post op Flashcards
Post-Op Assessment
-Understand the components of an initial post-anaesthesia assessment
* Understand key nursing responsibilities in admitting patients to the post-anaesthesia care unit (PACU)
* Explain the etiology, nursing assessment, and management of potential problems in the PACU, but especially upon transfer to the acute surgical unit during the postoperative period
risk for post-op complications
-older adult, babies
-smokers, alcohol use
-diabetics
-obesity !!!
-immunocompromised -sepsis
-fluid/electrolyte. imbalances
-pregnancy
-Malnourished
general > local
Pts who have undergone general anaesthesia are more likely to have complications than those who have had sedation or local anaesthesia.
Two phases in the post-op course:
Immediate recovery (in the PACU)- hours
Postop convalescence (surgical unit)- days
PACU Report:
Vitals
Complications during surgery
Fluid loss, replaced
IV fluids or blood products given?
Which meds given?
Which anestheics
Location of surgical site
Central line? Catheter? Ect
Special diet?
How do they ambulate? Indep? Assist?
Priority care in PACU
Monitoring & management of:
Respiratory functions
Circulatory functions
Pain
Temperature
Surgical site
Patient’s response to reversal of anesthetic
e.g., sedation score, level of spinal block
ABC
A
Airway
-a patent airway( pt may need stimulation, repositioning to rt side or chin tilt to breathe.)
-oral or nasal airway
-endotracheal tube (ETT)
If laying on back and not breathing well, sit them upright.
What if an older adult has fluid overload- sit them up so it drains.
COPD has to sit 90 degrees.
If that doesn’t work, insert airway. Then ETT
ABC
B
Breathing
-RR and quality
-Auscultate lungs
-Pulse oximetry
-O2
ABC
C
Circulation
-ECG: rate, rhythm
-BP ( compare to _baseline__)
-Temp, color of skin
-Peripheral pulses
Neurological
Neurological
LOC
orientation (x 3)
- sensory and motor status
* Hearing is 1st sense to return
GI/GU
GI/GU
-Intake
ex Fluids, irrigation
-Output
ex. Emesis, urine, drains
Surgical site
Surgical site
-Dressings
-Drainage
-appearance
Pain
Incision
Potential alteration in RESPIRATORY function
EXAM
In PACU
- A/W Obstruction
dt tongue, thick secretions
N INTERVENTIONS:
Assess a/w patency, depth, rate
Positioning:
Unconscious → recovery position
Conscious → supine, HOB↑ to 30 degrees
- hypoxemia - PaO2 <80mmHg
- hypoventilation
In surgical unit:
- atelectasis
- pneumonia
N INTERVENTIONS:
-DB & C
Prevents alveolar collapse & moves secretions to larger a/w
-Incentive spirometry
-Splinting important (pillow on abd when coughing)
-Change in position/ mobilizing
-Oral care
Potential alteration in CARDIOVASCULAR function
In PACU
- Hypotension
dt intra op fluid/blood loss - Hypertension
dt Stim of SNS from pain, anxiety, bladder distention, etc. - Dysrhythmias
dt electrolyte imbalances like potassium
N INTERVENTIONS:
Treat hypotension:
-concerned about blood loss
-start with IV fluids
-give O2 right away for organs to not get poorly perfused
-give meds
HTN:
-can be caused by pain, full bladder, cold
-give opioid analgesic
-check bladder, catheter, go to bathroom
vs————————————————————–
On regular Unit
- Fluid and electrolyte imbalances
dt stress of surgery - Fluid retention first 2-5 post-op days
- Release of antidiuretic hormone (ADH) and adrenocorticotrophic hormone (ACTH), and activation of renin-angiotensin-aldosterone system
= less urine - Stress response ↑ clotting tendencies from ↑ platelet production
= Risk of DVT
N INTERVENTIONS:
-Accurate I & O
-Monitor electrolytes, esp K+
dt fluid loss (N/G, drains, vomiting)
-Prevention of DVT
Low-molecular-weight heparin
Early and aggressive mobilization
Sequential compression devices
Potential alteration in NEUROLOGICAL function
In PACU
- Emergence delirium (awake from anaes in agitated state)
Agitation
Disorientation to place, time, and person
Thrashing and shouting
*rule out hypoxia by making sure they have adequate O2 - Delayed awakening
dt prolonged drug action
Most common causes of post-op agitation → Hypoxemia and sepsis
vs—————————————————————-
regular unit
Common cause of altered neurological function:
-meds for pain management
-sleep deprivation
-sensory overload
For patient who received regional anesthesia:
-assess sensation and motor function
