Exam # 1 Post-Operative Care

Question 1

What are the 8 Post-op complications commonly experienced by patient?

Answer 1

1) Ineffective Breathing Pattern
2) Fluid Volume Deficit
3) Urinary Retention
4) Constipation
5) Nausea
6) Acute Pain
7) Risk for Infection
8) Risk for Peripheral Neurovascular Dysfunction

Question 2

Define “Ineffective Breathing Pattern”

Answer 2

State in which inspiration and/or expiration does not provide adequate ventilation.

Question 3

Name 7 etiologies discussed in class that “Ineffective Breathing Pattern” may be related to.

Answer 3

1) Pharmacological agents
2) Obesity
3) Pain
4) Anxiety/fear
5) ⬇ Energy/fatigue
6) ⬆ O2 demands due to stress response
7) Underlying pathologies (i.e., asthma…)

Question 4

What are the 8 AEBs/defining characteristics related to Ineffective Breathing Pattern that were discussed in class?

Answer 4

1) Dyspnea
2) Respiratory rate (24 at rest)
3) Respiratory depth (shallow breathing r deep inspiration)
4) Respiratory timing (inspiration longer than expiration)
5) Respiratory rhythm
6) Use of accessory muscles
7) Atelactic crackles
8) Sudden ⬆ in temperature

Question 5

What are the 5 CNS clinical manifestations of Inadequate oxygen?

Answer 5

1) Restlessness
2) Agitation
3) Muscle twitching
4) Seizures
5) Coma

Question 6

What are the 5 Cardiovascular clinical manifestations of Inadequate oxygen?

Answer 6

1) Hypertension
2) Hypotension
3) Tachycardia
4) Bradycardia
5) Dysrhythmias

Question 7

What are the 3 Integumentary clinical manifestations of Inadequate oxygen?

Answer 7

1) Cyanosis
2) Prolonged cap refill
3) Flushed and moist skin

Question 8

What are the 4 Respiratory clinical manifestations of Inadequate oxygen?

Answer 8

1) ⬆ or absent respiratory effort
2) use of accessory muscles
3) abnormal breath sounds
4) abnormal ABGs

Question 9

What is the renal clinical manifestation of Inadequate oxygen?

Answer 9

Urine output < 0.5 mL/Kg/hr

Question 10

What is the normal timing of breathing?

Answer 10

Normal inspiration = 1-2 secs

Normal expiration = 2-4 secs

Question 13

What are 7 interventions used to manage Ineffective Breathing Pattern Post-op

Answer 13

1) Mobility
2) C & DB
3) I/S
4) Meds & pain control
5) O2
6) PT & RT
7) Patient teaching

Question 14

What 2 methods of “mobility” used as and intervention for Ineffective Breathing Pattern for Post-op patients were discussed in class?

Answer 14

1) Turn and position patient q2h

2) Early ambulation

Question 15

What are the 3 SxS of post-op Atelectasis?

Answer 15

1) Sudden fever (post-op day 1-2)
2) Tachypnea
3) Crackles or absence of sounds in lung bases

Question 16

Define Pneumonia

Answer 16

Inflammatory condition with collection and pooling of secretions in airless collapsed alveoli

Question 17

What are the 7 benefits of early ambulation post-op?

Answer 17

1) ⬆ Ventilation
2) ⬆ Morale
3) ⬆ Appetite
4) ⬆ Alertness
5) ⬆ Peristalsis
6) ⬆ Voiding
7) ⬆ Venous return

Question 18

How would you teach a patient to use C&DB and I/S post-op as an intervention for Ineffective Breathing Pattern?

Answer 18

1) C&DB - With the HOB up, use the pillow as a splint, holding it firmly against the stomach (over the incision) and C&DB.
2) I/S - Inhale and hold for 3 secs. Repeat 10x/hr until ambulatory.

Question 19

(T/F) Cough is stimulated by deep breathing.

Answer 19

TRUE

Question 20

What are the 6 ways to assess for pneumonia that were discussed in class?

Answer 20

1) Productive cough with colorful sputum
2) Pleuritic chest pain
3) Bronchial breath sounds d/t consolidation
4) Egophony (E sounds like A when auscultating)
5) Chest X-ray - alveolar infiltrates and consolidatin
6) ⬆ WBCs/sputum culture

Question 21

Define Egophony

Answer 21

A change in the voice sound of a patient with pleural effusion or pneumonia as heard on auscultation. When the patient is asked to make (eeee) sounds, they are heard over the peripheral chest wall as (aaaa), particularly over an area of consolidated or compressed lung above the effusion.

