POST OP Flashcards
Anaphylactic Reactions
Most caused by Latex or antibiotics
signs of Shock - tachycardia, drop BP,closed airway
Malignant hyperthermia (MH)
MH- very rare disorder. Usely manifest in PACU. usually Genetic.
S/S - hyperthermia, hypoxemia, lactic acidosis,cardiac dysrhythias
TX: dantrolene (Dantrium)
Common Postoperative Complications
Airway Obstruction, Hypoxemia, hypoventilation
Airway Obstruction
airway not patent, oral or nasal issue, remember ABCs - keep airways open
Hypoxemia
not awake enough, not breathing deep enough,too much sedation, use pulse oximeter
S/S - Sat too low, increwase RR, cap refill slow,cyanosis
Hypoventilation
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
Postanesthesia Care Unit (PACU)
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.
Initial Assessment
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
Respiratory Problems
Airway obstruction, Hypoxemia, Hypoventilation - this is main one
Pain - may not deep breath due to pain
Cardiovascular Problems
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
Neuro/Psych - Emergence delirium
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.
Post op Pain
PCA - usually started in sx. Will have a carrier fluid with it. (Normal saline etc)
Narcan
- reversal agent for pain meds
Urinary
bladder distension, pt can’t void, may need catheter, may do bladder scan, run water, ambulate if possible
Wounds – Drains
how many drains, are they working/draining
Dehiscence
Post Op Nursing Diagnoses
Ineffective breathing pattern � Acute pain �Nausea �Fear Anxiety �Hypothermia Risk for infection
Postanesthesia Discharge Criteria
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
Ambulatory Surgery Discharge
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
Client Comes up to Floor You are receiving Nurse
Get patient transferred to bed � Airway, breathing, circulation Vital signs �Pain assessment Admitting assessment �Protocols
Conscious Sedation
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
pre-op pt what can determine outcome of success
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
