Post-op

Question 1

Common cause of airway obstruction post-op is:

Answer 1

Pt’s tongue: put pillow under nech to manually elevate mandible to clear airway

Question 2

The most common cause of post-op hypoxemia is:

Answer 2

atelectasis caused by retained secrestions or decreased respiratroy excrusions

Question 3

What is the best postion in an unconsciuos pt recovering from surgery:

Answer 3

Lateral recovery postion to keep airway open and reduce risk of aspiration incase vomitting occurs, once conscious, pt is returned to supine position

Question 4

To prevent atelectasis, what should you have your pt do:

Answer 4

Deep breathe 10 per hr, incentive spirometer; have pt cough with pillow on abd; adequate hydration to keep mucos loose and thin

Question 5

If the pt had spinal anesthesia, what position do you have them lie:

Answer 5

supine

Question 6

If a pt’s cough reflex and swallowing is impaired d/t anesthesia, what is done until reflexed return:

Answer 6

suctioning

Question 7

What are the common s/s of neuropsychologic post-op:

Answer 7

pain, fever, delirum, hypothermia

Question 8

What are the common s/s of the respiratory system post-op

Answer 8

Airway obstruction, hypoventilation, aspiration of vomit, atelectasis, PNA, hypoxemia

Question 9

What are the common S/S of cardiovascular post op:

Answer 9

Dysrhythmias, hemorrhage, hypotension, HTN, phlebitis, VTE

Question 10

What are the common S/S of the GU post-op:

Answer 10

Retention, infection

Question 11

What are the common s/s of GI post-op:

Answer 11

N/V, distension/flatulence, paralytic ileus, hiccups, delayed gastric emptying

Question 12

What are the most s/s of the integumentary post-op:

Answer 12

Incision site: infection, hematoma, dehiscence/evisceration, keloid formation

Question 13

What are the most common s/s of fluid and electrolyte post-op:

Answer 13

FVO, FVD, electrolyte imbalances, acid-base disorders

Question 14

If pulse ox is lesss than 95%, what should be used to determine O2 sat:

Answer 14

Arterial blood gas analysis

Question 15

What are the potential RR compications post-op:

Answer 15

• airway obstruction: tongue
• Hypoventilation: hypoxemia/hypercania d/t anesthesia depression
• Aspiration: vomit into lungs may cause pulmonary edema
• PNA
• Hypoxemia

Question 16

Notes on nsg intervention for respiratory:

Answer 16

• Assess RR patency/accessory muscle use indicates RR distress
• auscultate BS: anteriorly, laterally, posteriorly
• Sputum characteristics: trachea and throat=colorless/thin, lungs/bronchi=thick and yellow
• Position pts: laterally for unconscious, supine for conscious and every 2 hrs for full chest expansion
• deep breathe and cough
• splinting: pillow/blanket against incision line as they cough for support
• ambulation

Question 17

What are the potential cardiovascular complications post-op:

Answer 17

• Dysrhythmias: d/t hypoxemia, hypercapnia, electrolyte/fluid imbalance
• Hemorrhage
• Hypotension: disorientation/loss of consciousness, chestpain d/t FVD such as hemorrhage
• HTN: d/t sns stimulation from pain/anxiety/bladder distension/repiratory compromise
• Hpovolemia: d/t dehydration, hemorrhage, vomitting, suction, wound drainage
• VTE: anesthesia contributes to vasodilation, inactivity, body position, and pressure

Question 18

Hypotension that accompanies by normal pulse with warm/dry/pink skin represents what:

Answer 18

normal residual effects of vasodilation after anesthesia requires just monitoring

Question 19

Hypotension that accompanies by rapid/weak pulse and cold/clammy/pale skin represents:

Answer 19

impending hypovolemic shock requiring immediate attention

Question 20

Nsg intervention of cardiovascular notes:

Answer 20

• Administration of IV/bolus to normalize BP d/t FVD
• O2 therapy and assessment of VS
• Accurate I7O record along with Lab serum levels
• Early AMb: to improve muscle tone/improve GI/GU function/stimulates circulation/wound healing
• Pharmacologic prophylaxis: Heparin or Fragmin along with SCDs to prevent VTE

