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NURS 412 > Post-op complications > Flashcards

Post-op complications Flashcards

1
Q

Respiratory Complications

A

Anaphylaxis
Atelectasis
Hypoxemia
Aspiration
Pneumonia
Sepsis

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2
Q

What causes buildup of mucous in the lungs = lung infection?

A

general anesthesia decreases normal breathing and removes urge to cough after surgery, hurts to breath

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3
Q

Anaphylaxis

A

affects AIRWAY, swells up, loose capacity to breathe

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4
Q

Atelectasis

A

hypoventilation and excessive retained secretions
happens when the air sacs of alveoli deflate (can cause collapse of the lungs)
most common cause of hypoxemia

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5
Q

What are signs and symptoms of atelectasis?

A

agitation
hypo/hypertension, tachycardia (compensation)
absent or decreased A/E to that lobe of the lung
diminished/absent breath sounds
dullness in percussion
reduced chest expansion, tachypnea
fever

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6
Q

pt has just gotten out of surgery and is in acute rep distress. What might cause this?

A

the tongue. Wake pt up or put in oral airway

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7
Q

Hypoxemia

A

reduction in the oxygen tension in arterial blood that leads to a reduction at the tissue level (which is hypoxia)

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8
Q

aspiration

A

foreign material that enters trachea instead of esophagus

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8
Q

what is the normal value of PaO2?

A

80mmhg, less than that is hypoxemia (need blood gas analysis to confirm)

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8
Q

what causes hypoxemia?

A

reduced ability of oxygen to diffuse across alveoli
reduce perfusion of ventilated alveoli
reduced ventilation of perfused alveoli
reduce oxygen tension of inspired air
reduced volume of inspired air

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8
Q

what can aspiration cause?

A

pneumonia

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8
Q

what are interventions for atelectasis?

A

DB and cough q1h when awake
incentive spirometer
reposition HOB
apply o2

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9
Q

What is the mechanism of swallowing?

A

involves 5 cranial nerves and 26 muscles (motor, cognitive and behavioral processes)
an abnormality of any of these can cause ineffective swallowing= aspiration

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9
Q

what prevents aspiration?

A

gag/cough reflex

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9
Q

who does not have gag/cough reflex?

A

Older adults, people with stroke, anesthesia

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10
Q

What do we do for people that do not have gag/cough reflex?

A

intubate, NPO
PPI preop in those who are obese or pregnant

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11
Q

Pneumonia signs and symptoms

A

sudden onset of chills, shaking, high fever
dyspnea, tachypnea, sharp chest pain (increased w inspiration)
productive cough
decreased breath sounds
cyanosis w hypoxemia (PaO2 <80)

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12
Q

Pneumonia intervetions

A

DB and C q1h
incentive spirometry
early ambulation
HOB >30 degrees
oral hygiene
maintain airway
apply o2
contact MRP/RT
labs and diagnostics (sputum cultures, CXR, blood cultures)
abx
fluids

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13
Q

SEPSIS

A

systemic response to overwhelming infection, when a pts immune system fails to control pathogens or their toxins from a site of infection (SIRS criteria)
Systemic illness caused by microbial invasion to sterile parts of the body
leading cause of death and hospitalization

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14
Q

What are the most common populations for SEPSIS?

A

aging pop
chronic disease
artificial joints, heart valves, CVCs
Cancer, autoimmune diseases, immunocompromised
organ transplants
increased use of antibiotics and antimicrobials

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15
Q

What are the most frequents sites of infection for SEPSIS?

A

lungs
urinary tract
abdo
soft tissue skin

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16
Q

Symptoms of SEPSIS

A

early on, organ hypo perfused despite good BP
blood flow/oxygen prioritized to brain and heart, thus shunted away from kidneys, skin, GI tract, lungs = organ disfunction

altered LOC
confusion
psychosis
sao2<90
jaundice
decreased albumin
tachycardia
hypotension
CVP
oliguria
anuria
creatinine
decreased platelets
PT
decreased protein C D-dimer

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17
Q

What does severe SEPSIS have…?

