Exam # 1 Post-Operative Care Flashcards
What are the 8 Post-op complications commonly experienced by patient?
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
Define “Ineffective Breathing Pattern”
State in which inspiration and/or expiration does not provide adequate ventilation.
Name 7 etiologies discussed in class that “Ineffective Breathing Pattern” may be related to.
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…)
What are the 8 AEBs/defining characteristics related to Ineffective Breathing Pattern that were discussed in class?
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
What are the 5 CNS clinical manifestations of Inadequate oxygen?
1) Restlessness
2) Agitation
3) Muscle twitching
4) Seizures
5) Coma
What are the 5 Cardiovascular clinical manifestations of Inadequate oxygen?
1) Hypertension
2) Hypotension
3) Tachycardia
4) Bradycardia
5) Dysrhythmias
What are the 3 Integumentary clinical manifestations of Inadequate oxygen?
1) Cyanosis
2) Prolonged cap refill
3) Flushed and moist skin
What are the 4 Respiratory clinical manifestations of Inadequate oxygen?
1) ⬆ or absent respiratory effort
2) use of accessory muscles
3) abnormal breath sounds
4) abnormal ABGs
What is the renal clinical manifestation of Inadequate oxygen?
Urine output < 0.5 mL/Kg/hr
What is the normal timing of breathing?
Normal inspiration = 1-2 secs
Normal expiration = 2-4 secs
What are 7 interventions used to manage Ineffective Breathing Pattern Post-op
1) Mobility
2) C & DB
3) I/S
4) Meds & pain control
5) O2
6) PT & RT
7) Patient teaching
What 2 methods of “mobility” used as and intervention for Ineffective Breathing Pattern for Post-op patients were discussed in class?
1) Turn and position patient q2h
2) Early ambulation
What are the 3 SxS of post-op Atelectasis?
1) Sudden fever (post-op day 1-2)
2) Tachypnea
3) Crackles or absence of sounds in lung bases
Define Pneumonia
Inflammatory condition with collection and pooling of secretions in airless collapsed alveoli
What are the 7 benefits of early ambulation post-op?
1) ⬆ Ventilation
2) ⬆ Morale
3) ⬆ Appetite
4) ⬆ Alertness
5) ⬆ Peristalsis
6) ⬆ Voiding
7) ⬆ Venous return
How would you teach a patient to use C&DB and I/S post-op as an intervention for Ineffective Breathing Pattern?
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.
(T/F) Cough is stimulated by deep breathing.
TRUE
What are the 6 ways to assess for pneumonia that were discussed in class?
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
Define Egophony
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.
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)
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
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?
Post-op day 3
What is the significance if an intermittent high temperature with shaking chills and diaphoresis?
Indicates septicemia
Define Acute Pain
The sudden or slow onset of pain of any intensity with an anticipated or predictable end.
(T/F) Acute pain can affect ALL body systems
True
What are the 7 SxS/defining characteristics of Acute Pain?
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
What is the difference between nociceptive pain and neuropathic pain?
1) Nociceptive pain - Incisional pain
2) Neuropathic pain - Peripheral or CNS nerve pain
What is the difference between Norco, Percoset and Vicodin?
1) Norco - Hydrocodone & Acetaminophen (5-325)
2) Vicodin - Hydrocodone & Acetaminophen (5-500)
3) Pecocet - Oxycodone & Acetaminophen (5-325)
Regarding nausea and vomiting, which one is a sign and which one is a symptom?
1) Vomiting - Sign
2) Nausea - Symptom
(T/F) Bowel obstruction when auscultated will be hyperactive above the obstruction and hypo active below it.
True
Most bowel obstructions occur in the small intestines. What are the 5 most common causes?
1) Surgical adhesions - scar tissue
2) Hernias - When bowels pert rude through the abdominal wall
3) Tumors
4) Carcinoma
5) Diverticular disease
How is the body’s General Adaptation Syndrome Activated
The GAS is activated by prolonged stress
There are physiological, psychological, and behavioral responses to stress. What are the 3 stages of the physiological response to stress?
1) Alarm
2) Resistance
3) Exhaustion
What are the 3 characteristics of the resistance stage of GAS?
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
When does exhaustion (final stage of GAS) occur?
Exhaustion occurs when all energy for adaptation has been exhausted.
Which three interrelated systems does stress affect?
1) Nervous system
2) Endocrine system
3) Immune system
Stress stimulates the Reticular Activating System (RAS) in the Nervous system. What is the effect on this on the body?
Stress ⬆ the frequency of alertness impulses leading to wakefulness and sleep disturbances.
Explain the effect of stress on the Endocrine system.
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
What are the 4 ways stress affect the immune system?
1) ⬇ # and Fx of NKC
2) Altered lymphocyte proliferation
3) ⬇ Production of cytokines
4) ⬇ Phagocytosis by neutrophils and monocytes
What are the 8 main effects of the GAS on the body?
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)
