postop ppt

Question 1

focus of nursing interventions post op

Answer 1

Prevent Respiratory Complications
Relieve Pain
Promote Cardiac Output
Encourage Activity
Care for Wounds
Maintain Normal Body Temperature
Managing Gastrointestinal Function and Resuming Nutrition
Promote Bowel Function
Managing Voiding
Maintaining a Safe Environment
Providing Emotional Support
Managing Potential Complications

Question 2

how would the following diagnostics be affected by hypovolemia

BUN
hct
K,
Na

Answer 2

• BUN can be elevated because of dehydration or decreased renal perfusion and function.
• Inc Hct.
• K and Na levels may be reduced or elevated.
• Hypokalmeia occurs with GI and renal losses
• Hyperkalmeia- adrenal insufficiency
• Hyponatremia –inc thirst and ADH release
• Hypernatremia – inc insensible losses and diabetes insipidus
• Urine specific gravity is inc in relation to the kidneys attempt to conserve water

Question 3

if pt is hypovolemic what type of solution will be hung iso/hypo/hyper
when is this necessary

Answer 3

try to use oral rehydration if possible

isotonic initially then hypotonic electrolyte soln to promote renal excretion of metb waste

Question 4

how are bun and hct affected by hypervolemia

what diagnostic can tell you about severe hypervolemia

Answer 4

both dec d/t plasma dilution

chest x ray might show pulm congestion

Question 5

what is azotemia

Answer 5

• Azotemia (increased nitrogen levels in the blood) can occur when urea and creatinine are not excreted due to decreased perfusion by the kidneys and decreased excretion of wastes. High uric acid levels (hyperuricemia) can also occur from increased reabsorption and decreased excretion of uric acid by the kidneys.

Question 6

how might you tell hypervolemic pt to alter their diet

Answer 6

dec table salt

Question 7

should pt mobilize or rest often if edematous

Answer 7

• Regular bed rest may be beneficial because bed rest favoursdiuresis of edema fluid.because of diminished venous pooling and increase in circulating blood volume.

Question 8

routes of intraspinal analgesia delivery

Answer 8

• Intraspinal analgesia can be administered through a 1) bolus 2) continuous infusion (pump can be external or surgically implanted) 3) continuous plus intermittent bolus (often patient-controlled episdural analgesia PCEA

Question 9

least desirable route for opioid delivery

Answer 9

IM d/t variable absorption and pain with admin•

Question 10

advantage of transnasal route for opioid delivery

Answer 10

Transnasal: rapid action of the medication because of direct absorption through the vascular nasal mucosa

Question 11

how do crystalloids work

Answer 11

by osmosis

Question 12

indications for crystalloid

advantage over colloid or blood product

Answer 12

• Replace fluid loss and promote urinary flow. Much less expensive than colloids and blood products.

Question 13

which is better at expanding plasma volume colloid or crystalloid

which stays in vascular space longer

Answer 13

colloids

colloids

Question 14

is colloid or crystalloid more likely to cause edema and why

Answer 14

crystalloids because you need a much larger volume to achieve the effect

Question 15

post op recovery room how often are your checks

Answer 15

Q15 min skilled focused assessments (head to toe w focus on ABCDE)—i dont have my epi check sheet anymore

Question 16

what % of o adults get postop delirium

Answer 16

lots. in class she said up to 50

Question 17

what assessments should you do for resp system

Answer 17

1. RR, look in their mouth, listen to resp sounds (may sound like gargling), may need to put hand in front of nose to feel breath
2. look in their mouth, RR etc
3. for swelling, ask pt how their throat feels

look for laryngeal edema

Question 18

nursing dx r/t airway (not breathing)

Answer 18

1. Potential airway obstruction d/t hypopharyngeal obstruction (floppy airway) r/t effects of anaesthesia.
2. Potential airway obstruction d/t presence of vomitus in the airway. (have emesis basin and suction ready)
3. Potential airway obstruction d/t allergic reaction to medications (analgesia, antibiotics)
4. Sore throat d/t insertion of endotracheal tube and NPO status for many hours.

