Module 3: Postoperative care & Substance misuse Flashcards
List the potential risks for the patient post-surgery.
Outline body systems.
- Airway:
- obstruction
- bronchospasm
- hypoxaemia
- pulmonary oedema
- Breathing:
- hypoventilation
- Cardiovascular:
- Hyper/Hypo tension
- VTE
- syncope
- Arrhythmias
- Fluid & electrolyte balance:
- fluid retention
- fluid overload
- fluid deficits
- hypokalaemia
- Temperature:
- hypothermia
- fever
- Neuropsychological:
- emergence
- delirium
- pain
- Integumentary:
- wound / drains / IVC
- infections / sepsis
- haematoma
- GI:
- nausea & vomiting
- distension
- Ileus
- Urinary:
- retention
- oliguria
- CAUTI
List the criteria for a patient to be discharged from PARU
- Patent airway
- Patient awake (or at baseline)
- Haemodynamic stability ( BP & HR at baseline)
- No respiratory depression
- Oxygen saturation > 92%
- Pain management
- Minimal nausea
- Condition of surgical site
List and describe the post-op interventions for: Respiratory
- Proper patient positioning
- Lateral ‘recovery’ position
- Once conscious -supine position
- Oxygen delivery & monitoring
- Deep breathing, coughing & spirometry
List and describe the post-op interventions for: Cardiovascular
- Monitor - temp, HR & BP
- Monitor lab results
- Record intake & output
- Exercises & early ambulation ( being mindful of changing body position and risk of syncope)
List and describe the post-op interventions for: Neuropsychological
- Monitor & document consciousness level
- Monitor & document Oxygen levels
- Pain management
- Assess for anxiety or depression
- Fluid & electrolyte balance
- Sleep
- Alcohol withdrawal protocols
- Adequate nutrition
- Proper bowel and bladder functioning
- Mobility status
List and describe the post-op interventions for: Integumentary
- Asepsis & assessment of wounds & drains
- wound-care management
- Prophylactic antibiotics
- Maintain glycaemic control
List and describe the post-op interventions for: GI
- Nausea / Vomiting
- NGT care
- Antiemetics / prokinetics
- Adequate hydration
- Assess bowel function
- Early mobilisation
List and describe the post-op interventions for: Urinary
- monitor output
- Bladder scan
- IDC management (insertion/removal)
- Normal positioning for elimination
List the criteria for a patient to be discharged from the surgical unit?
- mobile & alert
- No IV opioids in the past 30mins
- Minimal nausea/vomiting
- PIVC removed
- Responsible adult present if D/C same day as OT
- Written D/C instructions given and understood
what information is included in the discharge information?
- Care instructions for incision(s) and dressings
- Actions & side effects of any medications
- Activities allowed and prohibited
- Dietary requirements
- Information on how and when a patient should seek help
define: addiction
the fact or condition of being addicted to a particular substance or activity
define: dependence
the state of relying on or needing something/one for aid or support
define: Substance use
when someone consumes alcohol or drugs, but does not always lead to addiction
define: Substance misuse
the harmful use of substances despite consequences
define: tolerance
a person’s diminished response to a substance that is the result of repeated use
define: withdrawal
a group of symptoms that occur upon the abrupt discontinuation of consuming a substance
define: Intoxication
a condition that follows the consumption of a psychoactive substance and results in disturbances in the level of consciousness
what commonly addictive substances are in the following categories? Stimulants, Depressants, Hallucinogens, Inhalants
Stimulants:
- nicotine
- caffeine
- cocaine
- amphetamines
Depressants:
- alcohol
- sedatives (benzos)
- opioids (heroin, oxycodone)
- cannabis
Hallucinogens:
- LSD
- PCP
Inhalants:
- nitrous oxide
- petrol
- paint
- glue
- paint thinners
What considerations should the nurse be aware of for a surgical patient who has a history of substance misuse?
– Standards amount of anaesthetic and analgesic drugs may not be sufficient
– Anaesthetic agents may have a prolonged sedative affect requiring extended monitoring
– Increased risk to cardiac and respiratory depression, bleeding, postop complications and infection
– Withdrawal symptoms may be delayed due to anaesthetics and analgesia
– Increased doses of pain medications and combination therapy may be necessary
– Wound healing may be delayed
When considering alcohol withdrawal from the time of the last drink, discuss the risks and timeframes for the following areas:
- Risk of seizures
- Risk of severe complications (list)
- Risk of mild withdrawal symptoms (list)
Risk of seizures:
- high risk within the first 24hrs
- after 24hrs it drops off and plateaus out
Risk of mild withdrawal symptoms:
- highest between 12th- 72hrs (round curve)
- nausea
- tremor
- sweating
- anxiety
- disturbed sleep
- hypertension
- tachycardia
- hyperthermia
Risk of severe complications:
- highest from 24hr - 72hr
- vomiting
- confusion
- disorientation
- dehydration
- hallucinations
- extreme agitation
- delirium tremors (DTs)
Discuss the multidisciplinary and nursing care for the following: Tobacco
Use the brief clinical interventions called the ‘5As’ :
- Ask - identify tobacco users
- Advise - encourage them to quit
- Assess - determine their willingness to quit
- Assist - them in quitting
- Arrange - for follow-up to prevent relapse.
Use the ‘5Rs’ to help motivate those unwilling to quit by addressing:
- Relevance
- Risks
- Rewards
- Roadblocks
- Repetition
Discuss the multidisciplinary and nursing care for the following: Stimulants
Overdose:
- occurs frequently = death
- manage toxicity
Withdrawal - rarely causes hospitalization, craving is intense
Discuss the multidisciplinary and nursing care for the following: Alcohol
– Alcohol intoxication – Alcohol withdrawal syndrome – Alcohol withdrawal delirium – Alcohol detoxification – Alcohol Withdrawal Assessment form
Discuss the multidisciplinary and nursing care for the following: Sedatives
- Treatment:
- mild-moderate (oral diazepam)
- severe (IV diazepam)
- closely monitor for apnoea (withdrawal should be medically supervised)
Discuss the multidisciplinary and nursing care for the following: Opioids
- Overdose is medical emergency
- Monitor closely
- treatment based on symptoms
- Methadone for detoxification
Discuss the multidisciplinary and nursing care for the following: Cannabis
- Symptom relief
* Social and family support
