Post Operative Phase Flashcards
Aldrette scale
Point scale patient passes to leave PACU
Patient may be in PACU for 45 minutes to several hours
Report from OR to PACU RN
What was done Anesthetics used Allergies Medical HX Blood loss Meds used
Discharge to home after outpatient surgery
Need to be much more alert and stable
Have a higher aldrette score
Who’s a candidate for outpatient surgery
Cataracts
Carpal tunnel
Minor ortho procedures
Short procedures
When can they leave from outpatient surgery
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
Advantages of outpatient surgery
Less expensive
Less risk for infection
Recovery at home
Disadvantages of out patient surgery
The burden of care is shifted to non professionals
Report from PACU to nursing unit
Past medical HX
General or spinal
How patient is doing and did in recovery
What be needed in room for pt.
Stridor or snoring
Priority if heard
Stridor shows there may be an upper respiratory obstruction
Snoring may mean tongue is blocking air way
Check lung sounds Q4
Obstructive sleep apnea
Physical characteristics lead to apnea
If patient is considered high risk they get cont. pulse ox and capnography(apnea protocol)
Keep O2 above 95
Atelectasis
Pneumonia:collapse of alveoli
Mucous collecting
Occurs 24 hours after surgery if patient is not doing breathing exercises(IS/coughing)
Ways to help prevent pneumonia
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
Cardiovascular
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
VS upon arrival
15X4(1st hour)
30X2(2nd hour)
1X4(3rd-6th hour)
Report variances of BP of 15 to surgeon and check heart rhythm
Nursing thoughts (temp)
Temp>37.5 increase respiration exercises
Temp>38.5 look for physician orders
Temp below 36 warm them up
Nursing thoughts BP and HR
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
Neurological
Potential for injury related to sedation and or neuromuscular blockade
LOC:if they had general anesthesia should be speaking and awake soon
Level of anesthesia blockade
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
Potential complications of anesthesia blockade
Spinal headache
Urinary retention
Hypotension
Orders may say lay flat or have head up
May be on restricted activity
Fluids and electrolytes
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
Normal hemoglobin
12-18
Normal hematocrit
35-50%
BUN
10-20
Creatinine
1.0
GFR
90-120
PONV
Post operative nausea and vomiting
Increased after anesthesia(especially in obese,abd surgery, HX of motion sickness)
Post op NG tube
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)
Bowel activity reminisces with surgery
Monitor for constipation and ileus
Ileus:part of intestine isn’t working
Chewing gum and drinking coffee may help with peristalsis
Ambulatory can help postop
Improves peristalsis
Prevention of Atelectasis
Young adults lose 1% of muscle mass everyday bed rest, older adults 5%
Primary incision
Skin should looked healed in 2 weeks,under skin 6 weeks-2 years
Drainage still occurring by postop day 5 is abnormal
Hemovac drain
Can be hooked up to suction on the wall
Dressings
In immediate post op setting check dressing every time you check vitals
Remove sutures and staples by day 8
Changing dressings
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
Tape blister
Be sure to document
Sensitivity to tape
Cover the blister up
Impaired wound healing
An infection of to occurs usually happens 5-8 days after surgery
Redness,swelling, increased drainage WBC and temperature
Dehiscence
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
Evisceration
Cover with normal saline and sterile gauze
Get feet up in bent position
Get vitals
Hemorrhage
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
Hematoma
Collection of blood(bruise)
Most hematomas absorbed by the body
Medicinal leech therapy
Used to help restore venous circulation where the is an area of venous congestion
Compartment syndrome
Happens in post op patients or trauma
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
Deep vein thrombosis
SCD’s
Anti-embolism socks
Anticoagulation therapy
Ambulation
Pulmonary embolism
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
Pain management post op
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
Self management education
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
What happens in PACU
Assess level of anesthesia
Stabilize condition
Tend to postop complications
