Post OP and Pulmonary Embolism

Question 1

Respiratory Post OP alterations

Answer 1

obstruction (blockage of airway by patients tounge), hypoxemia, hypoventilation
patients at risk include those who receive general anaesthesia, are older, have a smoking history, lung disease, obese, or are undergoing thoracic, airway or abdominal surgery.

Question 2

Nursing Respiratory Management

Answer 2

assess airway patency, chest symmetry, presence of sputum, and for hypoxemia (o2 status)

Question 3

Prevention of respiratory complications

Answer 3

deep breathing, incentive spirometry, reposition 1-2 hours, ambulation asap, adequate pain medication, hydration

Question 4

Cardiovascular Post OP alterations

Answer 4

fluid and electrolyte imbalances - alterations in cardiovascular functions
fluid retention - can be a result of the stress response
fluid overload or deficit
hypokalemia
DVT
pulmonary embolism
syncope

Question 5

Nursing Cardiovascular management

Answer 5

assess vital signs every 15 minutes until stable and compare to baseline
assess apical-radial pulse and report irregularities
assess skin colour, temperate and moisture
leg exercises
mouth care - can lead to CV disease
compression stockings
admin unfractionated or low molecular weight heparin (anticoagulant)
slowly progress ambulation

Question 6

Psychological Function Post OP alterations

Answer 6

anxiety and depression
confusion and delirium (d/t fluid and electrolyte imbalances, hypoxemia, medication effects, sleep deprivation)

Question 7

Planning for discharge

Answer 7

patients and their families should have the following info: dietary restrictions or modifications, symptoms to be reported, instructions for follow up care, answers to questions or concerns.
comprehensive, inter-professional approach is recommended.

Question 8

Pulmonary Embolism (PE)

Answer 8

blockage of pulmonary arteries by a thrombus, fat or air embolus or tumour tissue
most arise from DVTs
mortality rate of 30% if not treated

Question 9

Fat embolus vs Blood clot embolus

Answer 9

both will have altered mental status, decreased O2, chest pain, crackles, and increased respirations and pulse
A fat embolus will have petechiae (pinpoint red spots that form on skin)

Question 10

Clinical Manifestations of PE

Answer 10

classic triad - dyspnea, chest pain and hemoptysis (coughing up blood)

Question 11

Diagnosis of PE

Answer 11

Spiral CT scan - most common
Ventilation Perfusion scan - if patient cannot have contrast media
D Dimer - measures amount of cross linked fibrin fragments which are found in circulation after clotting events
**ABGs are important to measure but not diagnostic (O2 is low, pH normal)

Question 12

aPTT

Answer 12

measures how long it takes the body to form a clot. often used to monitor heparin therapy
normal 30-40 seconds
critical >70 seconds

Question 13

Nursing Management of PE

Answer 13

place pt in semi-fowlers and bedrest
obtain IV access for medication/fluid administration
O2 therapy if indicated
monitor labs - PTT, INR and adjust therapy (ie heparin) accordingly

Question 14

Heparin overdose antidote

Answer 14

protamine sulfate