The document discusses perioperative nursing, which involves 3 phases: preoperative, intraoperative, and postoperative care. It describes various types of surgeries based on factors like blood loss and urgency. The preoperative phase involves assessment, consent, and preparation of the patient. Preparation includes education, testing, restriction of food/fluids, and sometimes medications. The intraoperative phase focuses on the surgical procedure and roles of the surgical team.
at the end of this lecture, the learner will be able to Define the three phases of perioperative nursing.
Identify the members and functions of the surgical team.
Describe the principles of surgical asepsis.
Differentiate the three phases of post-anesthesia care.
Identify measures to manage postoperative complications.
at the end of this lecture, the learner will be able to Define the three phases of perioperative nursing.
Identify the members and functions of the surgical team.
Describe the principles of surgical asepsis.
Differentiate the three phases of post-anesthesia care.
Identify measures to manage postoperative complications.
Discover what it takes to be a Perioperative Clinical Nurse Specialist. This presentation is from AORN's webinar which describes the role of the perioperative CNS, RN. Receive 0.5 contact hours by registering for the webinar replay and successfully completing the evaluation. The webinar is available at http://bit.ly/1aROqKI.
Interested in obtaining the new CNS-CP nursing credential? Learn valuable test-taking strategies and more through a CNS-CP Certification Exam Preparation Course: http://bit.ly/GQ5Yy0.
Safe Laparoscopic Cholecystectomy Techniques that are discussed here are based on current literature and Evidence Based Medicine guidelines and reviews.
Prof. Mridul Panditrao's Peri-operative MANAGEMENT OF Patients for LaparoscopyProf. Mridul Panditrao
Prof. Panditrao takes you in the detailed discussion about the historical aspects, problems, altered physiology, preparation of and Anesthetic/ peri-operative management of the patients for various laparoscopic surgical procedures
Hoofdstuk 5. Concentraties van oplossingen met toepassing op reacties - ChemieTom Mortier
Deze presentatie behoort bij de onderwijsleeractiviteit oefeningen in het kader van de lessen Algemene Chemie gedoceerd aan de richting Chemie van de UC Leuven-Limburg.
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
Preanesthetic evaluation of patients in oral and maxillofacial surgeryPunam Nagargoje
The word is derived from the Greek words an, which means “without” and aithesia which means “feeling”
The use of medical anesthesia was first reported in 1846
The development of anesthesia has made today’s modern surgical techniques possible
• Basic Principles of Anesthesia
• “Triad of General Anesthesia”
need for unconsciousness
need for analgesia
need for muscle relaxation and loss of reflexes
• Preoperative Evaluation
• The preanesthetic evaluation has specific objectives including:
- Establishing a doctor-patient relationship,
- Becoming familiar with the surgical illness and
- coexisting medical conditions,
- Anticipating potential complication
Developing a management strategy for perioperative anesthetic care,
- Obtaining informed consent for the anesthetic plan.
The overall goals of the preoperative assessment are to reduce perioperative morbidity and mortality and to allay patient anxiety.
• Pre-operative
This applied both in evaluation & investigations
• General
This include the following:
1-General condition of the patient.
2-Psychological condition. ( Specially in major operations).
• Specific
This include the following:
1-Related to anaesthesia.
2-Related to the surgery.
• Medical History
1. Review the chart
2. Review previous records
3. Interview the patient
• Demographic Data
Height / weight
Vital signs
Diagnosis
History and Physical Exam
Note any abnormalities
Don’t assume that all problems are listed
• Steps of the preoperative visit :
• Preoperative testing should be performed on a selective basis for purposes of guiding or optimizing perioperative management.
• Pre-op Testing Schema Example
• Preoperative Laboratory Testing:
• only if indicated from the preoperative history and physical examination.
• "Routine or standing" pre operative tests should be discouraged
• -CBC anticipated significant blood loss, suspected hematological disorder (eg.anemia, thalassemia, SCD), or recent chemotherapy.
• -Electrolytes diuretics, chemotherapy, renal or adrenal disorders
• -ECG age >50 yrs ,history of cardiac disease, hypertension, peripheral vascular disease, DM, renal, thyroid or metabolic disease.
