Lecture 12 - Perioperative Nursing

‭Perioperative Period‬ ‭Preoperative Phase‬ ‭‬ B ● ‭ egins when the patient and surgeon mutually decide that surgery is necessary/will occur‬ ‭●‬ ‭Ends when the patient is transferred to the operating room (OR) or procedural bed‬ ‭Intraoperative Phase‬ ‭‬ B ● ‭ egins when the patient is transferred to the OR bed‬ ‭●‬ ‭Ends with transfer to the postanesthesia care unit (PACU)‬ ‭Postoperative Phase‬ ‭‬ B ● ‭ egins with admission to the PACU or other recovery area‬ ‭●‬ ‭Ends with complete recovery from surgery and the last-follow up provider visit‬ ‭Question:‬‭In which phase of the perioperative period‬‭is a patient be transferred to the OR bed?‬ ‭a.‬ ‭Preoperative phase‬ ‭b.‬ ‭Intraoperative phase‬ ‭c.‬ ‭Postoperative phase‬ ‭Classification of Surgical Procedures‬ ‭Urgency‬ ‭Emergency‬ ‭‬ D ● ‭ one immediately‬ ‭●‬ ‭Purpose: Prevent further tissue damage and preserve life‬ ‭●‬ ‭Ex. repair of trauma and perforated ulcer‬ ‭Urgent‬ ‭‬ W ● ‭ ithin 24-48 hours, a short time frame but not an emergency‬ ‭●‬ ‭Purpose: Remove/repair a body part to preserve/restore health‬ ‭●‬ ‭Ex. surgical removal of a malignant tumor, amputation, or CABG‬ ‭Elective‬ ‭‬ N ● ‭ o ill effects‬ ‭●‬ ‭Can be scheduled and preplanned based on the patient’s choice‬ ‭●‬ ‭Purpose: Restore function, improve health, improve self-concept, and remove/repair a‬ ‭body part‬ ‭●‬ ‭Ex. Tonsillectomy, facelift, hernia repair‬ ‭Risk‬ ‭Major‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ lective, urgent, or emergency; may require hospitalization and specialized care‬ E ‭Higher degree of risk and involves major body organs or life-threatening situations‬ ‭Purpose: Preserve life, remove/repair a part, restore function, improve/maintain health‬ ‭Ex. Colostomy, trauma repair, amputation‬ ‭Minor‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ rimarily elective‬ P ‭Low risk and results in few complications‬ ‭Performed in settings such as a healthcare provider’s office or outpatient clinic‬ ‭Purpose: Remove skin lesions and correct deformities‬ ‭Ex. Tooth extraction, skin biopsy, and arthroscopy‬ ‭Purpose‬ ‭Diagnostic‬ ‭‬ T ● ‭ o make or confirm a diagnosis‬ ‭●‬ ‭Ex. biopsy‬ ‭Ablative‬ ‭‬ T ● ‭ o remove a diseased part‬ ‭●‬ ‭Ex. amputation‬ ‭Palliative‬ ‭‬ T ● ‭ o relieve/reduce intensity of an illness‬ ‭●‬ ‭Ex. tumor debulking‬ ‭Reconstructive‬ ‭‬ T ● ‭ o restore function to tissue‬ ‭●‬ ‭Ex. plastic surgery‬ ‭Constructive‬ ‭‬ T ● ‭ o restore function in congenital abnormalities‬ ‭●‬ ‭Ex. cleft palate‬ ‭Transplantation‬ ‭‬ T ● ‭ o replace organs‬ ‭●‬ ‭Ex. kidney transplant‬ ‭ uestion:‬‭An exploratory laparotomy is considered which of the following classifications of‬ Q ‭surgery based on purpose?‬ ‭a.‬ ‭Diagnostic‬ ‭b.‬ ‭Ablative‬ ‭c.‬ ‭Palliative‬ ‭d.