Post-Op Flashcards
What do you do when the patient arrives in Post-Op?
- GET VITAL SIGNS
- EVALUATE LOC
- Hook up any equipment or monitoring device
- Observe dressings, incision, ect.
- Get report (How did the surgery go)
- RN from PACU shouldn’t leave until the receiving RN are satisfied patient is stable
What should the Anesthesiologist/RN from PACU report?
- Name of patient and surgical procedure
- Anesthetic agents and reversal agents used
- Estimated blood/fluid loss and replacement
- Vital signs and any problems encountered
- Complications (anesthetic or surgical)
- Preoperative condition and co-morbidities
- Parameters for immediate post-op management
What are some expected outcomes for a post operative patient?
-Airway maintained = gag reflex
- normal spontaneous
respiration
- ABGs within preoperative normal values (coming back up)
- No evidence of aspirations (listen to crackles [rails] at the bottom of the lungs)
- Heart rate and BP return to pre-op values 1-2 hours post anesthesia and remain stable
- Body temperature continues to rise until wdl (cold after surgery)
- No evidence of hyper/hypo-volemia (high bp = hypervolemia, tenting skin turgor = hypovolemia)
- Arousas easily and responds appropriately to commands
- Moves all extremities purposefully and with normal strength
- Skin integrity intact (redness and swelling at incision site is normal)
-Nutritional intake re-established
-Pain less than 4 on pain/visual scale
-Has personal support system used to reduce anxiety
What is an extremely important expected outcome post-op and post-pacu?
Urine Output > 0.5 mL/kg/hr.
What route can a nurse re-establish nutritional intake and when can they do so?
- Oral (Involves Swallowing) when protective airway reflexes return
- Enteral (Sticks Tube Down Throat) when bowel sounds return
- Parenteral Route when hemodynamically stable (heart and circulation is stable)
What is a sign of a hemorrhage complication?
-Pulse increase even if they are laying with no activity
What are some potential complications in post-op care?
- Hemorrhage
- Thromboembolism
- Urinary Retention
- Paralytic Ileus (Dead Bowel)
How do you treat URINARY RETENTION in post-op?
How do you treat PARALYTIC ILEUS, dead bowel, in post-op?
- Give patient water, get them moving, catheterization is a last resort
- Get them moving
What happens to the lungs during surgery?
What can you do to treat this afterwards?
- Aclectasis (alveli collapse during surgery and some stay collapse)
- Incentive Spirometer
What does the coughing and deep breathing do?
- Moves up secretions up respiratory tract and helps cough it up
- Splint abdomen with pillow or blanket by clutching it to the patient’s abdomen on top of the wound, deep breath in, and cough while deep breathing out
What are some ways to prevent venous stasis of the legs?
- Put something at their feet so they have something to push against to EXERCISE CALF MUSCLES because he majority of blood clots occur there
- Quadriceps exercise, knee flexion and extension
- Food circles
- PUSH KNEE TOWARDS BED
Who is more likely to have a THROMBOEMBOLISM complication?
What might they need to be put on?
- The Elderly and those with Hip Surgery
- Anticoagulants
What are some of the effects that pain causes?
- Increased sympathetic activity
- –> Increases metabolism
- –>Increases O2 demand
- Increases Stress
- –>Decrease ability to fight infection
- –>Decreases healing
- Interferes with sleep, eating, activity, and healing
- Interferes with cough and deep breathing
What is dependence?
What is addiction?
Dependence- a PHYSIOLOGICAL need for the drug based on long term use
Addiction- PSYCHOLOGICAL need for drug
You’re more likely to develop dependence on drugs through chronic use than acute use
What are the advantages of PCAs?
- Sense of control over pain
- Better pain control
- Less pain medication used over time
- Less chance of overdose
What is the main side effect of using opioid analgesics?
What are some other side effects?
Respiratory Depression
- N/V
- Sedation
- Allergic Reaction (itching is common)
Whenever you take over a patient, what else are you doing?
What do you need to verify?
Responsibility for the Accuracy of the PCA
- Medication Name
- Basal Rate
- Dose
- Lockout Interval
What do you need to document with a PCA?
- Vital Sign (especially respirations)
- Amount of drug used
What should you do when there PCA Breakthrough Pain occurs?
What is the first thing you should do and why this first?
- Use bolus via PCA
- Increase basal or trigger dose
- Give another medication in conjunction (ex. NSAIDs)
Notify the physician first because you must have an order to do any of the above
What works better, Epidural Analgesic or a combination of Opioids and Local Anesthetics?
Combination of Opioid and Local Anesthetic because it provides BETTER ANELGESIA and FEWER SIDE EFFECTS
When should you use an epidural?
- Orthopedic surgery on LOWER LIMBS
- Pelvic surgery
- Genitourinary surgery
- GI surgery
What important teachings are there for an epidural?
- Position head of bed slightly elevated
- Check dermatomes by touching patient down the body until no more sensation is being felt and if anesthetic effects have been drifted
What are some safety nursing interventions are there for monitoring epidural effectiveness?
- Check ability to move extremities
- Inspect for areas of pressure
- Check pain level
- Check level of sensory loss
WHAT IS THE CRITERIA TO CLASSIFY SOMETHING AS RESPIRATORY DEPRESSION?
- RR <8 breaths per minute
- O2 Sat. <90% and Decreased LOC (Can occur 20 hours after morphine stopped)
What do you do if respiratory depression occurs during epidural?
If it occurs with standing orders…
- Stop or slow epidural
- Narcan
- Ambu (if not breathing)… possibly intubate
Define urinary retention
What do you do if urinary retention occurs during epidural?
-Higher intake of fluids than output
- Assess by bladder scan and palpating bladder after 6-8 hours without urination
- May need to be catheterized
- Monitor I & O
What is a side effect of an epidural and what should you do if you encounter that?
- Hypotention and, less commonly, decreased HR
- Lie flat with elevated legs and notify anesthesia (likely IV bolus)
What happens when epidural levels are too high?
What should you do in response?
- Rise in level of sensation loss
- SOB
- Elevate HOB (Head of Bed)
- Notify Anesthesia
What are some signs for a catheter dislodgement?
What should you do in response?
- Change in pain relief
- Damp or Wet Dressing
-Notify Anesthesia
What does BASAL RATE refer to in epidural usage?
Demand dose?
Lockout?
Basal Rate- Continuous rate of infusion
Demand Dose- dose each trigger from PCA will deliver
Lockout- Total amount that can be delivered in 1 hour
What are some opioid side effects?
What are the best way to treat these opioid side effects?
- Pruritus (itching)
- Nausea
- Sedation
- Respiratory Depression ( < 8 breaths per minute)
Lowering the dose and don’t give other drugs that may cause sedation
