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N353: Practice of Nursing II > MedSurg Start: Module 7: Nursing Care of the Post Operative Patient > Flashcards

MedSurg Start: Module 7: Nursing Care of the Post Operative Patient Flashcards

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1
Q

Difference between Medical v Surgical Patients?

A

Both have a system pathology BUT…

Surgery is the critical TREATMENT of a surgical patient’s pathology (medical is a diagnosis).

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2
Q

Different Surgical Purpose Types?

A

Diagnostic
Curative
Reparative
Reconstructive
Palliative

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3
Q

Different Surgical Degrees of Urgency?

A

Emergent
Urgent
Required
Elective

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4
Q

Diagnostics Procedure

A

Gathering information/Going into the body and trying to find out what is occurring - maybe obtain tissue in order to diagnose

Ex: Diagnostic Biopsy of the Breast; HCT or Hgb Drops lead to Exploratory Surgery

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5
Q

Curative Procedure

A

Procedure in order to cure a problem

Ex: Appendectomy

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6
Q

Reparative Procedure

A

Repairs something that is wrong that is already there - not adding just fixing

Ex: Dislocated Shoulder needs to be put back in place

Ex: Ligament repair

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7
Q

Reconstructive Procedure

A

Recreating something normally in the body but generally using “Aftermarket Parts” or other materials

ex: Using titanium or ceramic or plastic to replace a hip

Ex: Reconstructive breast surgery post mastectomy

Ex: Grafts

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8
Q

Palliative Procedure

A

Not looking for a cure, but a procedure to provide better comfort

ex: If a chest tumor is pressing on the diaphragm they have trouble breathing, so a surgery could reduce the size and help with comfort.

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9
Q

Degree of Urgency: Emergent

A

A procedure that needs to be done IMMEDIATELY or else there will be serious consequences

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10
Q

Degree of Urgency: Urgent

A

A procedure that has a little more time than emergent, but still needs to be done within 24 hours

ex: most appendix surgeries

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11
Q

Degree of Urgency: Required

A

A procedure that must occur within the next few days/weeks

ex: Myocardial ischemia surgery must be done within 2 weeks

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12
Q

Degree of Urgency: Elective

A

A procedure that SHOULD/COULD be done, but you choose whether to do it or not

ex: A total hip replacement could be elective where you determine time and day

No serious consequences for not getting this

2020 Made this type of urgency more difficult and caused financial strains for hospitals

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13
Q

Possible Surgical Settings

A

Outpatient

Ambulatory or Same Day Surgery

Inpatient Surgery

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14
Q

Outpatient Surgical Setting

A

Done in the office, and you can often go home/drive home after - not done in the ER

ex: Blemish removal in the MD office

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15
Q

Ambulatory or Same Day Surgery Setting

A

Often a same day surgery that is invasive but is small and allows for ambulation in for the procedure and being brought to the car in a wheelchair allowing them to not have a need to spend the night

ex: Laparoscopic cholecystectomy

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16
Q

Laparoscopic cholecystectomy

A

A special device that goes down a tube to remove the gall bladder in pieces - small openings from it can be covered with bandaids and the person can leave same day

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17
Q

Inpatient Surgery Setting

A

A surgery involving overnight stay potentially even for a few days

ex: Open cholecystectomy (gallbladder removal)

ex: total joint replacement (sometimes Ambulatory, but often inpatient)

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18
Q

Peri-Operative Phases

A

Pre Operative

Intra Operative

Post Operative

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19
Q

Pre-Operative

A

Time between decision to proceed with surgery and arrival in the operating room

This period can take months if it is an elective history

This period allows for teaching, preparation, etc

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20
Q

Intra-Operative

A

Time actually in the OR

Not just while surgery is occurring, but when they are physically in the OR as well

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21
Q

Post-Operative

A

Starts with admission to PACU and ends with the last post-op follow up visit!

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22
Q

PACU

A

Post Anesthesia Care Unit

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23
Q

How might the peri operative phases change in length?

A

Based on the urgency of the surgery

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24
Q

What two important things does Informed Consent do?

A
  1. protects the medical team
  2. Protects the patient
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25
Q

What things must informed consent be?