A

NO SYMTPOMS

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18
Q

What is SIRS criteria?

A

2 or more of…
altered LOC
HR>90
emp >38 or <36
Resp >20
WBC count >12 (normal 4-11)

+

suspected infection

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19
Q

SEPSIS interventions

A

thorough assessment and VS (keep Sao2>92%)
advise MD, PCC (GET HELP)
contact ICU team (lab work and diagnostics - cultures and lactate, abx - after diagnostics and blood work, IV fluids- bolus, monitor - VS, urine output)

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20
Q

When do you have to be careful with bolus?

A

HF and renal patients

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21
Q

Septic shock

A

BP not greater than 90mmhg systolic or MAP 65 despite IV fluids

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22
Q

Diagnostics for SEPSIS

A

blood culture
CBC, coagulation profile, D-dimer
ABGs
lactate level
C-reactive protein
serum proteins
blood sugar
serum cr and u
liver function

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23
Q

Cardiovascular complications

A

VTE: DVT/PE
Pulmonary embolism
Peri-operative stroke
Fluid overload
Dehydration
Hypovolemia
Post-op bleeding
Electrolyte imbalance

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24
Q

Who is at risk for VTE?

A

pts without prophylaxis
obesity
acute illness
>40 y/o
cancer (hypercoagulation) use low molecular heparin

25
Q

What do VTEs lead to?

A

PE!!!!!! if not treated

26
Q

Why does PE need immediate intervention?

A

blocks O2 in bloodstream, leading to hypoxemia, lead to tissue hypoxia

27
Q

Who is most at risk for PE?

A

joint replacement surgeries (immobility!!!!)

28
Q

What is used to prevent PE?

A

Prophylaxis…
detect those at risk
education
early/frequent mobilization
hydration
post op symptom assessment
treatment advocacy (do they have decreased sensation?)

29
Q

What is the tx of PE?

A

heparin

30
Q

Heparin

A

increased risk of bleeding
check lab values (PT)
route: SubQ

31
Q

what is the antidote of heparin?

A

protamine sulfate

32
Q

Peri-operative stroke risks

A

vascular surgeries
longer surgeries
HF, low ejection fraction, MI
dehydration
hyperglycemia
stasis in postop, bed rest
withholding antiplatelet/anticoagulant

33
Q

Peri-op stroke

A

ischemic and embolic
happens POD1

34
Q

Periop stroke interventions

A

Call MD!! (facial droop, slurring, sudden neurologic changes)
neurology consultation
Pts are eligible for thrombolytics within 3 hour window of onset of symptoms

  1. Doctor
  2. CT scan (tPA)
  3. thrombolytics

swallowing screening
early mobilization
glucose control
BP control
no indwelling catheter (high risk of bleeding with tPA)
diagnostics (CXR, holter monitor, carotid doppler, echocardiogram)

35
Q

Fluid overload prec factors

A

stress response (increase ADH and water retention)
CHP
rapid high volume IV intra op

36
Q

Fluid overload detection

A

decreased urine output (<30ml/hr)
Increased BP, HR or SOB
abnormal breath sounds (crackles/decreased A/E)
Peripheral edema

37
Q

Fluid overload prevention

A

monitor IV fluids/blood products rate and amount
monitor output - note 24 hour balance
assess for signs of overload
meds as ordered (diuretics, ACE inhibitors, digoxin)

38
Q

Dehydration

A

Excessive loss of water from tissues

39
Q

Dehydration detection

A

less than 350cc of urine in 12 hours
Hypotension/tachycardia
dry lips and mucous membranes
lack of skin turgor
muscle weakness, dizziness, headache, restlessness

40
Q

Prevention of dehydration

A

monitoring urine output oral/IV intake
blood loss during surgery
VS including temp
correct dehydration and avoid unnecessary transfusion

(similar to anemia)

41
Q

hypovolemia causes

A

total blood volume loss of 15-24%
blood loss from surgical site
severe dehydration
third spacing (not enough albumin, liver disease, fluid loss from vomiting/diarrhea, N/G tube suction)

42
Q

What are symptoms of hypovolemia?