‬ ‭Reconstructive‬ ‭Method‬ ‭Laparotomy‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ pen abdominal surgery‬ O ‭Incision into teh abdominal wall, exposing peritoneal cavity‬ ‭Urgency: Ranges from elective to emergent‬ ‭Degree of risk: Major‬ ‭Purposes: Diagnostic, ablative, palliative, transplantation‬ ‭Endoscopic‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ inimally invasive procedure with a small incision‬ M ‭Inserting scope to photograph/record internal structures‬ ‭Surgical instruments inserted into openings to operate‬ ‭Urgency: Ranges from elective to urgent‬ ‭Degree of risk: Minor‬ ‭Purposes: Diagnostic, palliative, reconstructive‬ ‭Laparoscopic‬ ‭●‬ ‭Abdomen/pelvis‬ ‭●‬ ‭Ex. tubal ligation‬ ‭Arthroscopic‬ ‭●‬ ‭Joints‬ ‭●‬ ‭Ex. ACL tear repair‬ ‭Thoracoscopic‬ ‭●‬ ‭Thoracic cavity‬ ‭●‬ ‭Ex. lobectomy‬ ‭Robotic‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ inimally invasive procedure‬ M ‭A surgeon controls robotic arms to perform a surgical procedure‬ ‭Uses a high-definition camera and more precise movements‬ ‭Urgency: Ranges from elective to emergent‬ ‭‬ D ● ‭ egree of risk: Minor (low infection risk)‬ ‭●‬ ‭Purposes: Palliative, reconstructive‬ ‭Legal Documents‬ ‭Informed Constent‬ ‭●‬ P ‭ atient’s voluntary agreement to undergo a particular procedure/tx completed by the‬ ‭person performing the procedure, includes:‬ ‭○‬ ‭Description of the procedure (name, site) and alternatives‬ ‭○‬ ‭The disease process and its natural course‬ ‭○‬ ‭Name and qualification of the person performing the procedure‬ ‭○‬ ‭Common risks associated with surgery‬ ‭○‬ ‭That consent can be withdrawn and the patient has the right to refuse‬ ‭○‬ ‭Expected outcome, recovery, and rehabilitation plan‬ ‭●‬ ‭Must be signed, dated, and timed as a legal document‬ ‭●‬ ‭The pt must not be confused, unconscious, sedated, mentally incompetent, or a minor‬ ‭○‬ ‭Consent may be given by parent, spouse, next of kin, or legal guardian‬ ‭Advanced Directives‬ ‭‬ L ● ‭ iving wills (ex. DNR)‬ ‭●‬ ‭Durable power of attorney for healthcare‬ ‭ uestion:‬‭A nurse is discussing a surgical procedure‬‭with a client who needs to sign his‬ Q ‭informed consent. Which of these tasks is part of the nursing role?‬ ‭a.‬ ‭Explaining to the client potential risks of having the surgery‬ ‭b.‬ ‭Witnessing the client’s signature with their consent for surgery‬ ‭c.‬ ‭Describing how the client will benefit from the surgical procedure‬ ‭d.‬ ‭Determining for the client what other treatment options exist‬ ‭Types of Anesthesia‬ ‭‬ G ● ‭ eneral‬ ‭●‬ ‭Regional‬ ‭●‬ ‭Topical/local anesthesia: Applied or injected as an ointment/cream (ex. lidocaine; done‬ ‭for a simple procedure (ex. cosmetic/dental)‬ ‭●‬ ‭Moderate sedation/analgesia (conscious sedation/analgesia)‬ ‭○‬ ‭Partial consciousness‬ ‭○‬ ‭Maintain CV function and breathing but increased threshold of pain‬ ‭○‬ ‭Ex. colonoscopy, upper GI endoscopy‬ ‭○‬ ‭More uncomfortable than painful‬ ‭General Anesthesia‬ ‭Optimal Combination of the agents‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ nalgesia (loss of response to pain)‬ A ‭Loss of reflexes (temporary paralysis)‬ ‭Loss of consciousness‬ ‭Relaxation (skeletal muscle)‬ ‭○‬ ‭Allows surgery to be performed‬ ‭○‬ ‭Breathing is maintained‬ ‭Three Phases‬ ‭ ‬ I‭ nduction: From administration of anesthesia to ready for incision‬ ● ‭●‬ ‭Maintenance: From incision to near completion of procedure (incision made to suture)‬ ‭●‬ ‭Emergence: Starts when patient emerges from anesthesia/awakens and is ready to leave‬ ‭the OR‬ ‭ uestion:‬‭As a circulating nurse caring for a 45 y/o‬‭male undergoing L knee arthroscopic‬ Q ‭exploratory surgery, which task ensures that the team is on the same page and will perform the‬ ‭procedure on the right client and at the right site?