Post-op Care

Question 1

Assessment of VS and CVP

Answer 1

• Pulse, resp and BP until stable
• Freq depends on operation
• EKG monitoring
• Record CVP post op if fluid shifts or blood loss
• Swan Ganz catheter if cardiac or resp compromise

Question 2

Normal fluid maintenance

Answer 2

• Notify surgeon if failure to void 6-8 hrs post-op
• 1500-2500 mL depending of sex, wt, ht
• LR or normal saline
• Pts wt x 30
• More if fever, hyper vent, hyper catabolic

Question 3

ID and mgmt of 3rd spacing

Answer 3

• Typically replaced during operation

- Retroperitoneal dissection, severe pancreatitis

Question 4

Volume overload

Answer 4

• Edema, JVD, tachypnea
• Increased CVP
• Urine: low sodium, high potassium
• Sodium restriction, diuretics

Question 5

Volume depletion

Answer 5

• NG suction, fistulas, adrenal insufficiency, burns
• Hypernatremia- CNS depression, lethargy, coma
• Musc rigidity, tremors, spasticity and seizures
• Tx with 5% glucose in water or hypotonic saline

Question 6

Whole blood

Answer 6

RBC replacement in massive loos with hypovolemia

Question 7

Fresh frozen plasma

Answer 7

Replacement of coag factors in clotting deficies, warfarin

Question 8

Platelets

Answer 8

Thrombocytopenic pts

• Clotting disorders
• Not donor matched

Question 9

Washed RBCs

Answer 9

Anemic puts with severe or recurrent allergic rxns

Question 10

Return to bowel fxn

Answer 10

• Sm intestine- 24 hrs
• R colon- 48 hrs
• L colon 72 hrs
• Stomach 3-4 days
• Return or peristalsis = appetite, bowel sounds, farting

Question 11

Packed RBCs

Answer 11

• Tx of choice to replace RBCs

- Increases carrying capacity in anemic pts

Question 12

Leukocyte reduced RBCs

Answer 12

• Febrile, nonhemolytic tranfusion rxn to RBCs

Question 13

Irradated RBCs

Answer 13

• Severely immunocompromised

- Prevents graft v host dz

Question 14

Frozen deglycerolized RBCs

Answer 14

Alloimunized for rare blood types