A

lethargy
hypotension
rapid/weak pulse
cool/clammy skin
rapid shallow resps
oliguria/anuria

MOST CONCERNED ABOUT BP

43
Q

Hypovolemia interventions

A

VS, o2, IV fluids
MRP, ICU outreach

44
Q

Post op bleeding symptoms

A

excessive bleeding
low hgb
hypotension, tachycardia
pale, cool

45
Q

Post op bleeding interventions

A

VS
notify surgeon
Patent IV (1,2)
apply pressure
keep pt warm
lie pt flat (decreased card. work)
warfarin? INR?

46
Q

Electrolyte imbalance common electrolytes

A

NA, KCl, bicarbonate, Ca, phosphorus, Mg

47
Q

what affects heart function?

A

hypokalemia

48
Q

What causes electrolyte imbalance?

A

N/V
fluid loss during surgery
preop NPO status

49
Q

Electrolyte imbalance prevention

A

monitor lab values
report/record abnormal
meds (IV/PO)
prevent c-diff
tx and prevent N/V

50
Q

GI complications

A

Paralytic ileus
Post op N and V (PONV)

51
Q

Paralytic ileus

A

decreased motility of intestines beyond 24 hours

52
Q

when does paralytic ileus happen?

A

24-48 hours postop

53
Q

What causes paralytic ileus ?

A

Gi tract innervation is dusrupted from intestinal manipulation
hypokalemia
wound infection (increased stress, decreased wound healing)
narcotics

54
Q

symptoms of paralytic ileus

A

severe abdo distension
N/V
decreased or absent BS
severe constipation or passage of flatus and small liquid stools

55
Q

interventions for paralytic ileus

A

ambulate!
Pain management
hold fluids and food
NG tube to decompress stomach (prevent intestinal preformation)
anti-emetic
notify surgeon (abd X ray)

56
Q

Post op N/V (PONV)

A

administer anti-emetics
modify analgesic routine if necessary
change to alternate opioid

57
Q

GU complications

A

Urinary retention
Healthcare associated UTI (HAUTI)

58
Q

Urinary retention symptoms

A

absence of voiding
bladder distension
discomfort
anxiety/restlessness
diaphoresis
htn
urinary frequency/urgency/sensation that bladder isnt fully emptied with voiding

59
Q

Urinary retention interventions

A

ambulate
bladder scan

60
Q

HAUTI risks

A

most common type of infection
catheter (biofilm crawls up catheter)
female
catheter management techniques
older age
DM, immunosuppressed
malnourished

61
Q

HAUTI complications

A

delirium
decreased mobility
infection
mobility, mortality

62
Q

asymptomatic bacteriuria

A

urine culture positive without signs and symptoms of UTI
DO NOT TREAT W ABX

63
Q

Symptomatic UTI

A

urine culture (+)
at least one positive with the following: fever, suprapubic tenderness, CVA tenderness)
+
at least one of the following: urgency/frequency, dysuria

64
Q

Indications for a indwelling catheter

A

acute urinary retention +/ obstruction that cannot be relieved by use of intermittent catheterization
short term monitoring of urinary output in critically ill pt
per-op use
intra op monitoring of urinary output
facilitate healing in advanced pressure ulcers in incontinent pts
requires prolonged immobilization with inability yo void
improve comfort for end of life care

65
Q

After removal of catheter…

A

mobilize at least BID
commode bathroom to void q2h
avoid bed pans
optimize bowel function
if unable to void for 4 hours - bladder scan

66
Q

Surgical site infection prevention

A

4 pillars!!
1. homothermia (maintain temp)
2. antibiotic timing (given within 1 hour of surgery)
3. glycemic control (lower)
4. skin prep (preop) - with CHG

67
Q

Interventions for surgical site infection

A

local: would culture and PO antibiotics
systemic: same as for sepsis

NURS 412 (21 decks)

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