Chapter 19 - Postoperative Care

Question 1

PACU

Answer 1

post anesthesia care unit

• manages immediate recovery period
• maintain patient safety
• ID actual + potential patient problems

Question 2

initial assessment

Answer 2

evaluate ABC

Question 3

_____ are used to detect resp depression in high risk patients

Answer 3

PtcCO2 (transcutaneous CO2) +

PetCO2 (end-tidal CO2)

Question 4

initial neurological assessment

Answer 4

• level of consciousness
• orientation
• sensory + motor status
• pupils (size, quality, reactivity)

Question 5

first sense to return in unconscious patients

Answer 5

hearing

-explain all activities to patient fr time of admission to PACU

Question 6

which areas are the first and last to return from regional anesthesia

Answer 6

first-distal fr site where anesthesia was given

last-areas near site of injection

Question 7

UO of inadequate oxygenation

Answer 7

urine output <0.5 mL/kg/hr

Question 8

airway obstruction

Answer 8

• commonly caused by tongue blocking pharynx

- —high risk: supine positions w extremely sleep patients

Question 9

hypoxemia

Answer 9

PaO2 < 60mmHg
O2 sats < 92%

• commonly caused by atelactasis
• –other causes: pulm edema, pulm embolism, aspiration, bronchospasms

Question 10

hypoventilation

Answer 10

common complication in PACU

• decr resp rate/effort
• hypoxemia
• hypercapnia (incr CO2)

Question 11

always assess _____ when giving opiods

Answer 11

resp depression

Question 12

what do you do when patient has poor resp effort, noisy respiration, or other signs of resp distress?

Answer 12

arouse them immediately and have them take deep breaths

Question 13

how often should a patient perform deep breathing practice/incentive spirometer?

Answer 13

10x every hour while awake

Question 14

change the patients every ___ hours to allow full expansion + increase perfusion of both lungs

Answer 14

1-2 hours

Question 15

hypotension

Answer 15

-can cause hypoperfusion to vital organs

s/s - disorientation, LOC, chest pain, oliguria

Question 16

most common cause of hypotension in PACU

Answer 16

fluid + blood loss

Question 17

if there is no response to fluid administration, ______ may be the cause of hypotension

Answer 17

heart dysfunction

Question 18

primary heart dysfunction

Answer 18

may occur in MI, cardiac tamponame, PE

-results in acute drop in CO

Question 19

hypertension most often occurs from _____

Answer 19

SNS stimulation

-may be r/t hypothermia + preexisting hypertension

Question 20

fluid overload

Answer 20

• may occur during a period of fluid retention
• if we infuse IV fluids too rapidly
• when chronic disease exist
• or w older patients

Question 21

indication of adequate renal function

Answer 21

urine output >0.5mL/kg/hr

normal serum creatinine

Question 22

PE s/s

Answer 22

• tachypnea
• chest pain
• hypotension
• agitation
• tachycardia
• dyspnea

Question 23

how often are VS taken during post op?

Answer 23

phase I = q15min until stabilized

Question 24

hypotension w rapid/weak pulse, cold clammy pale skin may indicate _____

Answer 24

hypovolemic shock

Question 25

treatment of hypotension

Answer 25

begins w O2 therapy

• IV fluid boluses
• inspect incision site for excess bleeding

Question 26

treatment of hypertension

Answer 26

focused on removing cause of SNS stimulation

• analgesic
• assist w voiding
• correct rep problem

Question 27

emergence delirium

Answer 27

short term neurologic change

• s/s restlessness, agitation, disorientation, thrashing, shouting
• –first suspect hypoxia

Question 28

most common cause of agitation in PACU

Answer 28

HYPOXEMIA