• -Chest X-rays prior cardiothoracic procedures ,COPD, asthma, a change in respiratory symptoms in the past six months.
• -Urine analysis DM, renal disease or recent UTI.
• -tests for different systems according to history and examination
• Disease-based indications
Alcohol abuse
CBC, ECG, lytes, LFTs, PT
Anemia
CBC
Bleeding disorder
CBC, LFTs, PT, PTT
Cardiovascular
CBC, creatinine, CXR, ECG, lytes
• Disease-based indications
Cerebrovascular disease
Creatinine, glucose, ECG
Diabetes
Creatinine, electrolytes, glucose, ECG
Hepatic disease
CBC, creatinine, lytes, LFTs, PT
• Disease-based indications
Pregnancy (controversial)
Serum B-hCG- 7 days, Upreg 3 days
Pulmonary disease
CBC, ECG, CXR
Renal disease
CBC, Cr, lytes, ECG
RA
CBC, ECG, CX
perioperative preparations in obstetrics and Gynecology.pptxEkramNasher
This PowerPoint describe all preparations that doctors follow during preparation obstetrical and Gynecological cases for operations and the important instructions which should be taken
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
3. PERIOPERATIVE NURSING Perioperative nursing It is divided into 3 Phases: 1. Preoperative – From the decision for surgical intervention to transfer to operating room
10. Optional Surgery – Surgery at the preference of the client. Surgery is not needed Ex. Cosmetic surgery ; liposuction
11. Elective Surgery – Surgery at the convenience of the patient as failure to have surgery is not life threatening Ex. Excision of superficial cyst.
12. Planned/ Required surgery- The time of the surgery is within a few weeks from time of decision to have surgery as surgery is important ex. Cataract extraction
13. Urgent/ Imperative surgery – Within 24-48 hours from the time of the decision to have surgery Ex. Cancer surgery
14. Emergency Surgery – Immediate surgery without delay to maintain life or organ, to remove damage, to stop bleeding Ex. Intestinal obstruction, gun shot wounds
17. Exploratory – To estimate the extent of the disease & confirm diagnosis Ex. Exploratory Laparotomy
18. Curative Surgery a. Ablative – Removal of diseased organ Ex. Hysterectomy b. Constructive – Repair of congenital defects Ex. Repair of Cleft palate
19. c. Reconstructive – Restoration of damaged organ Ex. Total joint replacement
20. Palliative – Relieves Symptom but does not cure the disease Ex. Rhizotomy for pain relief, Myringotomy
21. CLASSIFICATION of PHYSICAL STATUS: ASA I – Healthy person, with no systemic disease, undergoing elective surgery, Not very Young or very old
22. ASA II – Client w/ 1 system well controlled disease. Diseases does not affect daily activities. Those clients w/ mild obesity, alcoholism, and smokers
23. ASA III – Client w/ multiple system disease or well controlled major system diseases. The disease status limits daily Activities. However there is no immediate threat of death due to individual system disease.
24. ASA IV – Client w/ severe incapacitating disease. Typically the disease is poorly controlled, or end stage disease is present. Danger of death related to organ failure is present
25. ASA V - Client is very ill, in imminent danger of death. Operation is the last attempt in preserving life. The client is not expected to live the next 24 hours.
27. Past Medical Health History Previous Surgery & Experience with anesthesia = any untoward reaction to anesthesia e.g. malignant hyperthermia, intraoperative death in the family= INFORM physician.
28. Serious Illness or Trauma: ABCDE A – Allergy B- Bleeding C- Cortisone use D – Diabetes mellitus E – Emboli (thromoembolism)
29. Age Infant, Young children, & older Adults are at greater risk for surgery
32. Alcohol / Recreational Drug Use Alcohol has an unpredictable reaction with anesthetic agents; Smoking = reduce hemoglobin, Smokers are susceptible to clot formation & Nicotine is a vasoconstrictor
52. Cardiovascular assessment MI, angina pectoris for the last six months, may influence tissue perfusion or wound healing
53. Respiratory assessment – Chronic lung conditions ex. emphysema, asthma, bronchitis, increase the operative risk bec. These diseases impair gas exchange = DOB notify the physician.
