B) semi-restricted area
In nurses station

attire scrub + Cap

:

->

C) transition area
↳ area for handwashing and scrubbing
-> attire :

MaSk

D) restricted area
↳ OR theater

In attire OR gown t gloves

:

B. Aseptic technique tongue depressor =

tongue blade

⑪ Handwashing
BBQ Duration - 10-20 secs
:

Elements :
/ H20
~ soap CW8 :

~ friction -> most important brush -

skin impairment
② Scrubbing povidone -

skin integrity
↳ done :
/ Sterile personnel
↳ equipment :
·

sponge
orange stick
·

↳ solin :

chlorhexidine soln
 ↳ Area from tip :

5 fingers to Cinches above elbow

->
after
:
hands / fingers are pointing up
⑤ Sterile Field
↳ center :
sterile
unsterile
edges
:

⑭ Gown
↳ Sterile from chest to level : sterile field
I from
:

2 inches above elbow to stockinette

rest : unsterile
⑤ Gowning another person
: e gown shoulder area and
grasp I outside portion
↳ at

tuck hands
A gown until 2 inches above elbows and let go
↳ the gown - non-sterile personnel
④ Do not shake the gown/linen
R O turbulance
:

⑦ Opening sterile packs

↳ tech :

away
->
placing needed supply on e SF-DROP !
-> check e packaging ->
exp .
date
Ipmanufacturer's instruction
↳ integrity
⑧ Air cycle
-> 15 air exchanges hr
⑨ Donning OR A!ire
* PBQ cap-mask-gown-gloves
⑩ Doffing OR A!ire
* PBQ gown-gloves mask-cap -

⑪ Torn , soiled, wet linen/drapes

Unused surgical fluids 3 Discard

⑲ C. Or team
Sterile personnel Non-sterile personnel
↑

- -
R

"Scrubbing" "handwashing"
Sterile team
① Surgeon
↳
captain : ship
->
anything in ORwron -
accountable

↳ conducts directs, oversee the

,
surgery
↳ creates progress notes
-
performs skin preparation
->
applies e 1st dressing
 ② Assistant Surgeon
AssISTS
I" Fin
.

↳ hemostasis -
control bleeding
③ Scrub Nurse
↳ hands instruments / supplies
* PBQ 1st instrument to be handed

↳ assist in
↳ towel clips
surgical counting actual count ->

*
counting -> 3x-> 1st before opening -

↳ 2nd before closing a cavity

-

3rd-before closing e skin

assist in specimen collection
* PBai labels e specimen
I prepares mayo table/sterile field
↳ gowns e surgeon /assist Surgeon .

⑧ Patient
* PBA *
center : i sterile field

Non-sterile team
① Anesthesiologist
↳ A :
Guardian 8 2 pt
to Monitor e vitals (pt status
↳ Induction : anesthesia
↳ A Transfers i pt from OR to PACU
IP Primary Physician in PACU
↳ Incharge o pain mgt
② Circulating Nurse
I & Guardian sterility -
i conscience -> strict adherence to aseptic

In Prepares and ensures functionality tech I honesty

↳ pocanipmetitional inst/supplies/equipment t
I A Perform surgical time-out
↳ purpose O Wrong pt/site/ :

sury .

↳
Note Ist priority in receiving pts in OR
:

↳ Identity & consent

Assist in counting ->
verify count
↳ Assist in specimen collection - transport to lab
t Nurse Lidson -> coordinates : family
 ⑤ Bi!edical Technician
* In always present during laparoscopic procedure
⑭ Ancillary Personnel
↳ clean E OR

* best time to clean

:
in blu cases

* order case :
cleanest to dirtiest

A
ing Tandem -

Scrub-Circu

D. Skin prep
↳ prep the surgical site
ti cleanse e area
~ usepovidone iodine + alcohol strips
~ tech inner to outer
:

circular motion =

/ hairy site -> X shave

↳& clip ! -using electric clipper A

E. Anesthesia
↳ Types : black outlet -
nitrogen
① General
↓ route : Inhalation --
"-flurane"
L ANO (Nitroce oxide)[laughing gas)
·
IV -> A propofol
* safest children -> Ketamine (ketalar)
~ Complete state o total amnesia , analgesia Aconsciousness
,

~ stages :

A) beginning anes stage

/mgt
LOC -
:

B) excitement stage excessive mort (shout laugh cry) slow down ->
, ,

C) surgical anes stage -total loss o cons .

