Post Operative Flashcards
5 most common opioid side effects?
o Constipation o Nausea and Vomiting o Sedation o Pruritus o Urinary Retention
What is dehiscence?
partial or complete separation of wound edges.
What is evisceration
protrusion of organs through the surgical incision.
What is the PACU?
3 phases?
Postanesthesia Care Unit (PACU) – area where postoperative patients are monitored as they recover from anesthesia; formerly referred to as the recovery room or post anesthesia recovery room.
Phase I PACU – area designated for care of surgical patients immediately after surgery and for patients whose condition warrants close monitoring.
Phase II PACU – area designated for care of surgical patients who have been transferred from a phase I PACU because their condition no longer requires the close monitoring provided in a phase I PACU.
Phase III PACU – setting in which the patient is cared for in the immediate postoperative period and then prepared for discharge from the facility.
What is healing by second intention?
Second-intention healing – method of healing in which worun edges are not surgically approximated and integumentary continuity is restored by the process known as granulation.
What is healing by third intention
Third-intention healing – method of healing in which surgical approximation of wound edges is delayed and integumentary continuity is restored by apposing areas of granulation
KEY Nursing MNGMT in PACU?
Management in the PACU: The objective of nursing in the recovery room is to monitor the patient as they recover from anesthesia, is orientated, has stable vital signs, and no evidence of haemorrhage.
• Assessing Patient: baseline assessment, check tubes and lines, IV fluids, Vitals Q15mins, Post-op analgesic requirements is top priority.
• Maintaining Patent Airway: prevent hypoxia, prevent hypercania, nurse must “feel” breath on hand, do not remove airway devices left in place.
• Maintaining Cardio Stability: hypotension and shock is one of the most serious postoperative complications. Can be avoided by timely administration of IV fluids/blood products. Keep patient warm. Haemorrhage is uncommon yet serious complication
• Relieving Pain and Anxiety
• Controlling Nausea and Vomiting: at the onset of nausea, patient is turned completely to one side to promote drainage and prevent aspiration.
What consideration do geriatric pts in PACU require?
special attention to keeping patient warm, patient position changed frequently, may require additional support, more frequent monitoring.
Name some Post op nursing interventions
- Preventing Respiratory Complications
- Relieving Pain
- Promoting Cardiac Output
- Encouraging Activity
- Caring for Wounds
- Maintaining Normal Body Temperature
- Managing Gastrointestinal Fx and Nutrition
- Promoting Bowel Fx / Managing Voiding
- Maintaining Safe Environment
- Providing Emotional Support to Pt and Family
- Managing Potential Complications
- Promoting Home and Community-Based Care
- Gerontologic Considerations – recover slower, longer hospital stays, greater risk of complications, delirium is of particular concern.
What is PCA?
PCA is a method which allow patients to self administer their own opioids. It involves an infusion system with a pump. The client pushes a button an a set amount of opioid is released by bolus through an intravenous, subcutaneous, or epidural route. It includes a programmable lockout, and a max dose with-in a scheduled time option.
What respiratory complications are possible post op? When will they occur
usually develop in the first 48 hours after surgery most frequently seen are: - atelectasis - pneumonia - pulmonary embolism
What is Atelectasis
most common respiratory complication
r/t collapsed alveoli d/t insufficient tidal volume
Recognition:
Non-gravity dependent inspiratory crackles on auscultation. (i.e more patchy, not necessarily at bases, not bubbles like fluid crackles)
confirmed by X-ray
Could be related to LOC anesthetic, swelling (12hr peak)
Atelectasis interventions?
What is a potential complication
Actions- get pt mobilize, deep breathing, Sp02 monitor
Pneumonia is a common complication
What is pneumonia?
Signs and symptoms
inflammation or infection of lung tissue
Can be viral, back, or fungal
signs include: INC Temp pulse and resp productive cough dyspnea Crackles
What is a pulmonary emboli
Thrombus or fat embolus (air or amniotic)
May occur after any surgery but especially after surgery of abdomen or long bones
Potentially fatal
Occurs if thrombi pass into pulmonary blood vessels causing Dec blood flow to lungs and obstruction of flow of blood into left ventricle
S&S of Pulmonary embolus
dyspnea
pleuritic pain
apprehension
feverand hemoptysis (blood cough)
NOTE- Pt switchs side and oxygenation improves. Side with embolus up (good breathing), side with embolus down (poor breathing) because blood flows to lower 0ther. breath sounds will be present/normal (its vascular issue), Right side heart increase in workload- jugular vein distention as blood backs up .
Common reasons you get emboli
Vascular endothelial injury (IV or CVC), venous stasis, immobility, hypercoagulation (dehydration), trauma or fracture (fat emboli), arrhythmias, DVT
Causes of Resp Complications
Pre-existing respiratory infection/conditions
Respiratory infection after surgery
Use of anesthetics, oxygen, & endotracheal tubes
Aspiration
Prolonged immobility on OR table after surgery
Depressive effect of narcotics
Collapse of lung during surgery or inadequate re-expansion of lung after surgery
Post-operative pain reluctant to turn, deep breathe or cough
Surgery with high abdominal or chest incision no deep breathing & coughing due to pain
Debilitation
Post Op resp Interventions
Pre-operative teaching of moving and DB&C
Incentive spirometry exercises
Post-op, coach and encourage to perform q1-2h
Splint incision so coughing will be less painful & less likely to cause incision to rupture
Assess colour & consistency of mucus expectorated with coughing
Adequate hydration to keep mucus thin
Assess client for respiratory depression especially if on narcotic analgesics
Encourage ambulation ASAP
Assess respirations and listen to breath sounds routinely post-op
What is thrombophlebitis?
Where?
When?
Causes
inflammation of the wall of a vein with associated thrombosis
Affects peripheral veins, usually the calf
Occurs as a result of venous stasis or direct pressure on veins during surgery
Usually occurs 7 - 10 days post-op
Causes:
dehydration
prolonged bedrest
inadequate circulation due to hemorrhage (circulatory stasis & coagulability
MNFTS of blood loss
Manifestations include Narrow pulse pressure Delayed capillary refill tachycardia decreased urine output cool clammy skin decreased LOC
Tx of blood loss
Stop the bleeding Plasma expanders Albumin Large volumes of fluid Autotransfusion Transfusion Fresh frozen plasma Coagulation factors
When does inflm peak?
How long can acute last?
12hrs - 48hrs
Post op what can we expect with renal fx and fluid retention
During the first 3 to 4 days, expect:
- renal retention of water & sodium
- Expansion of ECF in excess of Na+; Cl
Nursing actions post op fluid and electrolyte balance
Prevent, monitor for & treat upper and lower GI losses
Accurate intake and output x 48 hrs
Monitor serum electrolyte values
Obtain and order for antiemetics
Proper maintenance of nasogastric suction
Encourage fluid intake and advance diet as tolerated
When should a client void post op if they are well hydrated
Expect the well-hydrated post-op client to void 6-8 hrs post-op
What does the post op diet begin with
clear fluid
When should normal peristalsis return
48 to 72 hrs
