Lecture 13: Post-Op Care Flashcards
1
Q
what does -ectomy mean + example
A
meaning: excision or removal of
ex: appendectomy and cholecystectomy
2
Q
what does -lysis mean + example
A
meaning: destruction of
ex: electrolysis and lysis of adhesions
3
Q
what does -orrhaphy mean + example
A
meaning: repair or suture of
ex: herniorrhaphy
4
Q
what does -oscopy mean + examples
A
meaning: looking into
ex: endoscopy, colonoscopy, laraproscopy
5
Q
what does -ostomy mean + examples
A
meaning: creation of opening into
ex: colostomy
6
Q
what is -otomy meaning and example
A
meaning: cutting into or incision of
ex: tracheotomy
7
Q
what does -plasty mean + examples
A
meaning: repair or reconstruction of
exx: mammoplasty and rhinoplasty
8
Q
what is the post-op journey (4 parts)
A
- operating room
- PACU (post anesthesia care unit)
- surgical ward (same day surgery)
- discharged from hospital
9
Q
what are the 5 things to monitor in PACU
A
- ABC’s: respiratory and circulatory function
- pain
- temperature
- surgical site
- client’s response to the reversal of anesthetic
10
Q
when are patients moved from PACU to surgical ward
A
once PACU discharge criteria is met:
- PACU nurse gives a verbal report to surgical nurse and escorts pt to floor
10
Q
what is lateral recovery
A
‘recovery position’ while they regain consciousness
10
Q
Postanaesthesia Discharge Criteria
A
- Pt awake for baseline
- vital signs stable
- no excess bleeding or drainage
- no resp depression
- oxygen saturation >90%
- report given
11
Q
what happens if pt is an ambulatory surgery in PACU, how are they released
A
can go home if they meet discharge criteria with PACU nurse discharge teaching instructions
12
Q
ambulatory surgery discharge criteria
A
- all PACU discharge criteria met
- no IV opioids for last 30 minutes
- minimal nausea and vomiting
- voided (if appropriate to procedures)
- able to ambulate if age appropriate or not contraindicated
- responsible adult present to accompany pt
- written discharge instructions given and understood
13
Q
what to check for LOC in post-op assessment
A
are they awake?
- alert
- voice
- pain
- unresponsive
are they drowsy or confused
14
Q
what are the 3 nursing post operative assessment
A
- LOC
- Vital signs + Pain
- Head-to-Toe
15
Q
whats the pain assessment
A
OPQRSTUV
16
Q
what’s an important thing to assess in post-op assessment
A
surgical drains and the surgical incision site
17
Q
what are some orders the surgical team may write out for a pt that the nurse would have to do in post-op? (4)
A
- IV’s
- Diet orders
- Input/output monitoring
- Vitals
18
Q
what is important to remember about pain management in post-op
A
keep it continuous
- when was their last dose? how effective? has pain changed in location or severity?
- alert pt to call you if pain increases
19
Q
what should you check before leaving the patient in room (3)
A
- check for support person in room
- call bell in reach
- provide emesis basin, ice chips/water (if allowed), offer a warm blanket
20
Q
what are the key topics of discharge teaching (7)
A
- new meds
- diet restrictions
- activity restrictions
- wound care/drains/bathing
- concerning sympt: go to ER or call surgeons to office
- follow-up appt w surgical team
- home care referrals
21
Q
what’s important for the communication of discharge teaching
A
give the pt a chance to ask questions during ur teaching
22
Q
what are the 3 most common respiratory complications in the PACU
A
- airway obstruction
- hypoxemia
- hypoventilation
23
1.what is airway obstruction? 2. what are potential clues? 3. what are interventions for it?
1. mechanical blockage to the airway
2. decreasing o2 sat, absent respirations
3. lateral 'recovery position' for PACU pts while recovering consciousness. head tilt, chin lift.
24
1.what is hypoxemia?
2. what are potential clues? 3. what are interventions for it?
1. inadequate oxygenation of blood
2. decreasing o2 sat, abnormal RR
3. applying supplemental O2 therapy (nasal prongs, etc), deep breathing
25
1.what is hypoventilation?
2. what are potential clues? 3. what are interventions for it?
1. decreased resps
2. low RR, decreased O2 sat
3. support ventilation, encourage deep breathing
26
2 most common respiratory complications on surgical unit
1. atelectasis
2. pneumonia
27
1. what is atelectasis?
