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Med Surg > Post Operative nursing > Flashcards

Post Operative nursing Flashcards

1
Q

What is the first thing you do when the pt arrives

A

assess physiological status (get vitals and do this first), surgical site (create a baseline by circling it), and influence of anesthesia

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2
Q

when assessing physiological status what are expected respiratory signs in these pts

A

increased RR

hearing dead space on the outer portions of the lungs

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3
Q

What is something to do to double check the fast RR is okay and the patient is stabalizing

A

compare O2 sat with preop baseline

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4
Q

when assessing physiological status what are expected signs at the surgical site in these pts

A

oozing

slight increase in the edges of a wound

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5
Q

How can you monitor the size of the pts wound

A

outline it with a marker

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6
Q

What is the goal for LOC immediately after surgery

A

arousable

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7
Q

What is a common problem for PACU pats involving airways and how can you fix it

A

obstruction by the tongue

tilt the head back and place a pillow at the base of the neck to keep it in that position

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8
Q

What is the guideline for positioning patients to avoid aspiration

A

test their gag reflex, if yes place in semifowler

if no place in lateral position

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9
Q

What is the postanesthesia discharge criteria

A 
Patient awake or at baseline
Vital signs stable
No excess bleeding or drainage (a little is expected) 
No respiratory depression (look at Sats)
Oxygen saturation > 90%
Report given
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10
Q

Ambulatory Surgery Discharge Criteria

A

All PACU discharge criteria met
No IV narcotics for last 30 minutes
Minimal nausea & vomiting
Voided (if appropriate to surgical procedure & orders)
Able to ambulate if age-appropriate and not contraindicated
Responsible adult present to accompany patient
Discharge instructions given and understood

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11
Q

What information should you get from the anesthe/RN from PACU before letting them leave

A

Name of patient & Surgical procedure(s)
Anesthetic agents & reversal agents used
Estimated blood/fluid loss & replacement
Vital signs & any problems encountered
Complications (anesthetic or surgical)
Preoperative condition & co-morbidities
Parameters for immediate post-op mgt.
Vent settings, pain mgt., anesthesia reversals

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12
Q

What are the expected outcomes by the time the pt gets to the floor

A

Airway maintained (part of the ABC assessment); protective reflexes intact (gag).
Normal spontaneous respiration.
ABGs within preoperative normal values
No evidence of aspiration (hearing fluid in the lungs like a crackles and gurgling)
Heart rate & BP return to pre-op values 1-2 hr post-anesthesia & remain stable.
Body temperature WNL
Urine output > 0.5 mL/kg/hr (the output should be heading that direction) 50-60 per hour is the end goal
No evidence hyper (like high BP)-/hypo-volemia (low BP and low turgor)
Arouses easily & responds appropriately to commands (present water and see if they reach out for it)
Moves all extremities purposefully & with normal strength
Skin integrity intact
Some redness and swelling at incision site is normal
Make sure Nutritional intake re-established
Remember – protein for healing (check albumin)
Pain less than 4 on pain/visual analogue scale

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13
Q

What is the criteria for route for nutrition

A

Via oral route when protective airway reflexes return
Via enteral route (like NG tube) only after bowel sounds return
Via parenteral route only when hemodynamically stable

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14
Q

What are some common potential problems during post op care

A

Hemorrhage (monitor signs of bleeding-GI bleeding can cause pulse to increase)
Thromboembolism (ambulate to prevent)
Urinary retention (drinking and ambulation and bladder scan and go get if they don’t urinate)
Paralytic ileus (ambulate)
Hypoxemia
Hypoventilation
Hypotension
Hypertension
Cardiac Dysrhythmias
Hypothermia (blanket and socks) – expect this!
Dizziness

