Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

STM: Exam 2 Surgery > Post Op Care > Flashcards

Post Op Care Flashcards

1
Q

Immediately post-op
the post op note: includes
orders
assessment

A

Immediately after leaving OR

Post Op Note: within 4 hours of finsihing in the OR

Note Includes the following
- vitals
- I/Os (blood, fluids, meds.)
- tubes/lines/draines (T/L/D)
- blood loss
- full exam

Orders
- labs
- imaging
- EKG
- diet
- activitiy
- ventilation
- medications

Wound Assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PACU phases

A

PACU pahse 1: patinet recoverying from anesthesia back to baseline vitals

PACU phase 2: preparing pt. for D/C home/admitted/etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PACU Complication: N/V

A

PONV
- the most common complication as a result of anesthesia

Apfel’s risk criteria
- female
- non smoker
- motion sickness
- opioids

  • get Clinical Assessment of pt.

Prvention and Treatment
- opioid sparing pain control
- antiemeitcs (ondansetron and dextamethasone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PACU Complications: Respiratory

A

Upper airways
- edema, phayrngeal msucle weakness
- vocal cord paralysis

Lower Airway
- aspiration
- edema
- bronchospasm
- tension PTX

Central/periphearl NS
- opioids
- poor reversal of NM block
- stroke

what to do
- PE
- CXR
- ABG

Treatment
- supplement O2
- ventilation
- suction
- chest tube
- reversal agents
- stroke protocol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PACU Complications: Cardiac

A

Cardiac
- hypotension/hyper
- arrythmias
- MI
- HF

What to Do
- EKG
- continuous tele.
- labs
- bedside echo

Treatment
- HTN = IV hydralazine, labetaol
- hypotension = fluids, pressors (phelyephinr, epi)
- arrythmia = ACS
- MI = MONA (morphin, o2, nitrate, asprin)
- HF: consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PACU Complications: Neruo and homeostasis related

A

Neuro
- delirum on emergence can wear off
- visual disturbances
- hematoma from epidural

hypo/hyperthermia = anesthesia

Urinary retention = need to pee before leaving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what to do when transferring from PACU to Floor

A

PACU –> Floor
- stable VS
- Post-Op check
- N/V controlled
- pain controlled
- ICU v Floor decided

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Post-Op Pain control
- what to use

A

Narcotics = mainstay
PCEA: pt. controlled epidural
PCA: pt. controlled analgesia via IV
IV push: from nurse
transition to oral!! (IV wears off quick)

ERAS protocol = pain control without narcotics if possible and early ambulation

Other management s
- Tylenol (4g max.daily)
- Ketorlac (watch NSAID in CKD and bleeding pt.)
- nerve blockes

look at pt. hisotry of med use and opioid use: migt need more or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

IV Fluids Post-Op

A

(pt. weight (kg) X 30) / 24 = maitnence per hour

Need fluid for
- maitnence
- fever, burns, losses
- drain losses
- third spacing

type of IV fluid: depends on pt. (commonly LR)
increase oral intake decrease fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Post Op Floor Care
- what are the things you need to manage
- types of drains for TLD

A

Floor Care: Post OP
- pain control
- fluids
- electrolytes
- diet
- PT/OT
- TLD everyday

TLD
- closed tubes: connected to their own suction (JP or Blake)
- always report amount and color of draingage
- open: no suction (penrose)
- sump drain: for large drainges (DAvol)
- chest tube: closed pressure drain
- foley cath.
- epidural
- NG tube (decomp.)
- feeding tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Discharge Planning
criteria to leave

A

Criteria to leave
- pain controlled on oral meds
- tolerating diet within IV fluids
- voding and BM returned
- PT/OT evaluated
- home care placement if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hemorrhagic Complications POst OP

A

what to do
- differentiate: is it surgical or other source (like a GI bleed)

Labs (trend them!!!)
- CBC
- coags
- active T&S

Treatment alwasy depends on stability of pt

example: if GI source: PPI, stop anticoags and transfuse if needed

asses need to go to OR to surgical control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hematoma Post Op

A

etiology
- a collection of blood from failure of priamry hemostasis or bleeding condition

Clincial signs
- pain
- draingage
- swelling
- asymptomatic but labs? (thinkg retroperitoneal)

Treament
- depends on presentationand size
- can go back to OR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Transfustion Thearpy
what types of blood can be given

A

Packed RBCs: usually given
- 1 unit = 1g/dL hemogloblin
- should increase hgb by 1
- come as washed, leukocyte reduced or irradiated

Platlets
- for active bleeding or low platlets

FFP
- those with deficient clotting factors

Crypoprecipitate
- uremic or dilutional coagulopathy

ensure T & S is UTD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Post Op Complication: Atelectasis

A

Etiology
- MC post op comp.
- decreased compliance of the lung
- retained secretions
- post op pain

Symptoms
- dyspnea
- hypoxemia

Diagnosis and Treatment
- clincal + CXR
- prevention is key!! get them up and waking
- incentive spirometry etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Bronchospams

A

etiology
- simialr to like COPD or asthma exacerbation

Symptoms
- dyspnea
- chest tightness and wheezing

Diagnosis
- clinical presenation
- hypercapneia
- prolonged expiratory

Treatment
- find underlying cause (opioids or anesthesia induced)
- SABA: albuterol
- SAMA: ipratropium

17
Q

Pleural Effusion

A

Etiology: commong after abd. surgery: typically spontaneous resolution
- can be due to fluid shifting during surgery
- holding excess fluid in the lungs

