Chapter 5 post-op care

Question 1

PACU/ post-op key points

Answer 1

• 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

Question 2

do you frequently check on post-op patients, do you assign UAPs to them for vital sign checks

Answer 2

-yes frequent monitoring
- no UAP assess vital signs first couple hours

Question 3

what are some nursing priorities in the 24 for post-op patients

Answer 3

• airway
• breathing
• circulation/vomiting/urination
• shock
• pain
• safety

Question 4

what factors for post-op px’s make them at risk for respiratory problems?

Answer 4

• effects of anesthesia on lungs
• being in one position for the duration of surgery
• limited mobility in the immediate post-op period

Question 5

nursing interventions of post-op px’s involving incentive spirometers

Answer 5

• 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

Question 6

how to maintain circulation and tissue perfusion?

Answer 6

• blood transfusion including autotransfusion
  -antithrombosis
• sequential pneumatic compression devices
• early ambulation
• heparin and low-molecular-weight sq heparin

Question 7

considerations for maintaining fluid balance and elimination for post-op px

Answer 7

• 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

Question 8

considerations for advancing the diet of post-op px

Answer 8

• 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

Question 9

discomfort from abdominal distention and considerable flatus may occur after what and why?

Answer 9

may occur after general anesthesia because peristalsis ceases

Question 10

what keeps flatus to a minimum? what position helps?

Answer 10

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

Question 11

how do you promote comfort in post-op px/s

Answer 11

• goal of comfort management is to allow px to perform levels of activity
• nonpharmacologic measures
• dressing and comfort
• hiccoughs

Question 12

what are some nonpharmacologic measures to relieve pain?

Answer 12

• 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

Question 13

how frequently should medications be given to post-op pxs? asses pxs what levels? remind px of what?

Answer 13

• 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

Question 14

nursing considerations of opioids?

Answer 14

• 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

Question 15

rest and activity interventions for post-op pxs

Answer 15

• sleep promotion
• ROM and ambulation
• prevent embolism
• physical therapy
• family involvement

Question 16

how do you promote wound healing by primary intention?

Answer 16

• 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

Question 17

what factors delay wound healing

Answer 17

• smoking
• mechanical injury from friction, pressure, or abrasion
• physical injury destroys granulation tissue
• pathogenic organisms
• corticosteroids and immunosuppression
• excessive stress, apprehension, and emotional disturbances

Question 18

what do you asses when doing

Answer 18

• 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

Question 19

proper splinting of the wound prevents what

Answer 19

• prevents dehiscence
• vomiting, abdominal distention, and strenuous respiratory efforts, such as coughing and forcefully exhaling breaths of air

Question 20

considerations/ interventions of post-op drainage of wounds? example of drainage devices?

Answer 20

• 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

Question 21

what are some discharge instructions

Answer 21

• know meds
• follow up appt
• dressing change
• s/s infection
• activity restrictions
• bathing
• driving