Exam 7 Post op

Question 1

PACU

Answer 1

Post
Anestassia
Care
Unit aka Recovery

Question 2

Stages of Post-op

Answer 2

Phase I-immediately after surgery
Phase II-no close monitoring
Phase III-prep for discharge

Question 3

PACU environment

Answer 3

Clean, quiet, no permanent walls

Question 4

Nursing Management

Answer 4

Provide care until anesthesia wears off
Pt is oriented, stable vs, and not bleeding
Constantly assessing

Question 5

Primary Consideration

Answer 5

Maintain a patent airway

Question 6

How to maintain a patent airway

Answer 6

Assess by putting hand near face/nose
Bed elevated 15-30 degrees
May require suction
If vomit, turn on left side

Question 7

Signs of Hypovolemic shock

Answer 7

Pale Cool Moist skin Clammy Rapid respirations Low BP Concentrated urine Rapid/weak/thready pulse
Cyanosis

Question 8

Classification of Hemorrhage

Answer 8

Primary
Intermediary
Secondary
Capillary/Venous/Arterial
Evident/Concealed

Question 9

Primary Hemorrhage

Answer 9

Occurs at time of surgery

Question 10

Intermediary Hemorrhage

Answer 10

1st few hours after surgery when BP come up and may push clot loose

Question 11

Secondary Hemorrhage

Answer 11

After surgery if suture slips

Question 12

Capillary Hemorrhage

Answer 12

Slow general ooze

Question 13

Venous Hemorrhage

Answer 13

Dark colored bubbles out quickly

Question 14

Arterial Hemorrhage

Answer 14

Bright red and spurts with heartbeat

Question 15

Evident Hemorrhage

Answer 15

On surface and can be seen

Question 16

Concealed hemorrhage

Answer 16

Can not be seen. in body cavity

Question 17

How to monitor cardiovascular stability

Answer 17

Monitor vs/LOC/rhythm/skin/ s&s of shock
Assess all IV lines
Monitor for hemorrhage
Monitor for hypertension/dyssrhythmia/hypoxia/hypothermia

Question 18

Ways to help with pain and anxiety

Answer 18

Assess pt comfort
Control environment
Admin pain med
Family visits

Question 19

Controlling N/V

Answer 19

Immediately turn on left side

Help control without sedating

Question 20

Medications used to control N/V

Answer 20

Metoclopramide (Reglan)
Prochlorperazine (compazine)
Promethazine (Phenergan)
Dimenhydrinate (Dramamine)
Hydroxyzine (Vistaril, Atarax)
Scopolamine (Transderm-Scop)
Ondansetron (Zofran)

Question 21

Dealing with Elderly

Answer 21

Monitor carefully & frequently
Inc chance of confusion/delirium
Causes for confusion - hypoxia,pain,hypotension,hypoglycemia, & fluid loss
Assess meds
Ensure hydration
Reorient

Question 22

When are you ready to discharge

Answer 22

Stable VS Orientation x3 Uncompromised pulmonary Adequate O2 sat Urine output 30 ml No N/V Minimum Pain

Question 23

Pars Evaluation Guide

Answer 23

Scored when enter PACU q 15 min
Activity (2 1 0) move on command/spontaneously
Resp (2 1 0) TDBC
Circulation (2 1 0) BP normal
Consciousness (2 1 0) fully awake
O2 sat (2 1 0) 92% with room air

Must be 8-10 to discharge

Question 24

Assessment for Post op Complication

Answer 24

Assess VS q 15 min
Monitor q 4 hours
Assess airway/respirations
Assess cardiovascular status
Assess pain

Question 25

What should the assessment include?

Answer 25

O2 IV Tubes VS Circulation General Airway/Suction Position resp/O2 sat/ breath sounds surgical wound LOC Neuro functioning spinal anes (extremities) dressing/drains/drainage I&O iv site/ iv fluids comfort pain standard precautions

Question 26

Responsibilities of PACU nurse

Answer 26

Review important info and the baseline assessment Assessments/Interventions Provide report & transfer pt to next location Communicate with pt

Question 27

What is reported when transferring?

Answer 27

What was done in PACU demographic data types/amt of med medical dx meds for pain procedure done if pt has voided co-morbid condition what info pt/family got allergies unexpected intra-op events est. blood loss

Question 28

Equipment needed

Answer 28

``` Bed (surgical) IV equipment Emesis Basin Pads Blankets Drainage receptors holders O2 Monitoring devices Post op charting ```

Question 29

Floor nurse responsibilities

Answer 29

``` Bed position Spirometer Make connections Bowel Sounds Airway Family VS TCDB Surgical Dsg. I&O/Safety Pain Oral care Activity ```

Question 30

Ambulatory surgery

Answer 30

``` Written instructions Complication to report phone numbers & who to call Prescriptions to fill Rules & how long to follow them ```

Question 31

Types of surgical drains

Answer 31

Penrose-open Jackson-Pratt-closed Hemovac-closed

Question 32

Wound healing mechanisms

Answer 32

First-intention-suture Second-intention-granulation Third-intention-granulation --> suture

Question 33

Factors that affect healing

Answer 33

``` Age Meds Edema Overactivity Handling of tissue Systemic disorders Hemorrhage Immunosuppressed state Hypovolemia Wound stressors Nutrition Foreign Bodies Oxygen deficit ```

Question 34

Purpose of post op dressing

Answer 34

``` Provide healing environment Absorb drainage Splint or immobilize the wound Protect from injury & contamination Promote hemostasis Promote pt's physical & mental comfort ```

Question 35

Changing post op dressing

Answer 35

``` Surgeon changes 1st Get dressing materials Wash hands Maintain sterile technique Assess wound Apply dressing & taping methods Include pt response & teaching Document findings & teaching ```

Question 36

Dehiscence

Answer 36

Parial/Complete seperation of outer layer of wound. | Causes: poor suturing, distention, excess vomiting/coughing, dehydration, and infection

Question 37

Evisceration

Answer 37

Total separation of layers & protrusion of organs/viscera thru open wound.