Chapter 5 post-op care Flashcards
PACU/ post-op key points
- report from anesthesia care provider
- attached to cardiac and pulse oximeter, monitor oxygen
- oral airway may still be in place; suction available
- warm blankets/ vital signs
do you frequently check on post-op patients, do you assign UAPs to them for vital sign checks
-yes frequent monitoring
- no UAP assess vital signs first couple hours
what are some nursing priorities in the 24 for post-op patients
- airway
- breathing
- circulation/vomiting/urination
- shock
- pain
- safety
what factors for post-op px’s make them at risk for respiratory problems?
- effects of anesthesia on lungs
- being in one position for the duration of surgery
- limited mobility in the immediate post-op period
nursing interventions of post-op px’s involving incentive spirometers
- incentive spirometer every hour while the patient is awake for the first 24 hrs following surgery and every 2 hrs after than
- elderly patient may need extra coaching to master the spirometer technique
how to maintain circulation and tissue perfusion?
- blood transfusion including autotransfusion
-antithrombosis - sequential pneumatic compression devices
- early ambulation
- heparin and low-molecular-weight sq heparin
considerations for maintaining fluid balance and elimination for post-op px
- urine output and potassium
- normal 30mL/hr
- px must void within 4-8 hours depending on the type of surgery
- if unable to void, obtain an order for catheterization
- notify surgeon if flow is less than 60 mL over 2 hour period
considerations for advancing the diet of post-op px
- once bowel sounds are heard surgeon orders clear liquid, followed by full liquids, then a regular diet
- px may be allowed to eat right away after spinal anesthesia
discomfort from abdominal distention and considerable flatus may occur after what and why?
may occur after general anesthesia because peristalsis ceases
what keeps flatus to a minimum? what position helps?
taking only small amounts of liquid or food at a time, drinking only tepid liquids, refraining from drinking through a straw, and ambulating to help move and evacuate gas
- if permitted slight Trendelensburg position may help
how do you promote comfort in post-op px/s
- goal of comfort management is to allow px to perform levels of activity
- nonpharmacologic measures
- dressing and comfort
- hiccoughs
what are some nonpharmacologic measures to relieve pain?
- rest, turn, cough, and deep breathe frequently
- reposition the px
- make sure bladder is not distended and causing discomfort
- make sure px is warm enough
- distraction and imagery
- teach relaxation techniques
how frequently should medications be given to post-op pxs? asses pxs what levels? remind px of what?
- consistently for first 24-48 hrs post-op
- assess px pain level and effectiveness of analgesia using pain scale at least every 3 hours
- remind px to request med before pain becomes severe
nursing considerations of opioids?
- may depress respirations and cough reflex
- may increase the possibility of nausea and vomiting
- used in combo, they help control pain with fewer side effects
rest and activity interventions for post-op pxs
- sleep promotion
- ROM and ambulation
- prevent embolism
- physical therapy
- family involvement
how do you promote wound healing by primary intention?
- rest decreases the metabolic rate and allows nutrients to be used for healing
- proteins provide the building blocks of tissue
- blood transports amino acids and other elements
- vitamin c is necessary for collagen production, formation of capillaries that bring blood to the healing tissues, and resistance to infection
- mineral- zinc, copper, and iron- assist in the formation of collagen
what factors delay wound healing
- smoking
- mechanical injury from friction, pressure, or abrasion
- physical injury destroys granulation tissue
- pathogenic organisms
- corticosteroids and immunosuppression
- excessive stress, apprehension, and emotional disturbances
what do you asses when doing
- excessive swelling
- formation of a hematoma
- seroma
- redness
- tearing of the skin or other signs of separation of the edges of skin that have been sutured together
- aseptic technique and standard precautions
proper splinting of the wound prevents what
- prevents dehiscence
- vomiting, abdominal distention, and strenuous respiratory efforts, such as coughing and forcefully exhaling breaths of air
considerations/ interventions of post-op drainage of wounds? example of drainage devices?
- prevent accumulation of fluids or air at the operative site
- protect suture lines
- remove specific fluids, such as bile, cerebrospinal fluid, or drainage from abscess
-ex: penrose drain, hemovac, jackson-pratt
what are some discharge instructions
- know meds
- follow up appt
- dressing change
- s/s infection
- activity restrictions
- bathing
- driving