A
  1. Signed voluntarily
  2. Signed by a person of legal age or emancipated minor
  3. The person must be mentally Competent and able to understand information
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26
Q

Informed consent is a legal mandate required for what kinds of procedures?

A

Invasive Procedures (biopsy, PICC line insertion)

Procedures requiring sedation

Procedures involving radiation

Non-emergent surgery

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27
Q

PICC

A

Peripherally inserted central catheter

It is put in the periphery (arm) and travels up and sits in the central vessel (subclavian vein right before the right atrium to the heart)

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28
Q

What is one situation that does not need informed consent?

A

A life saving emergency procedure

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29
Q

Informed consent requires patient education from ____

A

The physician!! (or advanced practitioner like PA or NP)

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30
Q

What things must be discussed with the patient in order to get consent?

A

Benefit to procedure

Possible alternatives to procedures

Risk of procedure

Complications that could occur

Post Op Period Expectations like Diet, Pain, Etc

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31
Q

Who can witness the signature for consent and who cannot?

A

A registered nurse can witness signature, but a nursing student can NOT witness a signature on consent

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32
Q

What is the purpose of a Pre-op assessment?

A
  1. Identify risk factors
  2. Provide a baseline of condition
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33
Q

What are some standards done for the pre op assessment?

A
  1. Health history
  2. Lab tests
  3. Chest x rays
  4. ECG (could pick up a former MI from years ago for example which is important for the anesthesiologist to know)
  5. Other indicated tests
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34
Q

Surgical Risk Factors (things that can cause complications of bad outcomes or issues when getting surgery)

A

Immunologic Compromises

Hepatic and/or Renal Compromise

Pulmonary Diseases

Pregnancy

Cardiovascular Diseases

Endocrine Dysfunction

Age (very young or very old)

Weight (under or over)

Disabilities

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35
Q

Possible Effects of Surgery

A

Fix/Repair/Cure/Diagnose a problem

Decreased defense against infection

Disrupted vascular system

Stress response

Disruption in body image

Lifestyle changes

Possible organ dysfunction

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36
Q

When should patient teaching about surgery be done and what kind of information should be taught?

A

It should be done prior to the procedure to understand why they need it

You can teach them information specific to the procedure and what to expect

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37
Q

What sort of things can be taught to the patient about what to expect after a surgery?

A

Surgical dressings and drains

Tubes and equipment (IV, NG tube, FOLEY, SCD)

Nutrition (NPO –> Clear –> As tolerated, etc)

Hydration (IV, sips of water, etc)

Activity (BR –> OOB as tolerated –> Ambulate)

Effects of decreased activity (stiffness, aches, skin integrity, decreased resp effort)

Physical feelings (nausea, pain, disorientation)

General post op progress/tests

General post op care (C-DB, turn/reposition qXhrs, pain management)

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38
Q

Post Op patients end up ____ faster than expected

A

ambulating

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39
Q

C-DB

A

Cough Deep Breath

Need to keep airways clear, no secretions or pooling wanted - They take deep good breaths to keep the airways from doing such

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40
Q

Pain cannot..

A

completely go away necessarily, we just need to keep it under control

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41
Q

About how often should we turn and reposition patients?

A

No later than every 2 hours

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42
Q

General Patient Prep for Surgery Steps

A
  1. NPO Before Surgery (usually midnight the day prior)
  2. Informed consent completed
  3. Correct patient identifiers in place
  4. Prep, if ordered, is done
  5. Pre Op checklist is completed
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43
Q

Why do we have people NPO prior to surgery?

A

We want the upper GI tract empty so if the airway is compromised by things they are less likely to aspirate on what is in the GI tract during surgery

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44
Q

What sort of things may be in the general patient prep for surgery checklist?

A

preop labs/test results available

H&P (History and physical) available

recent vital signs taken/documented

voiding (amount/time) documented

administer pre anesthesia medications

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45
Q

What are the first things done post-op by the nurse?

A
  1. Help settle patient in bed
  2. Get report from PACU (aka recovery room) nurse
  3. Match what you are told with what is seen (review orders, obtain VS baseline, clarify last dose of pain meds, clarify if/when voided/due to void time, assess surgical site and dressing)
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46
Q

Around how long of a period without voiding post op is concerning?

