POST OP

Question 1

Anaphylactic Reactions

Answer 1

Most caused by Latex or antibiotics

signs of Shock - tachycardia, drop BP,closed airway

Question 2

Malignant hyperthermia (MH)

Answer 2

MH- very rare disorder. Usely manifest in PACU. usually Genetic.
S/S - hyperthermia, hypoxemia, lactic acidosis,cardiac dysrhythias
TX: dantrolene (Dantrium)

Question 3

Common Postoperative Complications

Answer 3

Airway Obstruction, Hypoxemia, hypoventilation

Question 4

Airway Obstruction

Answer 4

airway not patent, oral or nasal issue, remember ABCs - keep airways open

Question 5

Hypoxemia

Answer 5

not awake enough, not breathing deep enough,too much sedation, use pulse oximeter
S/S - Sat too low, increwase RR, cap refill slow,cyanosis

Question 6

Hypoventilation

Answer 6

have pt deep breath. may be on nasal canula but breathing through mouth, if mouth breather - move nasal canula near lips to get O2 in system

Question 7

Postanesthesia Care Unit (PACU)

Answer 7

RN in PACU receives report from OR RN - how long sx took. what sat have been, amount blood loss,
General information - any complications,
� Patient history - allergies, etc
� Intraoperative management - drugs given etc.

Question 8

Initial Assessment

Answer 8

RN checks Airway, breathing, circulation, � Vitals - if O2 is low - may be disoroented
� ECG monitoring
� Explanation to client - �Hearing last to go, first to return

Question 9

Respiratory Problems

Answer 9

Airway obstruction, Hypoxemia, Hypoventilation - this is main one
Pain - may not deep breath due to pain

Question 10

Cardiovascular Problems

Answer 10

Hypotension - manifested by low BP or thready pulse if very severe
decreased LOC - be aware of hypotension vs low O2
almost all pts have fluids running

Question 11

Neuro/Psych - Emergence delirium

Answer 11

Pt wakes up wild, thrashing, restless, shouting, may have full bladder and can’t tell you, may be starting alcohol withdrawal, if pt was agitated when sx started may wake up agitated.

Question 12

Post op Pain

Answer 12

PCA - usually started in sx. Will have a carrier fluid with it. (Normal saline etc)

Question 13

Narcan

Answer 13

• reversal agent for pain meds

Question 14

Urinary

Answer 14

bladder distension, pt can’t void, may need catheter, may do bladder scan, run water, ambulate if possible

Question 15

Wounds – Drains

Answer 15

how many drains, are they working/draining

Dehiscence

Question 16

Post Op Nursing Diagnoses

Answer 16

Ineffective breathing pattern � 
Acute pain
�Nausea
�Fear
Anxiety
�Hypothermia
Risk for infection

Question 17

Postanesthesia Discharge Criteria

Answer 17

Patient awake (or baseline) - Awake - Can follow commands but may not be completely awake
�Vital signs stable -may be stable but not were they were in pre-op
�No excess bleeding or draining
�No respiratory depression - resp - need to be able to maintain O2 sats. Oxygen saturation >90%
� Report given to receiving nurse - will get info about vital signs, blood loss, sats, baseline, pain levels, last dose of pain meds etc
these pateints will be staying

Question 18

Ambulatory Surgery Discharge

Answer 18

All PACU discharge criteria met
� No IV opioid drugs for last 30 min
� Minimal nausea and vomiting
� Voided (If appropriate to procedure)
� Able to ambulate (if age appropriate)
� Responsible adult to accompany patient
� Discharge instructions given and understood
These patients will be going home

Question 19

Client Comes up to Floor You are receiving Nurse

Answer 19

Get patient transferred to bed �
Airway, breathing, circulation
Vital signs
�Pain assessment
Admitting assessment
�Protocols

Question 20

Conscious Sedation

Answer 20

no intubation
no general anesthesia
give IV meds - makes then sleepy 
usually versed and fentanyl - used because short acting
patient may wake up during procedure
- nurse monitor -O2/Respiration/HOB up

Question 21

pre-op pt what can determine outcome of success

Answer 21

Age
Anesthesia issues increase with Age
Other disease states - renal/hepatic
Cardiac issues
clotting issues - liver
renal insufficiency
may have ekg, respiratory eval, corotid duplex