lecture three--post op nursing Flashcards
who can discharge from the PACU and what are the requirements for someone to be discharged from the PACU
only the anesthesiologist discharges from the PACU and the requirements are that their vitals are stable and they’re in a normothermic temperature state
what are risk factors for complications in post op care
respiratory: thoracic, airway, abdominal procedures, general anesthesia, obesity, elderly, smokers
cardiac: alterations in respiratory function, cardiac hx, elderly, critically ill.
alterations of temperature:
hypo and hyperthermia
hypothermia: core temp is less than 95 degrees, heat loss, old age is a risk for it.
complications are increased bleeding, hypotension, slow metabolism, hypovolemia, and delayed wound healing
hyperthermia: atelectasis, prolonged use of anesthetics, etc.
symptoms: blurred vision, dizziness, fast breathing or heart rate, fatigue.
headache, light-headedness or syncope (fainting), low blood pressure, muscle aches or cramps.
atelectasis
most common cause of postoperative hypoxemia. suspect with febrile reaction in 1st 48 hours post op. atelectasis is also the number one cause of hyperthermia.
sx/sx: SOB, high HR, wheezing, cough
atelectasis is a complete or partial collapse of the entire lung or area (lobe) of the lung. It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid.
post op complication: hypoxemia
sx/sx: labored breathing, increased HR, note characteristics of sputum
evaluate: airway patency, chest symmetry and depth, rate and character of respirations
monitor: vitals regularly and O2 sats
auscultate: breath sounds
other respiratory complications
pulmonary edema: essentially fluid overload in the lungs
ASPIRATION of gastric contents–PREVENT this
bronchospasm
hypoventilation
respiratory complications prevention and interventions
prevention: lateral recovery position
once they are awake, supine with HOB slightly up
interventions:
provide adequate analgesia
provide o2 therapy as ordered and PRN
encourage deep breathing
teach coughing techniques
proper positioning to facilitate respirations and protect airway
cardiovascular post op complications
dysrhythmias
hypotension: decreased SVR, dehydration
hypertension: fluid overload, pain, anxiety, bladder distention
fluid and electrolyte imbalances
fluid overload
(fluid retention and hormone secretion/release)
increased aldosterone leads to Na+ fluid retentions, increasing blood volume
causes: retention, HF, kidney problems, IV infusing too fast
fluid deficit
untreated pre-op dehydration
intra-op blood loss
slow/inadequate fluid replacement
ambulation and vitals
what do you notify the MD for
early ambulation is KEY to prevent and treat VTEs, DVTs, PE’s.
frequent vital signs compared with baseline and evaluated for trends and considering Hx.
apical-radial pulse and report irregularities
skin color, temperature, and moisture
notify MD for: systolic less than 90 or greater than 160
pulse less than 60 or greater than 120
pulse pressure narrowing or gradual increase in bp with unidentified cause
if cardiac rhythm changes
what do you act on?
ACT ON WHAT’S NOT NORMAL
if you leave the room right now, what happens to your patient??
neuro nursing diagnoses and complications
nursing diagnoses: disturbed sensory perception, acute confusion/delirium, anxiety, fear, ineffective coping, impaired verbal communication, risk for injury
potential neuro complications:
post operative cognitive dysfunction
anxiety and depression
intra-operative CVA
delirium: psych and physio factors
assessment and management of neuro complications
dc this
GI
nursing diagnoses: nausea, aspiration, hiccups, deficient fluid volume, fluid and electrolyte imbalance
NPO until when?
until gag reflex has come back
begin PO intake when gag reflex returns but start on clear fluids
get them up and walking to prevent distention
NG tubes: placement and suction settings, patency, color, quantity of discharge.
urinary
complications:
impaired urinary elimination, acute urinary retention, low urine output
**low urine output up to 24 hours after surgery can also be due to ATN or renal failure
ACUTE urinary retention may occur as a result of the anesthesia, location of surgery, position, or immobility.
pts need to be voiding 30mL/hr at MINIMUM
monitor BUN and CR (creatinine)
if they HAVEN’T voided in 6-8 hours, use the bladder scanner 1st, and cath only if necessary
