Which of the following items on a client's presurgery laboratory results

would indicate a need to contact the surgeon?

d. Hemoglobin 9.5 mg/dl

A client is scheduled for surgery in the morning. Preoperative orders
have been written. What is most important to do before surgery?

b. Verify that all laboratory work is complete

c. Inform family or next of kin

d. Have all consent forms signed---

Which of the following drugs is administered to minimize respiratory
secretions preoperatively

c. Atropine sulfate--
The nurse is admitting a patient to the operating room. Which of the following
nursing actions should be given highest priority by the nurse?

a. Assessing the patient’s level of consciousness

b. Checking the patient’s vital signs

c. Checking the patient’s identification and correct operative permit

d. Positioning and performing skin preparation to the patient

Which of the following assessment data is most important to determine when
caring for a patient who has received spinal anesthesia?SAB--sub arachnoid
block--l3 to l4---

a. The time of return of motion and sensation in the patient’s legs and toes

b. The character if the patient’s respiration-

c. The patient’s level of consciousness

d. The amount of wound drainage

medications--
cardiovascular medication---antihypertensive---clonidine, anti
arrythmics----

xxxx---ace inhibitors--pril,, diuretics, calcium channel blockers

( nifedipine)

NSAID--10 days before the surgery --mobic

diclofenac--1 day before the surgery
ibuprofen-- 1 day before the surgery
antiplatelet medeication--- clopidogrel
aspirin--5 days before surgery
warfarin( coumadin)-oral-5 days surgery
pills-- (estrogen)--1 month before the surgery-- for thromboembolism
risk
Dm--metformin-1 day before the surgery---lactic acidosis

herbal preparation---garlic, gingko, ginseng---bleeding risk\

-st john’s wort
pre op meds
opiates--potentiate anesthesia, relieve the discomfort and relax the patient
meperidine- ) demerol
morphine and fetanyl
anticholinergic- decrease respiratory tract secretions/prevent slowing of HR
atropine sulfate--increase the heart rate--dry mouth

sedatives--relax the patient, reduce anxiety, ensure a restful night sleep

diazepam( valium), midazolam
H2 receptor antagonist--decreases the HCL
raniditine, famotidine, cimetidine
antiemetics-decrease n and V, increases the gastric emptying
-metoclopramide ( plasil), ondansetron
tranportation to the operating room
anesthesia--
general anethesia--IV or inhalation

local anesthesia

regional anesthesia--peripheral nerve block

spinal anesthesia
epidural anesthesia
• complication of general anesthesia

• MH--malignant hyperthermia--hypermetabolism of skeletal muscles

due to defective calcium transportation ( excessive intracellular
accumulations of calcium 0----hpermetabolism and muscle
contraction /spasm

• hereditary--defective genes
• more common in males
s/s--hypertabolism
first sign-----tachycardia
late sign--rise in temperature/high fever
tachypnea
unstable blood pressure--- increased in
pseudotetany-spasm/muscle rigidity
increased in C02- risk for respiratory acidosis
treatment
--discontinue administration of inhalant anesthetic
--sodium bicarbonate--correct the respiratory acidosis
--dantrolene sodium--treatment of choice
--diuretics( furosemide)
--oxygen therapy
--chilled Iv fluids NAcl or d5water---
--hypothermic measures--cooling blanket
Gestational diabetes
Diagnostic test

benedict test--sugar in the urine ( glycosuria)-blue--normal

--blue green --trace
---yellow--+1
--orange0-- +2
--red-- +3
• compliaction---
• hypoglycemia-----decrease muscle tone, poor sucking reflex, shakiness and
seizure cold skin, pale
• d10 water ( blue green), check the sugar level of the baby
management:
1. insulin therapy
2. diet and exercise--- well balanced diet
cho-- 50%
chon -30 %
fats -20 %
exercise-
3. monitor glucose level
4. wof complications--infection ---urinary infection, vaginal infection
preterm labor, pre eclampsia, gestational hypertension, cesearean section
Supine hypotension syndome- vena cava
syndrome
• supine-------enlarging uterus compressed the vena cava--decrease
venous return to the heart--- decrease blood pump by the heart
( decrease cardiac output)-----decrease tissue perfusion ( pallor,
dizziness, faintness, cold and clammy skin), hypotension and
tachychadia, fetal distress
• management---position on her side, avoid suine position, place a
pillow under the client;s hips
precipitous labor---labor lasting less than 3
hours
-mother--lacerations of the cervix, vagina or perineum
--baby---intracranial hemmorrhage-----sudden change in pressure on
the fetal head during rapid expulsion
Mangement:
1. delivery tray always available
2. stay with client at all times
3. encourage the client to pant between contraction
4. crowning---if bag of water intact--artificial rupture of the
membrane
5. encourage emotional support to the mother
Dystocia--difficult, prolonged, painful labor

• causes--uterine contraction-
• hypotonic contraction---short, irregular and
weak--administration oxytocin (Pitocin)
• hypertonic contraction--frequently and
uncoordinated cntraction---pain relief measures
• fetus---large, abnormal presention--breech
• bones of the maternal pelvis
• excessive abdominal pain
• abnormal contraction pattern
• fetal distress
• lack of progress in labor
management
1.monitor the uterine contraction
2. comfort measures-- back rubs
3. prophylactic antibiotic--
4. fluid replacement---iV fluids
5. check the color of amniotic fluid--- meconium stained
6. hypotonic contraction -- administration fo oxytocin
7. check the fht, monitor for fetal distress
8. prolonged labor with fetal distress- CS
9. assist for ultrasound and pelvic examinatiom
uterine inversion---inside out
• completely or partly turns inside out
• occurs during delivery or after delivery of the placenta

• assessement:
• depression in the fundal area of the uterus
• severe pain
• bleeding
• hypovolemic shock
• uterus seen through the cervix or protruding through the vagina
intervention
wof hypovolemic shock--- modified trendelenburg position
iv fluids replacemnet- PNSS
return the uterus to the correct position via the vagina-----if not
treated --laparotomy
uterine rupture---tearing in the wall of the
uterus
assessment--abdominal pain
--rigid abdomen
--conntraction may stop
--bleeding and hypovolemic
---absent of FHt and fetus palpated outside the uterus
management
WOF signs of HS and treatment for shock
prepare the client for cesarean section--if not repaired
---hysterectomy ( removal of the uterus)