Post-op

Question 1

Goal of post-op care

Answer 1

• support healing and recovery

- Prevent complications

Question 2

PACU RN verbal report to RN

Answer 2

General information, type of surgery, level of consciousness, equipment, any problems

Question 3

First priority when pt arrives on unit…

Answer 3

take vital signs and compare to baseline

Question 4

Post-op complications related to…

Answer 4

-pain -exhaustion - immobility -rxn to meds -loss of control -exposure

Question 5

Assess when arrive from PACU

Answer 5

• respiratory
• circulatory (skin color, cap refill, BP, P,T)
• neurological systems (level of consciousness)
• dressings (drainage, bleeding)
• pain
• safety (side rails, call bell)
• equipment (IV fluids, drainage system, EPCs, PCA)
• comfort (positioning)

Question 6

Alteration in respiratory functions (Assessment)

Answer 6

• Evaluate airway patency –tongue most common cause of obstruction
• position pt in sims or semi-prone with HOB 30 degrees
• evaluate chest symmetry
• evaluate depth, rate & character of resps

Question 7

Often first sign of respiratory problem

Answer 7

Restfulness!

Question 8

Atelectasis

Answer 8

• alveolar collapse causes airless condition of lung
• mucus blocks bronchioles>air beyond blocked>gradually absorbed> alveolus collapses
• Causes: hypoventilation, prolonged bedrest, ineffective cough
• S/S: pain, tachypnea, dyspnea, tachycardia, fever

Question 9

Pneumonia

Answer 9

-inflammation/infection of lungs
-most common respiratory complications in the elderly, obese, malnourished, chronic respiratory disease
-S/S: fever, dyspnea, pain, cough (productive)
(progresses from atelectasis)

Question 10

Aspiration Pneumonia

Answer 10

• inhalation of gastric contents
• gastric contents very acidic ph= 2-4 & toxic to lung tissue
• prevent w/ IS, OOB, deep breath -cough - HOB^ -turning)

Question 11

Nurse management of respiratory complications

Answer 11

• deep breathing & coughing (begin as soon as pt is responsive)
• turn, cough, & deep breathe (4-6 deep breaths then forceful cough)
• splint incision
• change position every 1-2 hours

Question 12

Deep breathing

Answer 12

• maximized lung expansion
• 10 deep breath/hour
• incentive spirometer

Question 13

Post operative day #

Answer 13

POD #1 = first full day after surgery

-each subsequent day counted

Question 14

Most important intervention to prevent post-op complications

Answer 14

EARLY AMBULATION

-increases vital capacity of lungs

Question 15

Alterations in cardiovascular function

Answer 15

-fluid and electrolyte imbalance
-fluid status directly affects cardiac output
Assessment– freq. VS monitoring, skin color, temp, cardiac arrhythmias

Question 16

Cardiac complications

Answer 16

DVT, thrombophlebitis, embolus

Question 17

Deep vein thrombosis (DVT)

Answer 17

blood clot
(usually in the legs)
-risk due to increased platelet production as body reacts to stress of surgery

Question 18

Thrombophlebitis

Answer 18

inflammation with a clot

Question 19

Embolus

Answer 19

clot dislodges and travels

Question 20

Interventions for cardiac complications

Answer 20

• early ambulation
• EPCs/SCDs and/or TEDs
• Leg exercises

Question 21

If thrombus occurs…

Answer 21

• duplex scan in vascular lab to confirm clot
• bed rest to prevent dislodgement
• Do NOT massage legs
• anti-coagulant therapy (heparin, lovenox)

Question 22

Pulmonary embolus

Answer 22

• clot lodged in pulmonary circulation
• blocks blood supply to lower lobe (anything below clot may die)
• S/S: restlessness, dyspnea, tachypnea, sudden sharp chest pain, crackles, change in mental status (hypoxia)
• size of emboli reflects results - death can result
• report any S/S to physician immediately

Question 23

Syncope

Answer 23

• brief lapse in consciousness caused by transient cerebral hypoxia (not enough oxygen to the brain)
• postural hypotension
• vascular pooling
• sudden changes in position

Question 24

Interventions for syncope

Answer 24

• change position slowly
• raise HOB, progress to sitting, dangle, stand
• monitor radial pulse
• safety for fall prevention
• -if pt faints, assist to floor to prevent injury

Question 25

Fluid and electrolyte imbalances

Answer 25

• normal response to surgery
• fluid retention 2-5 days post-op -protective measure to maintain BP & volume
• important to have accurate I&O, monitor labs, watch for dehydration

Question 26

Fluid deficit

Answer 26

• slow or inadequate fluid replacement

- vomiting/bleeding/drainage

Question 27

Hypokalemia

Answer 27

• results from urinary and GI losses, vomiting and diarrhea
• fluid & Na retention –> K excretion
• surgery stress causes K loss and excretion
• If K not replaced by IV = hypokalemia
• adequate ranges from 20-40 mEq daily

Question 28

Signs and Symptoms of hypokalemia

Answer 28

muscle weakness, confusion, cardiac arrhythmias

Question 29

Nurse management for hypokalemia

Answer 29

• accurate I&O
• monitor labs closely
• IV management
• assess for K overdose (paralysis, confusion, arrhythmias)
• incorrect K levels can kill

Question 30

Urinary complications

Answer 30

First void = approx 200 ml

• if spinal anesthesia, must void at least 50 ml before discharge
• regular voiding by 6-8 hours after surgery

Question 31

Urinary assessment

Answer 31

• quality & quantity of output
• color, amount, consistency, odor
• frequency
• dysuria
• fever
• indwelling catheter (patency)