Post Op Flashcards
How often are vital signs taken postop?
Every 15 minutes x4 then 30 minutes x4 then every 1-4 hours depending on stability!
Temperature is measured every four hours for the first 24 hours
How do you assess a surgical site?
Appearance-approximation of wound edges, drainage and drainage tubes-odor, signs of dehiscence, pain, sutures and staples, palpate temperature, color-red, yellow, black. Check CBC BUN and electrolytes.
Indicators of cardiovascular stability?
Mental status, vital signs, cardiac rhythm, skin temperatures, color and moister, urine output.
What are the causes of hypotension and shock postop?
Blood loss from surgery, hypoventilation, position changes, pooling of blood in extremities from nonmovement, side effects from the medication, and anesthetics.
Three classifications of hemorrhage?
Primary-during surgery
Intermediary- first few hrs after surgery. Can be caused by raise in BP with dislodged clots.
Secondary-sometime after surgery caused by slipped suture, infection, or erosion of drainage tube
Signs and symptoms of hemorrhage postop?
Restlessness, anxiety, flank pain, hypotension, cold clammy skin, weak thready and rapid pulse, cold and mottled extremities, deep rapid respirations, decreased urine output, thirst, and apprehension.
How do you treat a hemorrhaging patient?
Check surgical site for bleeding and the bed underneath the patient, stop the bleeding, apply pressure to bleeding site. Place patient in Trendelenburg position, provide warmth, notify the surgeon, replace blood volume – IVF wide open, and blood transfusion.
Signs of hypovolemic shock?
Can happen if blood loss exceeds 590 ml. Pallor, cold, moist skin, cyanosis, rapid weak thready pulse, increased pulse pressure, low blood pressure, and concentrated urine.
How do you treat shock?
Improve and maintain tissue perfusion, volume replacement with IV fluids and blood products, oxygen via nasal cannula, position patient flat in bed with legs elevated 30 to 45°, monitor vital signs, oxygen saturation, level of consciousness and urine output, maintain body warmth, and administer medications.
Preventing respiratory distress postop
Observe for airway patency, monitor vital signs, auscultate breath sounds, implement deep breathing and coughing, use incentive spirometry, turn patient every two hours, ambulate, maintain hydration, avoid positions that decrease ventilation, assess pain level and monitor response to narcotic analgesics
Signs and symptoms of atelectasis?
Decreased breath sounds over affected area, crackles, cough.
Hypostatic pulmonary congestion is usually seen in who?
Elderly patients who have not been ambulated.
Signs and symptoms of hypostatic pulmonary congestion?
Slight elevation of temperature pulse and respiration, cough, dullness and crackles at the base of the lungs.
Coughing is contraindicated in which patients?
Status post head injuries, intracranial surgeries, eye surgery, plastic surgery, and hernia surgeries.
DVT frequent causes?
Venus stasis due to bed rest, obesity, patients over 65, history of varicosities, and spinal cord injuries.
DVT prevention.
Early ambulation and hourly leg exercises, avoid use a blanket roll or pillow to elevate leg, avoid prolonged dangling, adequate hydration, prophylactic therapy with Lovenox, external pneumatic compression stockings and TED hose.
Risk factors for DVT?
Orthopedic surgery, gynecologic or urologic surgery, general surgery in patients who are obese, over 40 years of age, with a malignancy or previous history of DVT, neurosurgical patients.
Signs and symptoms of DVT?
Pain or cramping in calf or thigh, redness and swelling in the affected area, increased diameter of affected extremity, fever, chills, and diaphoresis.
Treatment of DVT?
Bedrest with leg elevated on pillow, warm moist socks two extremity, measure bilateral calf or thighs circumference every shift, maintain hydration with prescribed IVF and oral fluids, administer medications: anti-inflammatory agents, anticoagulants, and analgesics as ordered.
Signs and symptoms of PE?
Dyspnea, chest pain, cough, cyanosis, tachypnea, tachycardia, and anxiety.
Treatment of PE?
Notify physician immediately, bedrest and semi Fowler’s position, frequent vital signs check, oxygen therapy, administer anticoagulants and analgesics as ordered, and have patient avoid Valsalva maneuver.
Causes of urinary retention?
Anesthetics, anti-cholinergic agents, opioids, abdominal, pelvic or hip surgery due to pain and inability to ambulated, unable to use the bedpan or urinal and a recumbent position.