54. Musculoskeletal assessment – History of fractures, joint injury, arthritis, may influence the positioning of the client during intraoperative phase, or it may cause additional postop pain
55. Skin integrity assessment- Document & report lesions, pressure ulcers, necrotic skin, skin turgor, erythema, cyanosis of the skin, note the size & location so as to compare post op if lesions are stable or worsening.
56. Renal assessment- Adequate renal function is necessary to eliminate protein wastes, to preserve fluid & electrolyte balance & to remove anesthetic agents from the system
57. Liver function assessment - Liver dse like cirrhosis inc. a client’s surgical risk bec a diseased liver cannot detoxify drugs & anesthetic agents, liver dse. May be manifested through albumin levels= low albumin levels predispose to fluid shifts (fluid imbalance)
58. Cognitive assessment- Uncontrolled epilepsy, severe parkinson’s disease, increase the surgical risk
59. other important neurologic assessment; severe head ache, frequent dizziness, light headdeness, ringing in the ears, unsteady gait, unequal pupils & history of seizures.
60. Hematologic function – Clients w/ blood coagulation disorders are at risk for hemorrhage Ex. History of hemophilia, sickle cell anemia. Manifestations of easy brusing and abnormal bleeding time
92. 4. PREOPERATIVE HEALTH TEACHINGS / INSTRUCTIONS The best time to instruct the client is relatively close to the time of the surgery
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102. b) Non – Barbiturates – chloral hydrate; flurazepam ( Dalmane)
103. The drugs are given after all pre-op treatments have been completed. If a second barbiturate is needed, it must be given at least 4 hours before pre-op medications is due.
111. a) Sedatives – given to decrease the patient’s anxiety to lower BP and pulse and to reduce the amount of General Anesthesia; an overdose of sedatives may lead to respiratory depression
113. b) Tranquilizer – lowers a patient’s anxiety Ex. Thorazine 12.5 – 25 mg IM 1-2 hours prior to surgery
114. Phenergan- 12.5 – 25 mg IM 1-2 hours before surgery Note* these tranquilizers may cause dangerous hypotension both during and after the surgery
115. Narcotic Analgesics – Given to reduce anxiety and to reduce the amount of narcotics given during surgery
116. Ex. Morphine sulfate – 8-15 mg SQ one hr pre-op this drug can cause vomiting, respiratory depression and postural hypotension
117. Vagolytic or drying agents – To reduce the amount of tracheobronchial secretions w/c may clog the pulmonary alveoli and may produce atelectasis (lung collapse)
118. Ex. Atropine sulfate 0.3-0.6 mg IM 45 minutes before surgery overdose can cause severe tachycardia
119. *** Important ! – Nursing intervention after giving pre-op meds immediately raise the side rails of the bed for patient’s safety
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121. Transportation to OR – Make sure that the name tag of the client is in place. While transferring the patient on the stretcher make sure that the side rails are up
122. Woolen or synthetic blankets must never be sent to OR bec. It causes static electricity and may cause combustion of O2 or Other gases in the OR
138. Supine / Dorsal recumbent – Lying on the back – used for hernia repair, bowel resection, eplore lap, mastectomy, cholecystectomy
139. Prone – for back, spine, rectal surgeries, laminectomy- Note** after surgery, the patient will be returned to the supine position. This should be done gradually bec. Sudden turning of the client may cause a rapid drop in BP
140. Trendelenberg – Head and body are flexed by , breaking(bending the head of the table downwards) – pelvic surgeries, lower abdomen.
142. Lithotomy position - Thighs and legs are flexed at right angles and then simultaneously placed in stirrups – vaginal repairs, D&C, rectal surgery,
143. Lateral – used in kidney and chest surgery, hip surgeries
144. Other positions - in Thyroidectomy the head is hyperextended, a small sand bag or pillow on the neck and shoulders to provide exposure of the thyroid gland
149. Stage I . Stage of Analgesia / induction phase
150. This stage extends from the beginning of Administration of an anesthetic to the beginning of the loss of consciousness . The sensation of pain is not lost.
155. Extends from the loss of consciousness to the loss of eyelid reflex. Any stimulation has the potential to cause the client to become difficult to control.
191. Is the removal of as many bacteria as possible from the hands and arms by mechanical washing and chemical disinfection before participating in an operation. Done prior to gowning and gloving.