Lecture 2.1 - Peri and Post-Op Care

Question 1

What is inpatient surgery?

Answer 1

Same-day admission

Question 2

What is ambulatory surgery?

Answer 2

Procedures that take less the 2 hrs and usually less than 3-4 hours in PACU/PARR

Question 3

When is information about medications collected during the preoperative assessment?

Answer 3

Immediately in ER, weeks in advance for elective

Question 4

When does a person begin NPO before elective surgery?

Answer 4

from midnight the night before

Question 5

What is malignent hyperthermia?

Answer 5

An increase in temperature and muscle contractions - adverse effect of general anesthesia for some people. Must determine if there is a history during preoperative assessment

Question 6

Why might information about previous surgeries be important before another?

Answer 6

Tells story of medical Hx, presence of scar tissue can cause problems.

Question 7

What is delirium tremens? How is it treated?

Answer 7

Seizure, agitation, tremor associated with alcohol withdrawal.

Treated with valium (diazepam or other benzos)

Question 8

Why is deep breathing and coughing so important post-operatively?

Answer 8

Prevent alveolar collapse (atelectasis)

Question 9

What are the three types of information a patient might want preoperatively?

Answer 9

Sensory
Process (general flow of locations and what is to be expected)
Procedural (More details such as where IV will be started, what to expect at each location)

Question 10

What is the nursing role on the day of surgery, during preparation?

Answer 10

Communication, final pre-op teaching, and readiness

verify signed consent

Question 11

Why might anticholinergics be used in preop pts?

Answer 11

To reduce secretions

Question 12

What is the role of the perioperative nurse?

Answer 12

To prepare the room with the team and act as a patient advocate throughout the surgical experience

Question 13

What is the role of the circulating nurse during a surgery?

Answer 13

Not scrubbed, gowned, gloves
Remains in unsterile and documents

Question 14

What is the role of the scrub nurse during surgery?

Answer 14

To follow designated scrub procedure, remain gowned and gloved in sterile attire, and to remain in the sterile field.

Question 15

What is the role of the Registered Nurse First Assistant?

Answer 15

To handle tissue and instruments, provide exposure to the surgical site, and assist with homeostasis. Might perform suturing.

Required additional education.

Question 16

What is the difference between local and regional anesthisia?

Answer 16

Local is smaller area, regional is loss of sensation of an entire nerve group.

Question 17

What are the initial priorities during assessment right after surgery?

Answer 17

Vitals, neuro, GU/GI, assessment of surgical site and dressing, communication with pt

Question 18

Why is early ambulation so important in post-op patients?

Answer 18

Prevents blood clots and stimulates peristalsis (can take up to 72 hours for normal resumption of ileus peristalsis)

Question 19

What are the most common causes of airway compromise during the post-op period? Who is most at risk?

Answer 19

Obstruction, hypoxemia, hypoventilation d/t sedation or pain

Those who receive general anesthesia, are older, or smoke heavily are at higher risk

Question 20

What are potential alteration of the respiratory system common in patients postoperatively?

Answer 20

Atelectasis
–> Most common (alongside aspiration pneumonia) after abd and thoracic surgery

Pulmonary edema

Aspiration of gastric contents –> Pneumonia

Question 21

What causes atelectasis? What is is characterized by?

Answer 21

Obstruction of bronchi from retained secretions or decreased resp excursion.

No lung sounds will be present in the collapsed lung

Question 22

What can cause Pulmonary Edema? What signs are indicative of it?

Answer 22

Can result from fluid overload, left-Vent failure, prolonged airway obstruction, sepsis, aspiration

Characterized by hypoxemia, crackles, decreased compliance, infiltrates on X-ray.

Question 23

What are some signs of hypoxemia?

Answer 23

tachypnea, gasping, apprehension, restlessness, and a rapid, thready pulse.

Question 24

What are the most common complications in CDV function postoperatively?

Answer 24

Hypo, HTN, Dysrhythmias

Question 25

What might cause hypertension postoperatively?

Answer 25

Might be body’s normal response to stress of surgery, urinary retention can also cause HTN.

Question 26

What might cause dysrhythmias postop?

Answer 26

Fluid and electrolyte imbalances

Question 27

What is the normal K concentration in labs?

Answer 27

3.5-5.2

Question 28

What change in BP might be concerning postoperatively?

Answer 28

A narrowing Pulse Pressure (S - D = PP)

A change greater than 20mmHg preop baseline

Question 29

What might cause an increase in temp during the first 1-2 days postop?

Answer 29

Usually issues with the lungs - pneumonia, Pulmonary embolism d/t DVT

Question 30

What is usually the cause of increased temperature during day 3-5 postop?

Answer 30

UTI

Question 31

What is usually the cause of increased temperature during day 4-6 postop?

Answer 31

Circulation issues (DVT)

Question 32

What is usually the cause of increased temperature during day 5-7 postop?

Answer 32

Infection of wound

Question 33

What is usually the cause of increased temperature during day 7+ postop?

Answer 33

Wonder about medication reactions

Question 34

What are potential GI problems postop?

Answer 34

N&V are significant and most common, most pronounced after abd surgery

Paralytic ileus

Question 35

Which patients are predisposed to postoperative nausea and vomiting (PONV)?

Answer 35

Those over 50, females, pts w motion sickness, nonsmokers

Question 36

What might cause N&V postoperatively?

Answer 36

Opioids, delayed GI emptying, slowed peristalsis, resumption of food too soon.

Question 37

When can patents resume eating postoperatively?

Answer 37

Upon return of gag reflex OR return of bowel sounds for pts w abd surgery

Start with clear liquids, advance as tolerated.

Question 38

What urinary output can be expected postoperatively?

Answer 38

30ml/hour is expected in PACU

200ml within 6-8 hours PO

Question 39

Why is low urinary output expected postoperatively?

Answer 39

Increased aldosterone and AHD from stress of surgery

Fluid restriction

Fluid loss during surgery

Drainage, diaphoresis

Question 40

What is a key priority during discharge concerning follow up care?

Answer 40

patient and caregiver teaching