Question 21

What are the potential neurologic/psychologic complications:

Answer 21

• Emergence delirium: waking up wild/thrashing/shouting
• Delayed emergence: d/t prolonged opioids/sedatives
• Postoperative cognitive dysfunction: in eldlery d/t anesthesia is a declined cognitive fuction “sedated like”
• Delirium: out of control
• anxiety/depression
• alcohol withdrawal delrium

Question 22

Notes on nsg interventions for neurological/psychologic:

Answer 22

• Assess LOC
• Assess pupils
• Act as pt’s advocate until pt is fully awake and capable of communication;safeguard their safety
• Orient the pt using clocks, calendars, photographys
• observe pt’s behavior to determine normal from abnormal

Question 23

What are the potential GI complications:

Answer 23

• N/V: females, hx of motion sickness, anethetics/opioids, duration of surgery
• Distension/flatulence: d/t decreased perstalsis from handeling of bowel/NPO status
• Hiccups: d/t irritation of the phrenic nerve that innerviate the diaphragm
• paralytic ileus
• Delayed gastric emptying: d/t handeling of the bowel during abd surgery contributing to N/V

Question 24

Notes on nsg interventions of the GI:

Answer 24

• Assess abd distension, BS
• Administer IV fluids and antiemetics
• NPO
• Advance diet as tolerated
• early frequent ambulation to prevent abd distention; put pt on right side to help with easy flatulence

Question 25

How can you encourage a female to void:

Answer 25

Sitting, running water, privacy, drinking water, pouring warm water over perineum, ambulate to the bathroom, bedside commode

Question 26

How can you encourage a male pt to void:

Answer 26

Standing, running water, water intake, warm water on perinuem, bedside commode, ambulation to bathroom

Question 27

This type of drain is inserted to permit drainage of excessive serosanguineous fluid/purulent drainage via a latex tube; promotes healing of underlying tissue; prevents complications:

Answer 27

Penrose drain

Question 28

What are the two types of Close-wound drainage systems drains excess exudate that might interfere with the formation of granulation of tissue; reduce risks of microorganisms, tubes are sutured in place and connected to a resivori:

Answer 28

JP or a Hemovac; fresh post op drain is bloody, late post-op drain is yellowish color

Question 29

This type of drain facilitates the drainage of body fluids from an organ, duct, or abscess; inserted under the radiological guidance; is sterile/thin/long type of catheter:

Answer 29

Pigtail

Question 30

This type of suture requires that each stitch to be tied and knotted separately:

Answer 30

interrupted suture

Question 31

This type of suture is just one thread that runs in a series of stitched and tied only at the beginning and the end:

Answer 31

continuous suture

Question 32

This typ of suture is used primarily on obesed and DM pts; very large sutures, used in addition to skin sutures, attached to underlying tissues of fat and muscle as well as skin for better support in obesed pts or cases of long healing time:

Answer 32

Retention sutures

Question 33

A piece of stainless steel wire used to slose certain surgical wounds in place of sutures is defined as:

Answer 33

staples

Question 34

This type of tape is used primarily for superficial cuts, fall off on their own, strips of tapes used to securely close the edges of an incision; alternate for sutures, falls off within 10 days:

Answer 34

steri-strips

Question 35

Absence of bleeding and appearance of clot binding to wound edges, inflammation at wound edges for 1-3 days which reduced when clots diminishes, sign of scar formation, and diminished scar size over a period of mo to yrs is a sign of:

Answer 35

sequential signs of healing

Question 36

Post op pain is greatest when:

Answer 36

12-36 hrs after surgery and decreases within 2-3 days

Question 37

What are some tx for pain post-op

Answer 37

PCA, epidural analgesia, PRN meds, anti-inflammatory agents

Question 38

Notes on suctioning:

Answer 38

• NG tube REQUIRES IV MAINTENANCE
• chest tube
• Monitor F & E
• monitor drainage

Question 39

Gerontologic considerations for post op

Answer 39

• Decreased: EE/cardio/renal perfusion/liver function/sensory function
• increased risk of Postop delirium