‬ ‭a.‬ ‭Procedural pause (time-out)‬ ‭b.‬ ‭Preoperative checklist‬ ‭c.‬ ‭Informed consent‬ ‭d.‬ ‭Operative site marking‬ ‭Complications‬ ‭Respiratory‬ ‭●‬ ‭Sore throat (endotracheal tube)‬ ‭●‬ ‭Airway trauma‬ ‭●‬ ‭Hypoventilation (if mechanical ventilator is not properly set up)‬ ‭●‬ ‭Hypoxemia: PaO‬‭2‬ ‭< 80 mmHg)‬ ‭●‬ ‭Hypercarbia: PaCO‬‭2‬ ‭> 45 mmHg‬ ‭●‬ ‭Aspiration PNA: Secretions regurgitating to the trachea‬ ‭Cardiovascular‬ ‭●‬ ‭Hypotension: Vasodilation, reduced SVR and CO‬ ‭○‬ ‭Can lead to distributive shock‬ ‭○‬ ‭Not enough pressure to distribute blood‬ ‭●‬ ‭Hypertension: Activation of SNS, insufficient drug administration, decreased oxygen‬ ‭○‬ ‭Can lead to hemorrhage internally or at surgical site‬ ‭●‬ ‭Arrhythmias: Reduced CO and prolonged QT interval‬ ‭●‬ ‭Increased risk of:‬ ‭‬ ○ ‭○‬ ‭○‬ ‭○‬ ‭ ulmonary embolism/DVT: Lack of movement‬ P ‭Thrombophlebitis: Muscle relaxants and lack of movement‬ ‭Aspiration PNA: Stomach contents into the lungs‬ ‭Atelectasis: Changes in breathing pattern and gas exchange; deflated alveoli‬ ‭Neurological‬ ‭●‬ ‭Awareness: Partially conscious due to insufficient drug administration (different‬ ‭anesthetic requirements) or machine malfunction‬ ‭●‬ ‭Delayed recovery: Altered drug metabolism, drug interactions, very young/old, prolonged‬ ‭surgery, and hepatic/renal failure can make the patient unable to regain consciousness or‬ ‭respond to external stimuli within the expected timeframe after anesthesia‬ ‭●‬ ‭Perioperative neuropathy: Patient positioning, mechanical trauma, anesthetic toxicity,‬ ‭ischemic injury, and surgical trauma can damage nerves/decrease perfusion during a‬ ‭procedure‬ ‭Hypothermia‬ ‭●‬ ‭Core temperature less than 36° C (96.8° F)‬ ‭○‬ ‭Normal core temperature: 37° C (98.6° F)‬ ‭●‬ ‭Alters/suppresses thermoregulatory mechanisms (ex. Hypothalamus, shivering,‬ ‭vasoconstriction)‬ ‭●‬ ‭Decreased immune response, inactive ventilation, and inadequate circulation‬ ‭●‬ ‭Results in delayed postoperative recovery, surgical wound infection, pleural effusion,‬ ‭PNA, hypoxia, kidney failure, cardiac arrest‬ ‭Regional Anesthesia‬ ‭‬ P ● ‭ eripheral nerve blocks‬ ‭●‬ ‭Spinal anesthesia: To subarachnoid space‬ ‭○‬ ‭Ex. pelvic surgery, childbirth‬ ‭●‬ ‭Epidural anesthesia: To epidural space‬ ‭○‬ ‭Takes 10 minutes to work‬ ‭○‬ ‭Head kept flat to avoid leaking from injection site‬ ‭●‬ ‭Caudal anesthesia: To sacral hiatus epidural space‬ ‭●‬ ‭Not completely unconscious but rather numb; sedation may be given‬ ‭○‬ ‭Less complications than general anesthesia‬ ‭Developmental Considerations‬ ‭Infants‬ ‭●‬ ‭Lower total blood volume‬ ‭○‬ ‭Slight blood loss can lead to hypovolemia‬ ‭●‬ ‭Small, soft, and pliable airway‬ ‭○‬ ‭Obstruction can result in respiratory failure/hypoxia‬ ‭●‬ ‭Undeveloped shivering reflex (hypo/hyperthermia)‬ ‭●‬ ‭Prolonged effects/toxicity of muscle relaxants and narcotics due to immature liver‬ ‭Older Adults‬ ‭●‬ ‭Decreased ability to respond to teh stress of surgery‬ ‭○‬ ‭Prone to infectio‬ ‭○‬ ‭Increased time taken to heal‬ ‭●‬ ‭Health conditions and previous surgeries‬ ‭○‬ ‭Ex. diabetes, HF‬ ‭Risks of Medications‬ ‭Anticoagulants‬ ‭‬ C ● ‭ an cause hemorrhaging due to reduced clotting factors‬ ‭●‬ ‭Takes longer for clots to form when necessary, leading to excessive bleeding‬ ‭●‬ ‭Ex. warfarin, heparin‬ ‭Tranquilizers‬ ‭●‬ I‭ ncrease the probability of hypotension due to CNS depression, vasodilation, and‬ ‭decreased baroreceptor sensitivity‬ ‭●‬ ‭Ex. benzodiazepines, barbiturates‬ ‭-Mycin Antibiotics‬ ‭‬ M ● ‭ ay cause respiratory paralysis when combined with certain muscle relaxants‬ ‭●‬ ‭Combinecd, these interfere with acetylcholine function, affecting muscle contraction‬ ‭●‬ ‭Ex. streptomycin, erythromycin‬ ‭Diuretics‬ ‭●‬ M ‭ ay cause electrolyte imbalances due to increased excretion of sodium, potassium,‬ ‭chloride, and water‬ ‭●‬ ‭May intensify the effects of respiratory depression from anesthesia because of decreased‬ ‭muscle function and CNS disturbances‬ ‭●‬ ‭Ex. hydrochlorothiazide, chlorthalidone‬ ‭Adrenal Steroids‬ ‭●‬ M ‭ ay suppress immune function by inhibiting inflammatory cytokine production and‬ ‭impairing immune cell function‬ ‭●‬ C ‭ an also cause CV problems for long-term users, leading to HTN, atherosclerosis, and‬ ‭thrombosis‬ ‭●‬ ‭Ex. glucocorticoids‬ ‭Oral Antidiabetic Medication‬ ‭‬ C ● ‭ an cause acute renal failure when combined with iodine‬ ‭●‬ ‭Iodine contrast agents can reduce kidney function, and oral antidiabetics (ex. metformin)‬ ‭are cleared by the kidneys‬ ‭●‬ ‭If kidneys are impaired, metformin can build up, causing lactic acidosis and renal failure‬ ‭Patient Risk Factors‬ ‭Nutrition‬ ‭Malnutrition‬ ‭‬ F ● ‭ luid and electrolyte balance: Hyponatremia and hypokalemia‬ ‭●‬ ‭Wound complications: Delayed healing, risk for infectino, lower wound tensile strength,‬ ‭prolonged inflammation‬ ‭Obesity‬ ‭●‬ R ‭ espiratory: Obstructive sleep apnea, reduced lung volume, and obesity hypoventilation‬ ‭syndrome can increase the risk for respiratory distress‬ ‭●‬ ‭Cardiovascular: HTN, HLD, atherosclerosis, HF, dysrhythmias‬ ‭○‬ ‭Greater risk of complications, such as unstable BP, abnormal heart rhythms, and‬ ‭intraoperative HF‬ ‭●‬ ‭Positional injury: Compression of nerves/skin or reduced circulation/respiration‬ ‭●‬ ‭DVT: May cause PE; requires blood thinners‬ ‭●‬ ‭GERD: Risk for aspiration of stomach contents (leaking into esophagus)‬ ‭●‬ ‭Wound complications: Delayed healing, infeciton risk, disrupted wound integrity,‬ ‭decreased perfusion‬ ‭Patient Medical History‬ ‭Respiratory Disorders‬ ‭‬ E ● ‭ x. Pneumonia, bronchitis, asthma, emphysema, COPD‬ ‭●‬ ‭Increased risk from anesthesia for:‬ ‭○‬ ‭Respiratory depression‬ ‭○‬ ‭Post-operative PNA‬ ‭○‬ ‭Atelectasis‬ ‭○‬ ‭Alterations in acid-base balance‬ ‭Cardiovascular Disease‬ ‭‬ E ● ‭ x. thrombocytopenia, hemophilia, recent MI/cardiac surgery, HF, dysrhythmias‬ ‭●‬ ‭Increased risk from anesthesia for:‬ ‭○‬ ‭Hemorrhage‬ ‭○‬ ‭Hypovolemic shock‬ ‭○‬ ‭Hypotension‬ ‭○‬ ‭Venous stasis‬ ‭○‬ ‭Thrombophlebitis‬ ‭○‬ ‭Overhydration with IV fluids‬ ‭Liver and Kidney Diseases‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ I‭ nfluence response to anesthesia: Metabolism and excretion‬ ‭Electrolyte and acid base imbalance: Unable to maintain homeostasis‬ ‭Drug metabolism and excretion: Can prolong effects or cause toxicity‬ ‭Impaired wound healing:‬ ‭○‬ ‭Liver: Albumin, clotting factors‬ ‭○‬ ‭Edema, toxins in bloodstream, decreased erythropoiesis‬ ‭Endocrine Diseases‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ x. Diabetes mellitus‬ E ‭Increased risk for hypoglycemia or acidosis: Pre-operative fasting, stress, meds‬ ‭Slow wound healing: Impaired circulation, increased risk for infection‬ ‭Higher risk for post-operative CV complications: Chronic inflammation, vascular‬ ‭damage, metabolic imbalances‬ ‭Additional Risk Factors‬ ‭Substance Use‬ ‭‬ H ● ‭ abitual alcohol intake requires larger doses of anesthetic agents/analgesics‬ ‭●‬ ‭Illic drug use can cause a higher risk for interactions with anesthetic agents‬ ‭●‬ ‭Smoking increases the risk for post-operative respiratory complications and wound haling‬ ‭complications, such as vasoconstriction and impaired perfusion to healing tissues‬ ‭○‬ ‭Increased risk for hypoxia and post-operative PNA‬ ‭Functional Status and Occupation‬ ‭●‬ R ‭ egular exercise, rest, and sleep habits reduce surgical risks by improving overall health‬ ‭and facilitating recovery‬ ‭●‬ ‭Potential delays in returning to work/usual activities considered post-operative care‬ ‭Coping Mechanisms and Support Systems‬ ‭‬ S ● ‭ urgery is a major psychological stressor‬ ‭●‬ ‭Strong support system (family, friends, spirituality) to cope with stress‬ ‭Sociocultural Needs‬ ‭‬ P ● ‭ atient’s and family’s verbal/nonverbal communication should be considered‬ ‭●‬ ‭Familial health beleifs/practices, economic factors, and cultural/ethnic backgrounds‬ ‭Presurgical Screening Tests‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ omplete blood count‬ C ‭Electrolyte levels (Na, I, CO‬‭2‭,‬ Cl)‬ ‭BGL‬ ‭Kidney function (BUN, Cr)‬ ‭Live function (AST/ALT)‬ ‭Hemostasis (PTT, aPTT)‬ ‭Urinalysis‬ ‭Electrocardiography‬ ‭Chest XR‬ ‭CBC Normal Ranges‬ ‭Hemoglobin‬ ‭‬ M ● ‭ ale: 13.5-17.5 g/dL‬ ‭●‬ ‭Female: 12.0-15.5 g/dL‬ ‭Hematocrit‬ ‭‬ M ● ‭ ale: 38.8%-50%‬ ‭●‬ ‭Female: 35-44.5%‬ ‭WBC Count‬ ‭●‬ ‭4,500-10,000 cells/mcL‬ ‭Platelet Count‬ ‭●‬ ‭150,000-450,000 cell/mcL‬ ‭Electrolytes‬ ‭●‬ ‭Sodium: 135-145 mEq/L‬ ‭○‬ ‭Major extracellular fluid cation‬ ‭●‬ ‭Chloride: 97-107 mEq/L‬ ‭●‬ ‭●‬ ‭●‬ ‭‬ ● ‭●‬ ‭ ‬ ‭Major extracellular fluid antion‬ ○ ‭Potassium: 3.5-5.5 mEq/L‬ ‭○‬ ‭First intracellular fluid cation‬ ‭Magnesium: 1.5-2.5 mEq/L‬ ‭○‬ ‭Second intracellular fluid cation‬ ‭PO‬‭4‭:‬ 2.5-4.5 mg/dL‬ ‭○‬ ‭Major intracellular fluid anion‬ ‭HCO‬‭3‬‭: 22-29 mEq/L‬ ‭Ca: 8.5-10.2 mg/dL‬ ‭Blood Glucose‬ ‭●‬ ‭70/80 - 120 mg/dL‬ ‭Kidney Function‬ ‭Blood Urea Nitrogen (BUN)‬ ‭●‬ ‭7-20 mg/dL‬ ‭Serum Creatnine‬ ‭‬ M ● ‭ ale: 0.7-1.3 mg/dL‬ ‭●‬ F ‭ emale: 0.6-1.2 mg/dL‬ ‭Liver Function‬ ‭‬ L ● ‭ iver enzymes should be in the liver‬ ‭●‬ ‭If there are high amounts in blood, indicates liver impairment‬ ‭Alanine Aminotransferase (AST/GOT)‬ ‭●‬ ‭0-40 U/L‬ ‭Aspartate Aminotransferase (ALT/GPT)‬ ‭●‬ ‭0-30 U/L‬ ‭Hemostasis‬ ‭Prothrombin Time (PT)‬ ‭●‬ ‭10-20 seconds‬ ‭Activated Partial Thromboplastin Time (aPTT)‬ ‭●‬ ‭30-45 seconds‬ ‭Physical Preparation for Surgery‬ ‭Hygiene‬ ‭‬ R ● ‭ educe risk of surgical site infeciotn‬ ‭●‬ ‭Clean skin with antiseptic solutions (CHG) using “apply, lather, rinse” method‬ ‭●‬ ‭Shampoo hair, clean nails, and avoid unnecessary shaving at site‬ ‭Elimination‬ ‭‬ P ● ‭ revent complications related to bowel/bladder during surgery‬ ‭●‬ ‭Bowel preoperative enema may be prescribed prior to surgery of lower GI tract to avoid‬ ‭postoperative constipation‬ ‭●‬ ‭Indwelling catheter may be inserted prior to pelvic surgery to avoid bladder distention‬ ‭○‬ ‭Otherwise, instruct patient to void before receiving preoperative meds to ensure‬ ‭an empty bladder during surgery‬ ‭Nutrition and Fluids‬ ‭‬ C ● ‭ ounteract surgical stress and promote recovery‬ ‭●‬ ‭Perform nutrition assessments, ideally by a dietician, and provide supplemental nutrition,‬ ‭fluids, and electrolytes to ensure no deficiencies‬ ‭●‬ ‭Updated fasting guidelines:‬ ‭○‬ ‭Clear liquids: Up to 2 hours before surgery‬ ‭○‬ ‭Light meals: Up to 6 hours before surgery‬ ‭○‬ ‭Heavy meals: Up to 8 hours before surgery‬ ‭○‬ ‭Infants:‬ ‭■‬ ‭Breast milk: Up to 4 hours before surgery‬ ‭■‬ ‭Formula: Up to 6 hours before surgery‬ ‭●‬ ‭Explain and enforce NPO policies‬ ‭Rest and Sleep‬ ‭‬ R ● ‭ educe preoperative stress and promote postoperative recovery‬ ‭●‬ ‭Facilitate relaxation through psychological support, quiet environment, or sedatives‬ ‭Typical Preoperative Medications‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ arcotic/opioid analgesics: Sedation‬ N ‭Sedatives: Decrease anxiety‬ ‭Neuroleptanalgesic agents: Calmness (opioid and antipsychotic)‬ ‭Antiocholinergics: Decrease pulmonary secretion‬ ‭Antihistamines: Decrease gastric secretion‬ ‭○‬ ‭Prevent laryngospasm from intubation‬ ‭Preoperative Assessments and Interventions‬ ‭Level of Consciousness‬ ‭‬ V ● ‭ erify type of anesthesia‬ ‭●‬ ‭Assess and reorient PRN to person, place, and time‬ ‭●‬ ‭Assess reaction to stimuli and ability to move all four extremities‬ ‭Vital Signs and SpO‬‭2‬ ‭‬ O ● ‭ btain temperature, BP, pulse, RR, and SpO‬‭2‬ ‭●‬ ‭Note deviations from preoperative and PACU data as well as symptoms of complications‬ ‭●‬ ‭Assess respiartory function by monitoring respiratory rate, rhythm, and depth;‬ ‭auscultating breath sounds; noting O‬‭2‬ ‭level; assessing‬‭skin color; and observing CV and‬ ‭mental status‬ ‭●‬ ‭Assess cardiovascular function by taking vital signs, monitoring ECG rate/rhythm, and‬ ‭observing skin color/condition‬