post op

Question 1

one day after surgery patient has fever?

Answer 1

check respiratory system- wound infection takes a couple days

Question 2

Postoperative Period

Answer 2

Begins with completion of surgery and transfer to PACU, ambulatory care unit, or ICUSurgical Care Improvement Project (SCIP) measures established in the pre-operative period are re-evaluated (Core Measures)

Question 3

PACU Recovery Room

Answer 3

Ongoing evaluation and stabilization of patientsTo anticipate, prevent, and manage complications after surgeryThe Joint Commission’s NPSGs require circulating nurses and anesthesia providers to give PACU nurses verbal hand-off reports

Question 4

The PACU Nurse

Answer 4

Skilled in the care of patients with multiple medical and surgical problemsIn-depth knowledge ofAnatomy and physiologyAnesthetic agentsPharmacologyPain managementExtubationAble to make quick decisionsWorks closely with anesthesiologist and surgeon5Copyright © 2018 Elsevier Inc. All rights reserved.

Question 5

Respiratory System Assessment

Answer 5

Patent airway, adequate gas exchangeNote artificial airway when applicable Rate, pattern, depth of breathingBreath soundsAccessory muscle useSnoring and stridorRespiratory depression or hypoxemia

Question 6

Interprofessional Collaborative Care

Answer 6

Assessment: NoticingHistoryPhysical assessmentSigns and symptoms

Question 7

Assessment: NoticingRespiratory and Cardiovascular

Answer 7

RespiratoryRate, pattern, depthCardiovascularVital signsHeart soundsCardiac monitoringPeripheral vascular assessment•Monitor for VTE

Question 8

elevated creatinine

Answer 8

take longer for med to wear off?

Question 9

Assessment: NoticingNeurologic System

Answer 9

Cerebral functioningMotor and sensory assessment after epidural or spinal anesthesia

Question 10

Assessment: Noticing

Answer 10

Fluid, electrolyte, and acid–base balanceIntake and output (I&O)Hydration statusIV fluidsAcid–base balanceWound drainageNasogastric (NG) tube drainage

Question 11

Assessment: NoticingRenal/Urinary System

Answer 11

Check for urine retentionConsider other sources of outputSweatVomitusDiarrhea stoolsReport urine output of <30 mL/hr

Question 12

Assessment: NoticingGastrointestinal System

Answer 12

Postoperative nausea/vomiting commonPeristalsis may be delayed up to 24 hoursMonitor for bowel soundsTo reduce nausea/vomitingOndansetron (Zofran)Meclizine (Antivert, Dramamine)Scopolamine patch

Question 13

NG Tube Drainage

Answer 13

Inserted during surgery toDecompress and drain stomachPromote GI restAllow lower GI tract to healProvide enteral feeding routeMonitor any gastric bleedingPrevent intestinal obstructionAssess drained material every 8 hour

Question 14

bowel tones after surgery

Answer 14

slow, no or hypo bowel tones

Question 15

Assessment: Noticing Skin

Answer 15

Normal wound healingAssess tissue integrity frequentlyImpaired wound healing—Seen most often between 5 and 10 days after surgeryDehiscenceEvisceration

Question 16

Dehiscence

Answer 16

define
stomach usually
usually belly with lots adipose tissue
lots of liquid hard to close
will open see a space between sitches

Question 17

Evisceration

Answer 17

define
emergency-like DEHiscence
but something from inside is outside–go back to surgery

Question 18

Dressings and drains-

Answer 18

look at

Question 19

Comfort Alterations

Answer 19

Pain/discomfort expected after surgeryPain assessmentPhysical and emotional signs of painAssess need for medication according to NPSGs•Consider type of surgery•Extent of surgery•Length of surgical procedure

Question 20

Assessment: NoticingPsychosocial

Answer 20

Increased pulse and blood pressureIncreased respiratory rateProfuse sweating RestlessnessConfusion (older adults)Wincing, moaning, crying

Question 21

Laboratory Assessment

Answer 21

Analysis of electrolytes
CBC
“Left-shift” (bandemia)
Specimens for C&S
ABGs
Urine and renal laboratory tests
Procedure-specific labs
Glucose (diabetics)
Serum amylase (pancreatic surgery)

Question 22

Potential for Hypoxemia

Answer 22

Highest incidence occurs on 2nd postoperative dayInterventionsAirway maintenanceMonitor (SpO2)Semi-Fowler’s positionOxygen therapy, breathing exercisesMobilization as soon as possible

Question 23

Analysis: Interpreting

Answer 23

The priority collaborative problems for patients in the immediate post-operative period arePotential for compromised GAS EXCHANGEPotential for infection and delayed healingAcute painPotential for decreased peristalsis

Question 24

Improving Gas Exchange

Answer 24

Airway maintenanceMonitor oxygen saturationPositioningOxygen therapyBreathing exercisesMovement

Question 25

Preventing Wound Infection

Answer 25

Nursing assessment of surgical area is criticalDressings—First change usually done by surgeonDrains—Provide exit route for air, blood, bile; help prevent deep infections, abscess formation during healingInterventionsDrug therapy, irrigation to treat wound infectionDébridementSurgical management required for wound opening

Question 26

Managing Pain

Answer 26

always assess first
get self report

Drug therapyComplementary and integrative healthPositioningMassageRelaxation/diversion techniques

always know may not verbalize pain-look for signs

Question 27

Promoting Peristalsis

Answer 27

Monitoring with accurate abdominal assessmentEnsure adequate hydrationPromote mobilityNon-opioid interventionsGum chewingPharmacologic management

Question 28

Care Coordination and Transition Management

Answer 28

Home care managementSelf-management educationHealth care resources

Question 29

A patient has had bowel surgery. Which symptom, assessed by the nurse, is the best indicator of intestinal activity?A.Passage of flatus or stoolB.Patient’s report of hungerC.Abdominal cramping with distentionD.Detection of bowel sounds upon auscultation

Answer 29

A.Passage of flatus or stoolB.Patient’s report of hungerC.Abdominal cramping with distentionD.Detection of bowel sounds upon auscultation

A.

Question 30

What is the priority nursing assessment when a patient is admitted to the PACU?A.Level of consciousnessB.Airway and gas exchangeC.Dressing and incision statusD.Vital signs and body temperature

Answer 30

A.Level of consciousnessB.Airway and gas exchangeC.Dressing and incision statusD.Vital signs and body temperature

B or D

Question 31

When positioning to promote comfort in the postoperative patient, which intervention is most appropriate?A.Raise the knee gatch of the bed.B.Place pillows under the patient’s knees.C.Reposition the patient at least every 2 hours.D.Allow the patient to get out of bed as soon as possible.

Answer 31

A.Raise the knee gatch of the bed.B.Place pillows under the patient’s knees.C.Reposition the patient at least every 2 hours.D.Allow the patient to get out of bed as soon as possible

C.