2. risk factors
3. pt clues
4. prevention/intervention
1. complete/partial collapse of lung or lung segment when alveoli become deflated
2. heavy smoker, pulmonary disease, pulmonary infection, drying of mucous membranes from: intubation anesthetic or dehydration, mucous plugs from: hypoventilation or lying position
3. decreased o2 sat, decreased breath sounds, crackles auscultated
4. deep breathing/coughing, incentive spirometer, position change q1-2 hrs, ambulation, pain management, oral hydration
28
what are 2 key ideas about atelectasis
1. increased bronchial secretions post-operatively
2. decreased lung volume
29
1. what is pneumonia
2. pt clues
3. interventions
1. infection of lungs
2. cough w sputum, decreased breath sounds, fever
3. o2 therapy, treatment of pathogen, ambulation, deep breathing/coughing
30
3 most common PACU cardiovascular complications
1. hypotension
2. hypertension
3. dysrhythmias
31
1. what is hypotension
2. pt clues
3. interventions
1. low bp
2. bp measurement, dizziness, LOC, check pain, etc...
3. intravenous fluid therapy, RBC's
32
1. what is hypertension
2. pt clues
3. intervention
1. high bp
2. bp measurement, low temp
3. manage pain, manage anxiety, relieve bladder distention, manage hypothermia
33
1. what is dysrhythmias
2. pt clues
3. intervention
1. non-sinus cardiac rhythm
2. dizziness, chest palpitations/pain, pre-existing cardiac conditions
3. correct hypokalemia, manage hypoxemia and hypercarbia
34
if you see pt deteriorating who do u call
surgeon
35
2 common causes of cardiovascular complications in a surgical ward
1. electrolyte imbalance
2. fluid imbalance
36
1. what is electrolyte imbalance
2. causes/risk factors
1. abnormal K, Na levels
2. loss of K thru emesis/diarrhea and not replaced, chronic cardiac disease, chronic renal disease, advanced age
37
1. what is fluid imbalance?
2. causes/risk factors
1. hypovolemia or hypervolemia
2. IV fluids given too quickly or too slowly, stress response releases aldosterone = Na and fluid retention, fluid loss during surgery (blood) and post-op (emesis, urine, drainage)
38
what are 2 key points to remember about surgical ward cardiovascular problems
1. abnormal K levels can impact cardiac function
2. hypovolemia can cause syncope (decreased cardiac output) common in geriatric pts
39
what is virchow's triad (damage to the vessel lining)
1. stasis (alteration in blood flow)
2. hypercoagulability (changes in the constituents of the blood)
3. vascular endothelial injury
40
what is stasis
venous return from extremities is aided by muscular contraction and valves. post-op, pt are less mobile
41
what is vascular endothelial injury
damage occurs w bloodwork, IV access, and central venous access post-op
42
what is hypercoagulability
dehydration, cancer and surgery causes changes in the blood constituents making thrombus formation more likely
43
what is venous thromboembolism
- CVS complications
- thrombus forms in association w inflammation of vein; commonly the legs (DVT)
- can dislodge and move into lungs = pulmonary embolism (EMERGENCY)
44
1. what is DVT
2. pt clues
1. thrombus in vasculature of the extremities
2. unilateral swelling, unilateral pain, history of surgery/immobilization
45
1. what is pulmonary embolism
2. pt clues
1. thrombus in the vasculature of lungs
2. tachypnea, tachycardia, thoracic pain
46
what is non-pharmacological venous thromboembolism
- early mobilization
- exercises for pts that are bedrest
- elastic compression stockings: decrease distal calf vein thrombosis
- intermittent compression devices (automatic sleeve that applies intermittent pressure to legs)
47
what are 2 high risk post-op complications
1. virchow's triad
2. venous thromboembolism
48
what is intermittent compression device (ICD)
- pts w moderate to very high risk for DVT/PE
- must be applied correctly
- must be worn continuously
- not used when pt has an active DVT
49
pharmacological treatments of venous thromboembolism
anticoagulants
- prevent DVT + PE formation in high-risk pts
- treat DVT & PE by preventing new clot development, spread of clot, embolization, SC or orally, may require blood work for CBC, INR, aPITT
50
what are the VTE pharmacological options (5)
1. warfarin coumadin
2. dalteparin (low molec heparin)
3. unfractionated heparin
4. dabigatran
5. rivaroxaban
51
warfarin
route:
mech:
monitoring:
antidote:
route: PO
mech: vitamin K antagonist
monitoring: frequent INR
antidote: vitamin K, octaplex, fresh frozen plasma
dosing based on INR levels
52
dalteparin (LMWH)
route:
mech:
monitoring:
antidote:
route: SQ, q24hrs
mech: indirect thrombin, inhibitor
monitoring: CBC