D) medullary depression stage Resp Arrest -> .

~ complication Malignant Hyperthermia - ↑Temp

:

↳ cause Anes->ab contraction -> Theat DEATH

untreated ->
:

-> -

catform o muscle prod .

(Dantrium)
DOU Dantrolene
:

& Regional (aka nerve block)

/ Types spinal-anes deposited
:
in subarachnoid -> dural puncture
epidural-anes deposited in epidural space
·
spinal
complications :

CSF leakage
mgt : RN-pos flat ,
&
common complication o spinal
MD- blood patching & epidural hypotension
:

Epidural
complications :
bladder distention /Route & intrathecal (spine)
mgt
:
(athe ter
 ④ Local
↳ admin directly on e site
↳ forms IM
:

,
SQ , gargle spray topical
, ,

* EMLA-euletic mixture o local anes . -> Topical (for I insertion)

↓
cannulation

e .

g lidocaine
.

Post-op
A. Airway mgt
↳ pos unconscious
,
->
flat on bed I head turned to side
I pillow support
R O airway obstruction
:

* PBA Most :

common cause oairway obstruction post-ops :

hypopharyngeal Obstruction - tongue

conscious -- semi-fowler's
I equipment endotracheal :

/tracheostomy /suction set

I bed side
for emergency
:

B. Vital signs monitoring

↳ 1st hr ->
915 mins
↳
2nd hr-9 30 min;
3rd hr 91 when stable
94
->
↳ and

C. Monitor for post-op complications

A) atelectasis 24 480 - -

prevent deep :

breathing & coughing exercise

B) pneumonia -> 3-5

days
Mgt Antibiotics:

C) wound infection -
7-14 days
Mgt : Antibiotics
7-14 days
D) wound separation -

I
L Dehisence -

open up
mgt apply pressure
.

Evisceration ->
open up + expulsion : contents

most common cause : mgt cover I saline soaked dressing

.

WOUND INFECTION R O :

drying = 8 cellular death

E. GIT Complication
Constipation <3 days To anscultate
3 No bm confirm
-> :

Paralytic ileus -> >3 days BM bowel sounds

Mgt Early Ambulation
:

Special Senses
In Eye and Ear Concept

Eye concept
BASIC ANATOMY & PHYSIO2065
① Sclera -> whites e eye
-> outermost layer
- maintains eye shape
clinical significance
child -
lightly bluish
N
Elderly -

Highly yellowish
Blacks *
② Cornea -> anterior dome-like structure
↳ clear !
1 Refraction
n
->
bending of light
L "Kerato" -
medical term,

clinical significance
* PBA :

Keratitis -
> inflam I .
corned

③ Iris -> colors o i eyes

↳ color-> Black or hazelnut brown
In muscular organ -
contract - dilation
. - 0
I relax I constriction & -N
⑭ Pupil ->
space in e middle o iris

clinical significance med term

. meds :

bright -

constrict -> miosis ->

miotics
dim- dilate -p mydriasis -

mydriatics
* PERRLA (Pupils Equally Round & Reactive to Light and Accommodation)

↳ consensual pupil reflex

CN (cranial nerves #I -
occulomotor

⑤ Lens
I almostcompletely transparent lit a
In if lens becomes opaque
=
cataract

0
6
Retinal - innermost layer
In contains photoreceptors ->
cones + color
In rods-dimness

focus- clear
scatter-blurred
 clinical significance
color blindness ->
prob in econes
↓ hereditary
↳ A DX tool :
Ishihara plate test
⑦ Cilliary body - production of tumor
-N mmHg
⑧ Canal of Schlemn/ trabecular meshwork -

drainage o AHA Regulates IOP 10-21

⑨ Cranial nerve II (optic nerve)

↳ delivers
light interpret to occipital lobe