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Adult Health > Module 3: Postoperative care & Substance misuse > Flashcards

Module 3: Postoperative care & Substance misuse Flashcards

1
Q

List the potential risks for the patient post-surgery.

Outline body systems.

A
  • 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
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2
Q

List the criteria for a patient to be discharged from PARU

A
  • 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
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3
Q

List and describe the post-op interventions for: Respiratory

A
  • Proper patient positioning
  • Lateral ‘recovery’ position
  • Once conscious -supine position
  • Oxygen delivery & monitoring
  • Deep breathing, coughing & spirometry
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4
Q

List and describe the post-op interventions for: Cardiovascular

A
  • Monitor - temp, HR & BP
  • Monitor lab results
  • Record intake & output
  • Exercises & early ambulation ( being mindful of changing body position and risk of syncope)
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5
Q

List and describe the post-op interventions for: Neuropsychological

A
  • 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
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6
Q

List and describe the post-op interventions for: Integumentary

A
  • Asepsis & assessment of wounds & drains
  • wound-care management
  • Prophylactic antibiotics
  • Maintain glycaemic control
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7
Q

List and describe the post-op interventions for: GI

A
  • Nausea / Vomiting
  • NGT care
  • Antiemetics / prokinetics
  • Adequate hydration
  • Assess bowel function
  • Early mobilisation
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8
Q

List and describe the post-op interventions for: Urinary

A
  • monitor output
  • Bladder scan
  • IDC management (insertion/removal)
  • Normal positioning for elimination
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9
Q

List the criteria for a patient to be discharged from the surgical unit?

A
  • 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
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10
Q

what information is included in the discharge information?

A
  • 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
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11
Q

define: addiction

A

the fact or condition of being addicted to a particular substance or activity

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12
Q

define: dependence

A

the state of relying on or needing something/one for aid or support

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13
Q

define: Substance use

A

when someone consumes alcohol or drugs, but does not always lead to addiction

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14
Q

define: Substance misuse

A

the harmful use of substances despite consequences

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15
Q

define: tolerance

A

a person’s diminished response to a substance that is the result of repeated use

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16
Q

define: withdrawal

A

a group of symptoms that occur upon the abrupt discontinuation of consuming a substance

17
Q

define: Intoxication

A

a condition that follows the consumption of a psychoactive substance and results in disturbances in the level of consciousness

18
Q

what commonly addictive substances are in the following categories? Stimulants, Depressants, Hallucinogens, Inhalants

A

Stimulants:

  • nicotine
  • caffeine
  • cocaine
  • amphetamines

Depressants:

  • alcohol
  • sedatives (benzos)
  • opioids (heroin, oxycodone)
  • cannabis

Hallucinogens:

  • LSD
  • PCP

Inhalants:

  • nitrous oxide
  • petrol
  • paint
  • glue
  • paint thinners
19
Q

What considerations should the nurse be aware of for a surgical patient who has a history of substance misuse?

A

– 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

20
Q

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)
A

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)
21
Q

Discuss the multidisciplinary and nursing care for the following: Tobacco

A

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
22
Q

Discuss the multidisciplinary and nursing care for the following: Stimulants

A

Overdose:

  • occurs frequently = death
  • manage toxicity

Withdrawal - rarely causes hospitalization, craving is intense

23
Q

Discuss the multidisciplinary and nursing care for the following: Alcohol

A 
– Alcohol intoxication 
– Alcohol withdrawal syndrome 
– Alcohol withdrawal delirium 
– Alcohol detoxification 
– Alcohol Withdrawal Assessment form
24
Q

Discuss the multidisciplinary and nursing care for the following: Sedatives

A
  • Treatment:
  • mild-moderate (oral diazepam)
  • severe (IV diazepam)
  • closely monitor for apnoea (withdrawal should be medically supervised)
25
Q

Discuss the multidisciplinary and nursing care for the following: Opioids

A
  • Overdose is medical emergency
  • Monitor closely
  • treatment based on symptoms
  • Methadone for detoxification
26
Q

Discuss the multidisciplinary and nursing care for the following: Cannabis

A
  • Symptom relief

* Social and family support

Adult Health (9 decks)

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