A

8-10 hours without voiding

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47
Q

ABC

A

the 3 Immediate Priorities of the nurse caring for a post-op patient

A - Airway
B - Bleeding
C - Circulation

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48
Q

What does the A stand for in ABC

A

Airway

listen to breath sounds, rate and depth of respirations, ability to cough, mentation, O2 sat

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49
Q

What does the B stand for in ABC

A

Bleeding

feel beneath the patient with gloves for pooled blood, check dressing/surgical drains for bleeding and note amount so you can note any increase

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50
Q

What does the C stand for in ABC

A

Circulation

check skin color and temperature, note quality of pulse, blood pressure, check mental status (awake, alert, oriented?)

51
Q

VOID

A

Another acronym for 4 important things to assess post op

V - VS
O - Out
I - In
D - Documentation

52
Q

What does the V stand for in VOID

A

Vital Signs

assess temp, pulse, BP, pulse oximetry, pain

53
Q

What does the O stand for in VOID

A

Out

Assess foley, NG tube, chest tubes, dressings, surgical drains, SCDs, etc

54
Q

What does the I stand for in VOID

A

In

assess IVs, PCA pump, Oxygen/mechanical ventilation

55
Q

What does the D stand for in VOID

A

DOCUMENTATION!!!!

56
Q

What is important to keep in mind when assessing tubes?

A

Assess ALL tubes coming IN and going OUT

57
Q

If it is attached, it should be ____; If it is not attached…

A

If it is attached it should assessed; If it is not attached, should it be?

58
Q

Examples of Tubes that go in?

A
  1. IV Lines (Peripheral, PICC, Central)
  2. Arterial Lines
  3. Feeding Tubes
  4. Irrigation Tubes
59
Q

Examples of Tubes that come out?

A
  1. Foley Cath (Indwelling)
  2. Fecal Management System
  3. NG Tube
  4. Drains
  5. Chest Tube
  6. Nephrostomy Tube
60
Q

Which way does an NG tube go?

A

It comes OUT

61
Q

Which way does a feeding tube go?

A

It goes IN

62
Q

NG Tube

A

Tube that goes OUT

Larger bore - “G-arden hose (not really)” - Larger

Primary use for gastric emptying and decompression/drainage

Can perform wall suction

63
Q

Feeding Tube

A

Tube that goes IN

Smaller bore (opening) - F-ine, smaller diameter tube

Primary use for feedings and med administration

Brand: “Kangaroo Pump”

64
Q

What are the 4 things you assess on an IV (in correct order)?

A
  1. Site
  2. Tubing (Kinked? Free flowing?)
  3. Rate (of administration)
  4. Solution (given)

You wanna work from the patient outward in assessment

65
Q

What are the 3 things you assess on an NG Tube?

A
  1. Insertion Site
  2. Placement
  3. Output (coffee ground appearance may be bleeding; but green may be normal - depends)
66
Q

What should be assessed on a Foley Catheter?

A
  1. Integrity of Drainage Tubing
  2. Collection Chamber

also the site

67
Q

A catheter tubing and collection chamber must…

A

be below the level of the bladder

68
Q

What sort of things can we assess on Surgical Drains?

A
  1. Site/Where drainage is coming out
  2. What kind of drainage is coming out (Sanguineous may be bloody for example)
  3. What is coming out and actually collecting in the chamber
69
Q

Jackson-Pratt (JP) Drain

A

A smaller bubble like drain that was originally used for brain surgeries, but is now used elsewhere

The drain must be squeezes and deflated to allow a vacuum that provides suction for drainage

70
Q

Where is the surgical drain usually placed?

A

Almost never right in the incision because the inflammatory stress response can lead to fluid build up and infection

So, it is put nearby the incision

71
Q

SCD

A

Sequential Compression Devices

They are a set of pads and devices that squeeze the ankle –> calf –> thigh in that order one after another while connected to the pump in order to give better blood flow and allow venous return to the heart

This is used to prevent a blood clot from being in bed

Another name: “Pneumatic Devices”

72
Q

Foot Pump

A

A device that can pump the foot in order to help with venous return

NOT an SCD

73
Q

What universally must be assessed for tubes going IN?

A
  1. Entry Site (redness, edema, pain, drainage)
  2. Tubing (date, integrity)
  3. Solution (correct solution, rate, not outdated)
74
Q

What universally must be assessed for tubes coming OUT?

