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Nurs 186 > Post Operative Phase > Flashcards

Post Operative Phase Flashcards

1
Q

Aldrette scale

A

Point scale patient passes to leave PACU

Patient may be in PACU for 45 minutes to several hours

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2
Q

Report from OR to PACU RN

A 
What was done
Anesthetics used 
Allergies
Medical HX 
Blood loss
Meds used
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3
Q

Discharge to home after outpatient surgery

A

Need to be much more alert and stable

Have a higher aldrette score

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4
Q

Who’s a candidate for outpatient surgery

A

Cataracts
Carpal tunnel
Minor ortho procedures
Short procedures

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5
Q

When can they leave from outpatient surgery

A 
Can tolerate fluids 
Can void postop 
Ambulate within limits
Stable vitals
Controlled pain

No driving for 24 hours and don’t make big life decisions

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6
Q

Advantages of outpatient surgery

A

Less expensive
Less risk for infection
Recovery at home

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7
Q

Disadvantages of out patient surgery

A

The burden of care is shifted to non professionals

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8
Q

Report from PACU to nursing unit

A

Past medical HX
General or spinal
How patient is doing and did in recovery
What be needed in room for pt.

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9
Q

Stridor or snoring

Priority if heard

A

Stridor shows there may be an upper respiratory obstruction

Snoring may mean tongue is blocking air way
Check lung sounds Q4

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10
Q

Obstructive sleep apnea

A

Physical characteristics lead to apnea
If patient is considered high risk they get cont. pulse ox and capnography(apnea protocol)

Keep O2 above 95

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11
Q

Atelectasis

A

Pneumonia:collapse of alveoli
Mucous collecting
Occurs 24 hours after surgery if patient is not doing breathing exercises(IS/coughing)

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12
Q

Ways to help prevent pneumonia

A

Incentive spirometer
Cough and deep breathing
Turning and positioning
Ambulating

If patient develops an elevated temperature increase respiratory exercises that is the first sign of Atelectasis

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13
Q

Cardiovascular

A

BP tends to be variable
Check apical pulse and rhythm
Temperature:get back within norm(patients are usually cold coming from OR)

Cold= high BP warm=low BP

Peripheral pulses are important

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14
Q

VS upon arrival

A

15X4(1st hour)
30X2(2nd hour)
1X4(3rd-6th hour)

Report variances of BP of 15 to surgeon and check heart rhythm

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15
Q

Nursing thoughts (temp)

A

Temp>37.5 increase respiration exercises
Temp>38.5 look for physician orders
Temp below 36 warm them up

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16
Q

Nursing thoughts BP and HR

A

Be alert for pulse below 60 or above 100 or irregular(see what their norm is)(hypothermia can make you Brady,shock or pain can make you tachy)

Systolic

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17
Q

Neurological

A

Potential for injury related to sedation and or neuromuscular blockade

LOC:if they had general anesthesia should be speaking and awake soon

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18
Q

Level of anesthesia blockade

A

Assess how the blockade is wearing off, where is it still in place and where has it dissolved

If blocked at hip work your way down until level of blockade is still present. Watch for improvement

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19
Q

Potential complications of anesthesia blockade

A

Spinal headache
Urinary retention
Hypotension

Orders may say lay flat or have head up

May be on restricted activity

20
Q

Fluids and electrolytes

A 
I&O on all surgical pt's
Minimal 30cc/hr
Check output before end of shift 
Due to void 6-8 hours of no catheter 6-8 after removal 
Check mucous membranes and skin turgor

General anesthesia excreted aldosteron= increased sodium decreased potassium

21
Q

Normal hemoglobin

A

12-18

22
Q

Normal hematocrit

A

35-50%

23
Q

BUN

A

10-20

24
Q

Creatinine

A

1.0

25
Q

GFR

A

90-120

26
Q

PONV

Post operative nausea and vomiting

A

Increased after anesthesia(especially in obese,abd surgery, HX of motion sickness)

27
Q

Post op NG tube

A

NPO:NG to suction
Advance diet as tolerated
After surgery may not have vowel sounds for 24 hours(turn off NG suction to hear for sounds)

28
Q

Bowel activity reminisces with surgery

A

Monitor for constipation and ileus
Ileus:part of intestine isn’t working

Chewing gum and drinking coffee may help with peristalsis

29
Q

Ambulatory can help postop

A

Improves peristalsis
Prevention of Atelectasis

Young adults lose 1% of muscle mass everyday bed rest, older adults 5%

30
Q

Primary incision

A

Skin should looked healed in 2 weeks,under skin 6 weeks-2 years

Drainage still occurring by postop day 5 is abnormal

31
Q

Hemovac drain

A

Can be hooked up to suction on the wall

32
Q

Dressings

A

In immediate post op setting check dressing every time you check vitals
Remove sutures and staples by day 8

33
Q

Changing dressings

A

If you see drainage or shadow on dressing circle and initial it to monitor draining

If dressing is moist to putter environment change it(risk for infection)

A draining wound needs
to be covered
Most dressing changes happen after 24 hours or on post op day 2

Healing by secondary intention need to remain covered

34
Q

Tape blister

A

Be sure to document

Sensitivity to tape
Cover the blister up

35
Q

Impaired wound healing

A

An infection of to occurs usually happens 5-8 days after surgery

Redness,swelling, increased drainage WBC and temperature

36
Q

Dehiscence

A

Partial or complete opening of wound layers

High risk in:
Obese
Diabetes 
Malnutrition
Therapeutic steroids
Procedures that last> 2 hours

Cover with wet gauze
Binder help with prevention of stress related dehiscence

37
Q

Evisceration

A

Cover with normal saline and sterile gauze
Get feet up in bent position

Get vitals

38
Q

Hemorrhage

A

Internal:concealed
External:evident

Check closely at dressing, including around extreme motors and dependent areas

If drain is in place and an increase is occurring, that’s. Good indicator that there is still bleeding

39
Q

Hematoma

A

Collection of blood(bruise)

Most hematomas absorbed by the body

40
Q

Medicinal leech therapy

A

Used to help restore venous circulation where the is an area of venous congestion

41
Q

Compartment syndrome

Happens in post op patients or trauma

A

Internal swelling or bleeding into a portion of the body beyond its ability behinds its ability to expand

Can cause permanent damage in very short amount of time

S/S: pain not relieved with normal pain meds given

42
Q

Deep vein thrombosis

A

SCD’s
Anti-embolism socks
Anticoagulation therapy
Ambulation

43
Q

Pulmonary embolism

A

Blood clot broken loose and goes into pulmonary circulation

S/S: dyspnea, angina,bloody sputum,cardiac arrest,

Treatments: heads up, O2,heparin drip,heparin therapy followed by Coumadin therapy

44
Q

Pain management post op

A

Opioids(try to graduate patient from IV meds to PO meds)
PCA pump
Epidural(monitor very closely)

Reposition
Heat and cold as ordered
Massage

Opioids means NO DRIVING

45
Q

Self management education

A

Prevention of infection and S/S
Care and assessment of wound
Manage of drains
Nutrition therapy(increase calories,protein,vitamin C,iron,zinc)
Progressively increase activities and do not break weight restrictions

46
Q

What happens in PACU

A

Assess level of anesthesia
Stabilize condition
Tend to postop complications

Nurs 186 (12 decks)

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