Question 22

What is the significance of the following temperatures post-op at these specific times:

1) Up to 12 hours (hypothermia of 96.8F/36C)
2) First 24-48 hours (elevation to 100.4F/38C)
3) First 24-48 hours (elevation above 100.4F/38C)
4) 3rd day and later (elevation above 100F/37.7C)

Answer 22

1) Up to 12 hours (hypothermia of 96.8F/36C) - Effects of anesthesia or body heat losses during surgery.
2) First 24-48 hours (elevation to 100.4F/38C) - Inflammatory response to surgical stress.
3) First 24-48 hours (elevation above 100.4F/38C) - Lung congestion or atelectasis.
4) 3rd day and later (elevation above 100F/37.7C) - Infection

Question 23

Wound infection is often accompanied by fever spiking in the afternoon and being near normal in the morning. On what post-op day would you expect to see an elevated temperature related to a wound infection?

Answer 23

Post-op day 3

Question 24

What is the significance if an intermittent high temperature with shaking chills and diaphoresis?

Answer 24

Indicates septicemia

Question 25

Define Acute Pain

Answer 25

The sudden or slow onset of pain of any intensity with an anticipated or predictable end.

Question 26

(T/F) Acute pain can affect ALL body systems

Answer 26

True

Question 27

What are the 7 SxS/defining characteristics of Acute Pain?

Answer 27

1) Verbal or coded report
2) Guarding/protective behavior
3) Facial mask
4) Minor - antalgic position/gesture
5) Narrowed focus
6) Distraction behavior
7) Autonomic responses - change in vitals

Question 28

What is the difference between nociceptive pain and neuropathic pain?

Answer 28

1) Nociceptive pain - Incisional pain

2) Neuropathic pain - Peripheral or CNS nerve pain

Question 29

What is the difference between Norco, Percoset and Vicodin?

Answer 29

1) Norco - Hydrocodone & Acetaminophen (5-325)
2) Vicodin - Hydrocodone & Acetaminophen (5-500)
3) Pecocet - Oxycodone & Acetaminophen (5-325)

Question 30

Regarding nausea and vomiting, which one is a sign and which one is a symptom?

Answer 30

1) Vomiting - Sign

2) Nausea - Symptom

Question 31

(T/F) Bowel obstruction when auscultated will be hyperactive above the obstruction and hypo active below it.

Answer 31

True

Question 32

Most bowel obstructions occur in the small intestines. What are the 5 most common causes?

Answer 32

1) Surgical adhesions - scar tissue
2) Hernias - When bowels pert rude through the abdominal wall
3) Tumors
4) Carcinoma
5) Diverticular disease

Question 33

How is the body’s General Adaptation Syndrome Activated

Answer 33

The GAS is activated by prolonged stress

Question 34

There are physiological, psychological, and behavioral responses to stress. What are the 3 stages of the physiological response to stress?

Answer 34

1) Alarm
2) Resistance
3) Exhaustion

Question 35

What are the 3 characteristics of the resistance stage of GAS?

Answer 35

1) Ideal transition from alarm to resistance is quick
2) Physiologic reserves are mobilized to ⬆ resistance to stress
3) Adaptation may occur - Depends on physical health, coping strategies, and social/family support

Question 36

When does exhaustion (final stage of GAS) occur?

Answer 36

Exhaustion occurs when all energy for adaptation has been exhausted.

Question 37

Which three interrelated systems does stress affect?

Answer 37

1) Nervous system
2) Endocrine system
3) Immune system

Question 38

Stress stimulates the Reticular Activating System (RAS) in the Nervous system. What is the effect on this on the body?

Answer 38

Stress ⬆ the frequency of alertness impulses leading to wakefulness and sleep disturbances.

Question 39

Explain the effect of stress on the Endocrine system.

Answer 39

Stress activates the hypothalamus to release CRH which stimulate the anterior pituitary to release ACTH. This causes the adrenals to secrete corticosteroids which leads to:

1) ⬆ CO, blood glucose levels, O2 consumption, and metabolism.
2) Inhibition of inflammatory response > risk of infection
3) retained fluid volume

Question 40

What are the 4 ways stress affect the immune system?

Answer 40

1) ⬇ # and Fx of NKC
2) Altered lymphocyte proliferation
3) ⬇ Production of cytokines
4) ⬇ Phagocytosis by neutrophils and monocytes

Question 41

What are the 8 main effects of the GAS on the body?

Answer 41

1) ⬆ CO (⬆HR & SV)
2) ⬆ Blood glucose levels
3) ⬆ O2 consumption
4) ⬆ Metabolic rate
5) Dilation of skeletal muscle blood vessels
6) ⬆ Cerebral blood flow (⬆ mental alertness)
7) ⬆ Blood volume (from ⬆ ECF and blood shunting away from GI)
8) ⬆ Coagulation to ⬇ blood loss (DVT risk)