A
  1. Exit site (redness, edema, pain, drainage)
  2. Tubing (date, integrity, type of output)
  3. Collection container (amount, type of output)
75
Q

What are some potentially bad post-op complications?

A

Infection

Dehiscence

Evisceration

Gastric Dilation

Paralytic Ileus

Atelectasis

Pneumonia

Urinary Retention

Hypovolemic Shock

Pulmonary Embolism

76
Q

When are signs of surgical infection likely to show?

A

They do not usually show until at least a few days after surgery - typically 5 days later

77
Q

What are some S/S of Surgical Infection

A

redness

purulent drainage

fever

tachycardia

leukocytosis

78
Q

Dehiscence

A

Separation of incision

79
Q

Evisceration

A

evidence of bowel/organ through the surgical incision

very painful

80
Q

Dehiscence often goes along with ____

A

evisceration

81
Q

S/S of Gastric Dilation post-op

A

N/V

Abdominal Distension

82
Q

S/S Paralytic Ileus post-op

A

Diminished bowel sounds

No stool or flatus

N/V

Abdominal distention and tenderness

83
Q

What may be the root cause of a paralytic ileus

A

Anesthesia or from Not eating

84
Q

What is more serious, gastric distention or a paralytic ileus?

A

Paralytic Ileus

85
Q

What are some potential respiratory post op complications?

A

Atelectasis leading to pneumonia

86
Q

What are some potential urinary post op complications?

A

urinary retention

87
Q

What are some possible circulatory post op complications?

A

hypovolemic shock

pulmonary embolism

88
Q

S/S of Atelectasis

A

Dyspnea

Tachypnea

Decreased breath Sounds

Asymmetrical Chest Movement

Tachycardia

Increased restlessness

89
Q

What is interesting about what the nurse can do for atelectasis?

A

The nurse can reverse this by encouraging C-DB without an order

90
Q

Atelectasis can lead to …

A

Hypostatic Pneumonia (less than stasis/Less movement in the airways leading to sludging and bacterial multiplication)

91
Q

S/S of Hypostatic Pneumonia

A

Rapid respirations

Shallow respirations

Fever

Wet breath sounds

Asymmetrical Chest movement

Productive cough

Hypoxia

Tachycardia

Leukocytosis

92
Q

S/S of Urinary Retention

A

Unable to void 8-10 hours post op

Palpable Bladder

Frequent, small amount voiding

Pain in the Suprapubic area

93
Q

What may be causing urinary retention post op?

A

the general anesthesia

94
Q

What post-op complications are most likely to cause death?

A

Circulatory (Pulmonary embolism and Hypovolemic shock)

95
Q

What circulatory post op complication is more common?

A

Pulmonary Embolism (scariest upon assessment to find)

96
Q

How fast can a person die from a pulmonary embolism?

A

Within 1 hour

It blocks blood flow to the alveoli leading to no gas exchange!

97
Q

S/S of Pulmonary Embolism

A

Chest pain

dypsnea

Increased respiratory rate

Tachycardia

Increased anxiety

Diaphoresis

Decreased Orientation

Decreased BP

Blood gas changes

98
Q

S/S of Hypovolemic Shock

A

Decreased Urine

Decreased BP

Weak Pulse

cool and Clammy

Restless

Increased Bleeding

increased thirst

Decreased CVP

99
Q

Post Op Pulmonary Assessments

A

Monitor Breath sounds (wheezes, crackles rhonchi)

Monitor for signs of airway blockage (choking, irregular respirations, dusky skin tone)

Vital Signs (include pain and O2 sat)

Secretions (increase, amount, color, odor)

100
Q

Post Op Pulmonary Interventions

A

C-DB and/or incentive spirometer at least q (ordered) hours

Analgesia prn

Abdominal/Thoracic splinting to promote adequate coughing (makes it less painful)

Supplemental O2 as needed as ordered

Notify PCP of any change(s) in status

101
Q

Goal of Post Op Pulmonary Assessments and Interventions

A

Prevent Respiratory complications like atelectasis and hypostatic pneumonia

102
Q

Post Op Cardiovascular Assessments

A

Mentation, VS, Pulse Ox, cardiac rhythm, urinary output, edema, skin temperature/color/moisture

