Postop Flashcards
Phases of post anesthesia care
Phase 1: immediate postop period
-intense monitoring (might still be on vent)
-ACP gives handoff to PACU nurse
Phase 2:
Preparing pt for transfer to unit, home, or SNF(skilled nursing floor)
Discharge from PACU
Aldrete score
9-10 required for discharge
Higher score the better
This determines if your ready to go or not
Respiratory assessment ***
Breath sounds, effort, rate
Sputum characteristics
Signs of respiratory distress:
-neuro changes (early sign)
-accessory muscle use
Cyanosis (late sign)
Rispiratory complications ***
Obstruction:
1. Blockage due to tongue
2. Laryngeal edema/bronchospasm
Atelectasis: sounds llike quiet crackles (clears with cough)
-if not corrected can cause pneumonia
Hypoventilation:
CNS depression from meds, pain
Reversal agents: Narcan(opioid) , Flumazenil (reversal for benzo (versed)
What does narcan and flumazenil reverse ***
Narcan reverses opioids
Flumazenil reverses benzodiazepine (versed)
Nursing interventions
Respiratory ***
Airway obstruction: stimulation , jaw thrust/chin lift
Postition
Deep breathing
Insentive spirometer
Coughing
Ambulate/sit in chair
Adequate hydration
Treat pain
Suction for secretions
Cardiovascular assessment ***
VS: HR, BP
Peripheral pulses
Skin color
Cardiovascular complications ***
Hypotension (usually postop)
Hypertension: look for pain, bladder distention
VTE: can lead to PE
PE s/s:
Tachypnea
Tachycardia
Chest pain
Dyspnea
Nursing interventions
Cardiovascular ***
IVF as ordered
Rewarming
Monitor I/O, VS
Early ambulation
*start raising HOB 1-2 min, sit with legs dangling monitor pulse/bp
VTE prophylaxis: intermittent compression device, anticoagulants)
Neurological assessment ***
LOC
Pupils
Sensory/motor status
Neurologic and psychologic complications **
Emergency delirium (in PACU)
Delayed emergency (in PACU) r/t anesthesia
Postoperative cognitive dysfunction: can last weeks to months
Delirium
Anxiety/depression
ETOH withdrawal
Delirium
pain
sleep deprived
fluid imbalance
hypoxemia
drugs
Emergency delirium***
Happens in PACU
agitation, disorientation, thrashing, shouting
Nursing interventions
Neuro/psych
Orient pt frequently
Early ambulation
Provide psychological support
Assess for underlying causes to symptoms (oxygen status, fluid/ electrolyte imbalance)
Postop pain
Pain causes increased risk of atelectasis
Can delay recovery
Assess frequently
Teach pt to know when pain is too bad
Nursing interventions
PAIN
PRN: NSAID and opioid
PCA (patient controlled anesthesia)
Assess/document response: improve/ SEs
Assess gas pain (opioids can cause)
If having chest or leg pain evaluate for
VTE
PE
PCA
Patient controlled anesthesia ***
Pt has button and can administer a dose of pain med themselve
Usually morphine, hydromorphone
May have continuous dose with bolus or just bolus
Safety with PCA ***
Requires nurse double check
Nurse programs the pump, must be checked carefully
Gastrointestinal assessment ***
Bowel sounds: NPO until bowel sounds present
*must listen to bowels for 5min to say their absent
Nausea
Bowel movements/ passing gas
Tolerating PO
Gastrointesinal complications ***
Postop N/V
constipation
Postop ileus : temporary impaired bowel motility
*normal after abdominal surgeries
Nursing interventions
Gastrointestinal ***
Encourage PO fluids as tolerated
Suction available/ recovery position for vomiting
Position on right side (helps with gas pain)
Complications R/T Temp changes
Hypothermia
Hyperthermia
Hypothermia ***
Causes:
skin exposure
cold fluids
skin prep
inhaled gases
-can cause shivering (uses up O2)
-altered drug metabolism
-pain
-hypertension
-bleeding
Hyperthermia ***
malignant hyperthermia : immediately postop
Infection : later = 3-4 days postop
Difference in infection and malignant hyperthermia is the timing
Nursing interventions
Temp change
Passive warming measures:
Socks, warm blanket
Active warming:
External warming devices
Apply oxygen if shivering present
Temp >103 may need to use body-cooling measures
Urinary assesskments ***
UOP:
Min=0.5ml/kg/hr
Bladder scan if not voided in 6-8 hours
Remove catheter ASAP (Cauti)
*if nothing in bad first check for leak
Urinary complications ***
Acute urinary retention:
Anesthesia, drug SEs, lower abdominal/pelvic surgery, pain
UTI
Acute kidney injury:
From meds, dehydration/blood loss
Low UOP:
Expected postop but should increase
Nursing interventions
Urinary ***
Promote voiding with:
position
Running water
Walking to bathroom
Offer PO fluids
Bladder scan if no UOP in 6-8 hours
Integumentary assessment ***
Look for: bleeding, reddness, swelling, pain, drainage
Systemic infection (fever, leukocytosis)
Assess any drains
Assess wounds (Q15-30 min immediately postop)
Drainage should change from sanguinous-serosanguinous-serous
Drainage should change from what ***
sanguinous (bloody)
To
serosanguinous
To
serous (clear)
Integumentary complications ***
Skin and soft tissue infection (SSI)
*usually not evident for 3-5 days postop
Dehiscence: incision opens up
Evisceration: incision open and something sticking out
*dont push stuff back in
Nursing interventions
Integumentary ***
Hand hygiene
Adequate nutrition
Dressing changes as ordered
*surgeon usually does first dressing change
*if bleeding you can reinforce if but dont remove it
Spinal headache ***
Cause: leakage of CSF from hole in dura mater
Classic: frontal/occipital pain 24-72 hours after spinal anesthesia
Lay flat
Tx:
IVF
Blood patch
Caffeine
Discharge home ***
Must be:
Alert, hemodynamically stable, PONV/pain under control
Accompanied by an adult (no driving)
Need access to:
Pharmacy
Phone # to call emergency (surgeon)
Follow up instructions
Discharge home education ***
Get teach back from both patient and caregiver
Symptoms to report
Med teaching
Care of incision/drainage
Activity allowed
Give pt discharge paperwork
Delegation
RN:
Assessment
Report
Skills (dressing change, foley cath insertion)
Med administration
Teaching
UAP:
VS, I/O
ADL’s
CDB (cough and deep breath)