antidote: protamine
effective prevention/treatment of DVT
does not require anticoagulant monitoring and dose adjustment
53
unfractionated heparin
route:
mech:
monitoring:
antidote:
route: SQ q12hrs, IV continuous infusion
mech: indirect thrombin inhibitor
monitoring: CBC, aPITT
antidote: protamine
54
dabigatran (pradax)
route:
mech:
monitoring:
antidote:
route: SC
mech: direct thrombin inhibitor
monitoring: aPITT
antidote: n/a supportive care w RBC's, fresh frozen plasma
55
rivaroxaban (xarelto)
route:
mech:
monitoring:
antidote:
route: PO
mech: factor Xa inhibitors
monitoring: CBC
antidote: n/a supportive care w RBC's, fresh frozen plasma
56
what are the coagulation studies and how do you interpret the results
name the parameter and SI units for each (4)
1. international normalized ratio (INR): 0.81-1.2
2. platelet count (thrombocytes): 150-400 x10^9/L
3. prothrombin time (PT): 11-12.5 sec
4. partial thromboplastin time (PTT): 28-35 sec
57
2 PACU/surgical GI complications
1. nausea and vomiting
2. nutritional imbalance
58
what would you use to adjust your heparin infusion rate
heparin infusion order/table
59
1. what are risk factors/causes of nausea and vomiting
2. treatment
1. female w history of motion sickness, certain anesthetics/opioids, less the 50 yrs, prolonged or abdominal surgery, paralytic ileus
2. antiemetics (ondansetron), aromatherapy (alc swab/peppermint), IV fluid therapy
60
1. what are risk factors/causes of nutritional imbalance
2. treatment
1. temp diet limitations post surgery, paralytic ileus may delay starting oral intake
2. early pt mobilization to encourage flatus, resume normal diet when appropriate, if severe: total parenteral nutrition may be considered
61
severe emesis can lead to...
fluid and electrolyte balances
62
1. what is paralytic ileus
2. risk factors/causes
3. pt clues
4. treatment
1. impaired intestinal motility for several days post-op
2. abdominal/GI surgery, surgery
3. distended abdomen, abdominal pain, diminished bowel sounds, poor appetite, nausea/vomiting
4. encourage mobilization, if severe: nasogastric tube (bowel rest/decompression), monitor for flatus/stool
63
what are special post-op diets
- low sodium
- cardiac
- diabetic
- renal
64
what are 2 urinary tract complication
- low urinary output
- urinary retention
65
1. what is low urine output?
2. causes/risk factors
3. treatment
1. low urinary output (<30 ml/hr)
2. stress response post-op (aldosterone, ADH secretion), fluid restriction pre-surgery, fluid loss in OR, drain output/NG output, diaphoresis
3. accurate intake/output measurements, IV fluid replacement, increasing oral intake
66
what may oliguria indicate
inadequate renal perfusion and be a risk for renal failure and acute kidney injury
67
what is the MINIMUM output of urine
after 48 hrs it should be...
what is low urine output
30 mL/hr
after 48 hrs it should be: 1500-2500 mL
low urine output: 500-700mL
68
1. what is urinary retention
2. causes/risk factors
3. pt clues
4. treatment
1. inability to fully empty bladder or pass urine
2. urinary surgeries, uncontrolled pain, anesthesia, supine position, meds
3. low urine output, distended bladder upon palpation, hypertension
4. facilitate voiding (commode vs bedpan, running water, increased oral intake), bladder scan, foley catheter to relieve distension
69
aunuria
no urine
70
oliguria
low urine
71
polyuria
lots of urine
72
temp changes up to 12 hrs after surgery
temp:
possible causes:
interventions/prevention:
temp: hypothermia to 36 celsius
possible causes: effects of anesthesia, body heat loss in surgical exposure
interventions/prevention: assess temp q4hr, encourage airway clearance, warm blankets
73
temp changes in first 24-48 hrs after surgery
temp:
possible causes:
interventions/prevention:
temp: elevation to 38 celsius, or above
possible causes: inflammatory response to surgical stress, atelectasis
interventions/prevention: assess temp q4hr, encourage airway clearance
74
temp changes in 3rd day and later after surgery
temp:
possible causes:
interventions/prevention:
temp: elevation above 37.7 celsius
possible causes: wound infection, urinary infection, respiratory infection, phlebitis
interventions/prevention: aseptic wound care and IV site, if febrile: chest x-ray, cultures of wound/urine/blood, monitor leukocyte level
75
2 psychological complications post-op
1. anxiety and depression
2. confusion and delirium
76
treatment of anxiety and depression in post-op
therapeutic supportive listening
social work referral for support
77
treatment of confusion and delirium post-op
determine etiology of confusion/delirium and treat