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15
Q

What is a sign their is GI bleeding

A

pulse increase

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16
Q

What is an intervention to reduce the risk of thromboembolism

A

ambulate

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17
Q

What are some intervention to reduce urinary retentioin

A

drink fluid and ambulate

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18
Q

What is a sign of paralytic ileus

A

no bowel sounds

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19
Q

What is an intervention to reduce the risk for atelectasis

A

coughing and incentive spirometry

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20
Q

What is it called when you hold a pillow to the stomach during a cough to protect an abdominal incision

A

splinting

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21
Q

What are some essential and desirable interventions to prevent venous stasis in the legs

A

Essential- calf pumping and thigh setting

Desirable- foot circles and hip and knee flexion

22
Q

What is a risk that comes with activity and what should you do about it

A

dizziness, get them sitting or lying, assess LOC and vitals (especially BP), assess fluids for hypovolemia

23
Q

What may be necessary to check for hypovolemia

A

a fluid challenge

24
Q

What types of pain are PCA’s used for usu

A

Postoperatively
Cancer
Trauma
Pain uncontrolled by other means

25
Q

What drugs are usu used in PCA’s

A

Mepreridine (Demerol)
Morphine Sulfate
Hydromorphone (Dilaudid

26
Q

What are some side effects of the opioids used in PCA’s

A 
Resp dep
NV
allergic rx like itching 
sedation 
urinary ret
27
Q

When you take over a pt from another nurse and they are using a PCA, verify what on the pump

A

medication
basal rate
dose
lockout interval

28
Q

What should be documented using a PCA?

A

vital signs esp resp

amount of drug used including the number of times it was requested, actually delivered, total amount given in the shift

29
Q

What two adverse complications are we most concerned about early on with PCA’s

A

Resp Dep

NV

30
Q

What is the first intervention for patients with breakout pain

A

check to see the PCA is functioning

31
Q

What should the nurse do if the sys is working to help releive the pain

A

notify physician for orders like bolus, increasing basal or trigger dose and using another pain med

32
Q

What comb for pain results in better analgesia with fewer SE

A

opioid with local anesthetics

33
Q

Where does epidural anesthesia become contraindicated

A

at the diaphragm and above

34
Q

local anesthetics block what

A

spinal nerve fibers in the dorsal root ganglion

35
Q

opioids block what

A

impulse transmission to the cerebral cortex

36
Q

What are some common local anesthetics

A

end in caine

37
Q

What are some common opioids for epidural analgesia

A

morphinne

fentanyl

38
Q

What are good post op pains for epidural analgesia

A

orthopedic surgery of lower limbs
pelvic surgery
GU and GI surg

39
Q

How do you set up a epidural anal pump

A

just like a PCA

40
Q

What is a way to get a baseline for where the analgesia for the patient stops and to tell if the catheter has moved

A

scratch up their body and have them tell you when they start to feel a different sensation

41
Q

What are some things we need to teach pt with an epidural analgesic

A 
how to use a pain scale
report pain when they have it 
SE
dont get up without help
keep the bed head elevated slightly
42
Q

What are some interventions for assessing the effectiveness of the epidural analgesiv

A

assess ability to move

inspect areas of ppressure bec they dont feel as much

43
Q

What is the definitioni of resp depressioni

A

<8 RR
<90% O2
decreased LOC

44
Q

If resp depression occurs what should you do

A

stop or slow meds
use narcan
ambulate
intubate if needed

45
Q

After how many hours should you assess the bladder for urinary retentioin

A

6-8 without void

46
Q

What can sympathetic blockade of epidural analgesics can cause

A

decreased BP and sometimes decreased HR

47
Q

What can you do if you notice sympathetic blockade

A

lie them flat and elevate legs

call anesthesia

48
Q

what are some things you shoiuld documenvt with epidural analgesics

A 
VS &amp; neurologic signs
Sedation level
Pain level
Sensory level
Side effects
49
Q

What are some common complications of epidural analgesia

A

dislodgement of catheter

epidural level too high

50
Q

What can be a sign for too high epidural level

A

SOB

rise in the level of sensation loss

51
Q

What is an intervention for too high epidural level

A

elevate head of bed

notify anesthesia

Med Surg (35 decks)

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