Practical points for the patient with preexisting cardiac disease.

As the first in a series, the purpose of this article is to discuss common preexisting cardiac diseases seen in patients presenting for surgery. Defining characteristics, pathophysiology, etiologies, and treatments are presented along with perioperative nursing implications.

Practical points in the assessment of the patient with pulmonary disease.

The second in a series on perioperative assessment, this article focuses on the patient with preexisting pulmonary disease. For each disease presented, defining characteristics will be provided, including the cause and treatment. Most importantly, implications for nurses who care for these patients in a perioperative setting will also be provided.

Practical points for the patient with preexisting renal disease.

The third in a series, it is the purpose of this article to discuss common preexisting renal diseases seen in patients presenting for surgery. Defining characteristics, the pathophysiology of each disease, its causes, and treatments are presented along with perioperative nursing implications.

Ambulatory surgery. Care of the special needs patient.

This article discusses common pre-existing medical conditions seen in ambulatory surgical patients. Defining characteristics of the diseases are provided, etiology and treatment are described, and implications for perioperative nursing care are explained.

Practical points in the evaluation postoperative fever.

The finding of an elevated temperature in the PACU or ambulatory surgical unit in and of itself is not the challenge facing either the patient or the nurse. The challenge is in the interpretation of the finding, the outcomes of the alterations in temperature, and the physiologic sequellae that accompany the elevation.

Practical points on wound healing.

After a surgical procedure, one patient outcome for both the inpatient and ambulatory surgical patient is wound healing without complication. It is the purpose of this article to review the stages of wound healing and to identify potential complications. Nursing interventions designed to promote wound healing will be highlighted.

Intercostal nerve block.

The intercostal nerve block is an effective and relatively safe intervention for postoperative pain control after upper abdominal and thoracic surgery. It may be done in the operating room or in the PACU. Understanding the mechanics of the technique can help to improve care of patients receiving this intervention.

Practical points in the use of ondansetron.

It is the purpose of this article to discuss ondansetron hydrochloride (Zofran Glaxo, Research Triangle Park, NJ) and its mechanisms of action, indications for use, dosage and administration, side effects, and nursing implications.

Practical points in the use of dopamine.

Dopamine and its mechanism of action, indications, dosage and administration, and precautions are reviewed. A central purpose of this article is to highlight the nursing implications for use of dopamine.

Practical points in the use of sodium nitroprusside.

It is the purpose of this article to review sodium nitroprusside, including its mechanism of action, indications, dosage and administration, and precautions. A central purpose of this article is to highlight the nursing implications for use of sodium nitroprusside.

Post-anesthesia assessment: what medical-surgical nurses need to know.

Post-anesthesia patient assessment helps predict the acuity and nursing care needs of patients upon discharge to critical, general, or home care. The goals of postanesthesia assessment, with a focus on the potential respiratory, cardiovascular, neurologic, and other complications are discussed.

Bleeding and coagulation in the PACU.

Understanding normal coagulation processes will allow the critical care nurse to also understand disorders of coagulation. Understanding diagnostic tests used to assess coagulation will also allow the critical care nurse to evaluate disorders of coagulation and to identify patients at risk for bleeding disorders. Both should encourage the critical care nurse to institute appropriate measures designed to minimize and detect further bleeding. Nursing interventions will include maintenance of aseptic technique; minimizing tissue trauma (avoid venipunctures, use of a soft toothbrush); guaiacing stools; monitoring oxygenation and level of consciousness; and monitoring laboratory tests, including hemoglobin and hematocrit, along with laboratory tests of coagulation. Prompt detection and intervention will help minimize the morbidity and mortality associated with bleeding and alterations in coagulation.

Postoperative pulmonary complications.

This discussion presented the most common causes of postoperative pulmonary complications. The categories of obstruction, hypoxemia, and hypoventilation were used for structure, with the most common causes of each identified. Problems and patients at risk for these problems have been identified along with treatment priorities. The reader is reminded that the categories of obstruction, hypoxemia, and hypoventilation cannot be taken as absolute. The existence of one usually suggests the presence of another.

Efficacy of ephedrine in the prevention of postoperative nausea and vomiting.

Although reported in the aerospace literature and anecdotally by anesthesiologists, the putative antiemetic effect of ephedrine remains unquantitated. We therefore prospectively studied ephedrine as an antiemetic agent in the perioperative setting in 97 patients undergoing general anesthesia for outpatient gynecologic laparoscopy. Patients were assigned in a double-blind randomized fashion to receive a standardized general anesthetic followed by an intramuscular dose of either ephedrine (0.5 mg/kg), droperidol (0.04 mg/kg), or saline before the conclusion of surgery. Nausea, retching, or vomiting, as well as the degree of sedation and discharge times, were assessed in the recovery room and for 24 h postoperatively. Ephedrine was found to have a significantly antiemetic effect (P less than 0.05) when compared with placebo and an antiemetic effect similar to that of droperidol. Sedation scores were also significantly less in the ephedrine group than in both placebo and droperidol groups. Finally, variations in mean arterial blood pressure among the three groups were not statistically significant. We conclude that ephedrine is an effective antiemetic agent with minimal sedative side effects in patients undergoing outpatient laparoscopy.

Care of the patient post-abdominal aortic aneurysm repair.

Caring for the patient post-abdominal aortic aneurysm repair requires knowledge of pathophysiology and surgical procedure. By understanding these, the PACU nurse will be able to set appropriate patient priorities and optimize patient outcome.

Practical points in the care of the thoracic surgery patient.

There are three goals in caring for the patient who has undergone thoracic surgery: to optimize respiratory function, to assist the patient in liquifying and mobilizing secretions, and to promote ventilation of available lung tissue. This article discusses PACU assessment of the thoracic surgery patient and nursing priorities designed to promote these three goals.