PostOp

Question 1

Assessment in PACU

Answer 1

• Hx
• LOC & awareness
• Respiratory: airway & adequate gas exchange
• VS
• Oxygen saturation
• Surgical area for bleeding & drainage

Question 2

Respiratory Complications of Surgery

Answer 2

• Atelectasis
• Pneumonia
• Pulmonary Embolism (PE)
• Laryngeal Edema
• Ventilator dependence
• Pulmonary Edema

Question 3

Cardiovascular Complications of Surgery

Answer 3

• HTN
• Hypotension
• Hypovolemic shock
• Dysrhythmias
• Venous Thromboembolism (VTE); especially DVT
• HF
• Sepsis
• Disseminated Intravascular Coagulation (DIC)
• Anemia
• Anaphylaxis

Question 4

Skin Complications of Surgery

Answer 4

• Pressure ulcers
• Wound infection
• Wound dehiscnce
• Wound evisceration
• Skin rashes or comtact allergies

Question 5

Gastrointestinal Complications of Surgery

Answer 5

• Paralytic ileus
• Gastrointestinal ulcers & bleeding

Question 6

Neuromuscular Complications of Surgery

Answer 6

• Hypothermia
• Hyperthermia
• Nerve damage & paralysis
• Joint contractures

Question 7

Kidney/Urinary Complications of Surgery

Answer 7

• UTI
• Acute urinary retention
• Electrolyte imbalances
• AKI
• Stone formation

Question 8

Preventing Hypoxemia

Answer 8

• Airway maintenance
• Monitor oxygen sat, pulse ox
• Positioning
• Oxygen therapy
• Breathing exercises: splint incision, cough, deep breathe, use incentive spirometer
• Movement/mobility
  > early ambulation
  > if pt on bed rest; reposition q2, perform breathing & leg exercises
  > antiembolis stockings
  > pneumatic SCDs

Question 9

Preventing Wound Infection & Delayed Wound Healing

Answer 9

• Dressing change
• Assess wound for infection
  > warmth, swelling, tenderness or pain
  > type & amnt of drainage
• Assess drains
  > patency
  > amnt, color, & type of drainage
• Drug therapy (antibiotics)

Question 10

Dehiscence

Answer 10

• Partial or complete separation of outer wound layers, “splitting open of wound”
• Apply sterile nonadherent or saline dressing
• notify surgeon
• lie supine, bend knees, avoid coughing

Question 11

Evisceration

Answer 11

• Total separation of all wound layers & protrusion of internal organs through open wound
• Surgical emergency, prepare for surgery
• notify surgeon
• apply sterile saline soaked gauze
• liek supine, bend knees, avoid coughing

Question 12

Managing Pain

Answer 12

• Alternative Therapies: positioning, massage, relaxation techniques, diversion
• Drug therapy
  > opioid analgesics given first 24-48hrs after surgery
  > PCA
  > assess type, location, & intensity of pain before & after giving med
  > Morphine Sulfate, Hydromorphone (Dilaudid), Ketorolac (Toradol), Codiene, Butorphanol (Stadol), Oxyxodone w/ Aspirin (Percodan), Oxycodone w/ Acetaminophen (Tylox, Percocet)