Treatment
- could just IV duiresis
- may just need to restart their at home meds! (diuretics)

if clincally concerned about the origin of teh effusion: can thoracentesis and do lights criteria

18
Q

Pulmonary Edema

A

Etiology
- can be cardiogenic, noncardiogenic r mixed

Cardiogenic: most often within 36 hours of OR due to fluid retention
- get CRX and elevated Pulm. art pressures

Noncardiogenic: concenr for negative pressure pulm. edema
- can be due to larygeaspasm from extubation

Treatment
- supportive and dueresis

19
Q

PTX (Tension)

A

Etiology
- postive pressure in the pleural space causeing hemodynamic compromise

Symptoms
- Dyspena
- hypotesnion
- decreased BS
- tracheal dev. if tension

CRX if not tension - if tension you should know

Treatment
- need decomp and chest tube
- 4th-5th midax. space for needle decomp.
- 5-6th midax. for chest tube

20
Q

Pulmonary Embolism

A

etiology
- obstruction of pulm. artery or branch of artery via thrombus, air, tumor or fat

those at high risk
- malignancy
- pregnant
- hosptialzied
- disorders (like coag.)
- obesity
- smoker
- recent surgery

Symptom s
- Dyspnea
- pleuritic CP
- cough
- DVT! look at the legs

determine if stable or unstable

Wells Criteria : post op will be high so youll need to decide via imaging

LE US
D Dimer (surgery will be high anyway)
VQ scan
CT PE protocol CT with contrast is first line for surgery
CTA is the GS overall

21
Q

Pulmonary Embolism
Treatment

A

Anticoag. (watch risk for re bleed in post op. pt.)

  • start with Heparin drip (PTT 60-80)
  • d/c with warfarin or DOAC
  • history and RF determine length of treatmen t
22
Q

PNA post op

A

etiology
- post-op day 5

Symptoms
- fever
- leukocytosis
- secretions
- infiltrates on imaging
- hyoxemia

Diagnosis
- MC organsims: gram neg. and staph. aureus
- collect culutre and give HAP or VAP abx.
- consider anaerboci coverage in thoracoabd. cases

23
Q

Wounds Post OP

A

Etiolgoy
inflammation post op
POD 2: 48 hours = deep structures should stay sealed the the OR dressing can be removed

Signs of INfection
- erythema
- pus
- edema
- warmth

SSI: surgical site infection
- infective process near the surgical site within 30 days of the operation (90 if implant)

VAC dressing can be good for complicated wounds (24-72 hours)

remebr taht proper nutrtion really helps with wound healing!!!

24
Q

Hypotension Post Op Care

A

a systolic BP < 90 or MAP < 65 or a relative decrease in systolic from baseline > 20

Causes
- hypovolemia
- opioids
- adrenal insuff.

Treatment is based on the signs : think about wahts causing it

  • review post op labs: HGb and electrolytes
  • address surgical site
  • fluid bolus to help
  • products (blood if needed)
  • pressors

if shock develops: pressors and ICU

25
Q

Hypertension Post Op Care

A

systolic > 180 and diastlic > 110

Cuases
- poorly controlled preop HTN
- noxious stimuli
- hypervolemic
- withdrawal!
- HTN emergency
- poorly controlled pain

Treatment
- IV agents (metoprolol, hydralzaine)
- nicardipine drip
- address withdraw or noxious stimuli

26
Q

Sinust Tachycardia Post Op

A

narrow complex regualr tachycardia with HR > 100

Causes: common in post-op
- pain
- hypovolemia
- anemia

Treatment
- depends on causes

27
Q

A Fib

A

narrow complex arrythmia of focal atrail foci triggering a beat
- ireregularl irregualr

Causes
- preexisitng a fib
- electrolye issues
- high risk with pulm. and esopageal surgery

Treatment
- stable: IV metoprolol ; then amioderone to help rhythm
- unstabel: cardioversion

28
Q

MI post Op

A
  • rise in troponin with symptoms or EKG cahnges
  • MI after non cardiac surgery can be up to 30 days post op

Due to
- obstruction
- CAD

Symptoms
- ACS
- atypical!

Goldman Risk Criteria

Treatment
- stable or unstable?
- stat labs and trops
- EKG

management depends if STEMI or NSTEMI

29
Q

Heart Failure Post OP

A

PAthology
- fluid admin
- surgical postion
- stress induced cardiomyopathy

Clinical
- respiratory distress
- hypertension 2/2 hypervolemia
- hypotension if ins chok

Dx.
- EKG
- CXR
- Echo

Treatment
- supp. O2
- IV diureiss
- vasodilators (nitro)
- inotropes (ifdecreased EF)

30
Q

UTI post op

A

Risk
- catheter
- DM
- female

Symptoms
- dysuria
- hematuria
- frequency/urgency

Dx.
- urinalysis & culutre

Treatment
- abx.

31
Q

POst Op Fever
5 Ws

A

Fever: > 100.4 For > 38C
if its IMMEDIATE, think
- inflammation
- immune rxn
- malignant hyperthermia
- bacteremia
- gangrene

5 W’s

Wind: atelectasis (24-48hr)
Water: UTI
Walking: PE/PNA
Wound: infection
Wonder Drug: other drug

24-48: atelectasis
3-7 days: unresolved atelctasis = PNA
POD 3: UTI
POD 5: thrombophelbitis
POD 5-10 :wound infection
POD 7: Pulm. embo.
POD 10: deep infection (CT or IR and OR)
4 weeks = fever? = skin/soft tissue or viral illness

STM: Exam 2 Surgery (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions