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MedSurg > Lecture 2.1 - Peri and Post-Op Care > Flashcards

Lecture 2.1 - Peri and Post-Op Care Flashcards

1
Q

What is inpatient surgery?

A

Same-day admission

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2
Q

What is ambulatory surgery?

A

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

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3
Q

When is information about medications collected during the preoperative assessment?

A

Immediately in ER, weeks in advance for elective

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4
Q

When does a person begin NPO before elective surgery?

A

from midnight the night before

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5
Q

What is malignent hyperthermia?

A

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

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6
Q

Why might information about previous surgeries be important before another?

A

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

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7
Q

What is delirium tremens? How is it treated?

A

Seizure, agitation, tremor associated with alcohol withdrawal.

Treated with valium (diazepam or other benzos)

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8
Q

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

A

Prevent alveolar collapse (atelectasis)

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9
Q

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

A

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)

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10
Q

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

A

Communication, final pre-op teaching, and readiness

verify signed consent

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11
Q

Why might anticholinergics be used in preop pts?

A

To reduce secretions

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12
Q

What is the role of the perioperative nurse?

A

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

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13
Q

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

A

Not scrubbed, gowned, gloves
Remains in unsterile and documents

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14
Q

What is the role of the scrub nurse during surgery?

A

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

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15
Q

What is the role of the Registered Nurse First Assistant?

A

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

Required additional education.

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16
Q

What is the difference between local and regional anesthisia?

A

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

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17
Q

What are the initial priorities during assessment right after surgery?

A

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

18
Q

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

A

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

19
Q

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

A

Obstruction, hypoxemia, hypoventilation d/t sedation or pain

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

20
Q

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

A

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

Pulmonary edema

Aspiration of gastric contents –> Pneumonia

21
Q

What causes atelectasis? What is is characterized by?

A

Obstruction of bronchi from retained secretions or decreased resp excursion.

No lung sounds will be present in the collapsed lung

22
Q

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

A

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

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

23
Q

What are some signs of hypoxemia?

A

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

24
Q

What are the most common complications in CDV function postoperatively?

A

Hypo, HTN, Dysrhythmias

25
Q

What might cause hypertension postoperatively?

A

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

26
Q

What might cause dysrhythmias postop?

A

Fluid and electrolyte imbalances

27
Q

What is the normal K concentration in labs?

A

3.5-5.2

28
Q

What change in BP might be concerning postoperatively?

A

A narrowing Pulse Pressure (S - D = PP)

A change greater than 20mmHg preop baseline

29
Q

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

A

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

30
Q

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

A

UTI

31
Q

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

A

Circulation issues (DVT)

32
Q

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

A

Infection of wound

33
Q

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

A

Wonder about medication reactions

34
Q

What are potential GI problems postop?

A

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

Paralytic ileus

35
Q

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

A

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

36
Q

What might cause N&V postoperatively?

A

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

37
Q

When can patents resume eating postoperatively?

A

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

Start with clear liquids, advance as tolerated.

38
Q

What urinary output can be expected postoperatively?

A

30ml/hour is expected in PACU

200ml within 6-8 hours PO

39
Q

Why is low urinary output expected postoperatively?

A

Increased aldosterone and AHD from stress of surgery

Fluid restriction

Fluid loss during surgery

Drainage, diaphoresis

40
Q

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

A

patient and caregiver teaching

MedSurg (11 decks)

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