IV site (redness, swelling, leaking, temp)

IV fluid (correct sol’n and rate)

Swelling, redness, pain in calf

Bleeding (presence increase or decrease) of surgical site or drain

103
Q

Post Op Cardiovascular Interventions

A

AE Hose/SCDs

Leg Exercises

Supplemental O2 if needed as ordered

Adequate Fluid intake

Accurate I and O

Monitor Labs (H&H, electrolytes, PT/INR/PTT)

Notify PCP of any change(s) in status

104
Q

Goal of Post Op Cardiovascular Assessments and Interventions

A

Prevent cardiac complications like shock, hemorrhage, DVT, and PE

105
Q

Post op Skin Assessments

A

Surgical incision and drain insertion sites (REEDA/COCA, bruising, swelling, healing)

Dressing (clean, dry, intact)

Skin (temp, moisture, signs of breakdown like redness/burning/itching)

106
Q

Post op Skin Interventions

A

adequate fluid intake

accurate I and O

adequate nutrition

change/reinforce dressings as needed (put more gauze on it)

reposition every 2 hours (q2hr)

Keep skin moisturized and dry

notify PCP of any change(s) in status

107
Q

Goal of Post Op Skin Assessments and Interventions

A

Preventing skin breakdown, infection, dehiscence, hematoma

Promote wound healing

108
Q

Post op GI assessments

A

pain

bowel sounds (ileus?)

flatus

bowel movement

distention

nausea

109
Q

Post op GI Interventions

A

Analgesia

stool softener as needed if ordered

anti emetics as needed if ordered

advance diet as ordered/tolerated

encourage fluids

notify PCP of any changes in status

110
Q

Goal of Post op GI Assessments and Interventions

A

Prevent GI complications (like constipation and a paralytic ileus)

111
Q

What is the best way to maintain GI Tract function?

A

GET PEOPLE UP AND MOVING

112
Q

Post op Genito-urinary Assessments

A

Monitor output:

Amount, odor, clarity

needs to void within 8 hours of PACU time

needs to void within X hours of Foley removal

113
Q

Post op Genito-urinary Interventions

A

Adequate fluid intake

Accurate I and O

remove Foley ASAP (note due-to-void (DTV) time after Foley removal)

Labs (renal function markers) - creatinine and BUN

notify PCP of any changes in status

114
Q

Goal of Post op Genito-Urinary Assessments and Interventions

A

Prevent GU complications like urinary retention and UTI

115
Q

Post op Nutrition Assessments

A

Gag reflex

N/V present?

116
Q

Post op Nutrition Interventions

A

adequate hydration

accurate I and O

diet for healing
advance diet slowly as tolerated

proper positioning for feeding

give comfort measures for nausea

notify PCP of any changes in status

117
Q

What is a part of a diet for post op healing?

A

Protein - for tissue repair

Carbohydrates - for energy

Vitamin C - for connective tissues and tissue repair

118
Q

Goal of Post op nutrition assessments and interventions

A

maintain adequate nutrition for healing and energy

119
Q

Post op safety assessments

A

monitor level of awareness

monitor physical ability

120
Q

Post op safety interventions

A

side rails up and bed down

call bell appropriate for patient and in reach

minimal use of restraints

NPO until return of gag reflex

position properly for surgical consideration and PO intake

analgesia prn

notify PCP of any changes in status

121
Q

Goal of Post Op Safety Assessments and Interventions

A

Prevent collateral damage (fall, choking, fear, anxiety)_

122
Q

How do post op assessments and priorities change?

A

It is based on the time, situation, what you look at

123
Q

How may a “Fresh” (newly) post op patient priorities differ from a 2 days post op patient, 2 days post op with increased temp, 1 day post op w n/v, and a 3 days post op ready for rehab or discharge patients?

A

Important thing to note is priority differences!!!

Fresh - VS, Lungs, Incision, Comfort

2 Days Post Op - Diet, Activity, Dressing/Incision, Educations

2 Days Post Op with Increased Temp - Lungs, Urine, incision, Labs, Anxiety

1 Day Post Op w N/V - GI function, Medication effect?, VS, Labs, Incision

3 Days post op ready for rehab/discharge - education and follow up appointment are priorities

N353: Practice of Nursing II (14 decks)

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