Post-op assessment Flashcards
causes of Pre-op complications that lead to post op complications
Old or young
obesity, comorbidities
immunocompromised
malnourished
pregnancy
fluid and electrolyte imbalances
Other factors (previous surgeries, med hx, allergies, smoking/substance use/alcohol, family support, culture)
What sedation causes most complications?
General anesthesia
What are the two phases of post-op?
Immediate recovery (PACU)- hours
Postop convalescence (surgical unit) - days
What information is gathered in PACU?
Surgery
est blood loss
complications during surgery
type of anesthetic
pain meds given
IV blood products used in OR
electrolyte imbalances
allergies
drains
catheters
doctors orders
Priority care assessment in PACU
Airway - patent (pos R side, stimulation, chin tilt), oral/nasal airway, ETT
Breathing - RR and quality, auscultate, O2 sat, O2
Circulation - ECG (rate and rhythm), BP, temp and color of skin, peripheral pulses
Neurological - LOC, A+Ox3, sens and motor status (hearing is first sense to return), sedation scoring
GI/GU - intake (fluids, irrigation), output (emesis, urine, drains)
Surgical site - drsg, drainage, appearance
Pain - incision, other
Resp alterations
PACU
- A/W obstruction (from tongue, secretions)
- Hypoxemia
- hypoventilation
Reg Unit
- atelectasis and pneumonia
Management of resp alterations
PACU
- assess a/w patency, depth, rate and positioning (unconscious = recovery position, conscious = supine, HOB)
Reg unit
- DB and cough
-incentive spirometry
- oral care
changes in position, mobilize
What does DB + C do?
prevents alveolar collapse and moves secretions to larger a/w
Cardiovascular alterations
PACU
- hypotension (fluid and blood loss)
- HTN (stim of SNS from pain, bladder distension, anxiety)
- dysrhythmias
Reg unit
- fluid and electrolyte imbalances (stress)
- fluid retention first 2-5 post op days (release of ADH and ACTH and activation of RAAS)
- stress response increases clotting from increased platelet production (risk of DVT)
Management of Cardiovascular alterations
PACU
- tx hypotension (Bolus, O2, drugs)
- tx HTN (rewarm, pain, bladder distension)
Reg unit
- accurate I and O
- monitor elect (K+) - fluid loss, drains, vomiting
- Prevent DVT (heparin, low mol weight, early mob., compression devices)
Neuro alterations
PACU
1. emergence delirium (wakes agitated, disoriented to person, place, time)
- RULE OUT HYPOXIA
2. Delayed awakening (prolonged drug action)
3. hypoxemia and sepsis
Reg unit
- meds for pain managemet
- sleep depived
- sensory overload
for pts that received regional anesthetic = assess sensation and motor function
Management of neuro alternations
PACU
- pain r/t surgical, positioning, internal devices
- watch for non-verbal behaviours
Reg unit
- post op pain is most severe within first 48 hours
- opioid analgesia for mod-severe pain (5/10 or more)
- may use epidural catheter or PCA
GI Alterations
PACU
1. N+V
- r/t anesthetics, opioids
- delayed gastric emptying
- handling of bowel during surgery
2. ileus
- abdo distention, may req N/G (peristalsis has stopped)
3. Paralytic ileus
- uleus that persists >2-3 days
Reg unit
- slowed GI motility
Management of GI alterations
PACU
- antiemetics
- suction (bowel block)
- lateral position
Reg unit
- may resume oral intake as soon as gag reflex returns
- ambulation
- decrease IV infusion rate once clear liquid diet has started
- frequent position changes
- bowel protocol
GU alterations
Normal = 30ml/hr
PACU
- low u/o from stress response of increased secretion of aldosterone, ADH, fluid restriction, flid loss intraop, drainage
- with regional anesthesia - ANS blockade of sacral nerve (hypotonic bladder, abd or pelvic muscle spasms)
Reg unit
- most people urinate 200ml within 6-8 hours post surgery
- if no u/o = bladder scan
- may need to catheterize