Question 19

how are most anesthetics and how does this affect nursing care

Answer 19

1. Sometimes people after anesthetics will have lg pauses between inhalation/exhalation. Look at 02 sats, LOC (older adults and kids can be hyperactive or agitated), RR, listen to lung sounds, most anesthetics are excreted by the body by breathing (ask the pt to take deep breaths while listening)
2. DB&C and incentive spirometry.

Question 20

nursing dx r/t breathing

Answer 20

Hypoventilation (decreased respiratory rate) d/t affects of opioids and anesthetics

Decreased oxygenation due to atelectasis (collapse of the alveoli)

Retention of anaesthetics r/t hypoventilation

Question 21

why does pt have risk for DVT after sx

Answer 21

Risk for DVT, embolus d/t immobility for extended period during surgery, increased clotting response d/t surgical process, reduction in anticoagulant medications in preparation for surgery.
During sx we may have very thick blood, stress causes inc in clotting factors, venous stasis

Question 22

why is postop pt at risk of dysrhythmia

Answer 22

secondary to electrolyte imbalance, acidosis, pain, anesthetic agents, hypothermia, stress

Question 23

other than pain what postop assessments should be done r/t discomfort (3)

Answer 23

Assessment for nausea and vomiting-similar to LOTARP. Put on in and outs
Pruritus
People are cold when they return from OR, take temp and give blanket

Question 24

if the pt hasnt voided _hrs post sx use a bladder sanner to check urine amount

Answer 24

If they havent voided in 2hrs post sx check with bladder scanner

Question 25

rationale for these statements “The post-operative patient will most likely have an isotonic solution hanging during the post-operative period.” “Hypotonic and hypertonic solutions are rarely used in the surgical context.”

Answer 25

?

Question 26

WHAT IS PACU. what are the phases

Answer 26

Postanethesia care: is in the postanesthesia care unit (PACU) or recovery room or postanesthesia recovery room Phases of Post anesthesia Care: Phase 1 PACU: used during the immediate recovery place. Intensive care is provided Phase 2: patient is prepared for self-care or care in the hospital or an extended care setting Phase 3:prepared for discharge. Pt might sit in a recliners overa stretcher, to prepare for discharge

Question 27

how often are vitals done in PACU and when do you report changes in BP

Answer 27

• Vitals and general physical status q15 min. downtrend of less than 5mmHg systolic or

Question 28

hypopharyngeal obstruction and its treatment

Answer 28

• relaxation from anesthesia can extend to the pharynx so when the patient lies on back, the lower jaw and tongue fall backward and air becomes obstructed: hypopharyngeal obstruction. (treatment: tilting the head back and pushing forward on the angle of the lower jaw)

Question 29

how should bed be positoned for postop pt and their breathing

Answer 29

HOB at 15-30

Question 30

risk factors for N and V

Answer 30

• Risk factors for PONV: general anesthesia, female gender, nonsmoker, hx of nausea and vomitting, and hx of motion sickness

Question 31

what happens if you hear report that pt is feeling very nauseaous (what should you do)

Answer 31

With first report, pt turned to one side to promote drainage and reduce risk of asphyxiation. maybe give PRN antiemetic

Question 32

gerontological considerations postop

Answer 32

* Moved from stretcher slowly, BP & ventilation monitored * More susceptible to hypothermia * Change position freq: stimulate resps, promote circ & comfort * Prolonged recovery from sedatives d/t liver/kidney fx * Pre-existing health conditions necessitates more cardio, resp + renal supports * Less physiological reserve so need more frequent monitoring * Confusion + delirium post-op in 51% of older adults * Acute confusion d/t: pain, analgesic agents, hypotension, fever, hypoglycemia, fluid loss, fecal impaction, urinary retention, anemia * Restlessness possible from electrolyte imbalance, hypoxia, blood loss its very important that they mobilize early to prevent resp complications

Question 33

pt teaching if being discharged direct after sx

Answer 33

* Pt + family taught about expected outcomes and anticipated changes * Prescriptions given * Written instruction given * Provide appropriate telephone #’s * Info to provide includes: name of procedure, any permanent changes in anatomical structure, describe ongoing therapeutic regimen (including diet, activities to perform and avoid), date and time of follow up appointments, community resources &referals, pertinent health promotion activities… * Typically told 24-48hr window in which to limit activity (no alcohol, small meals, don’t make any important decisions…)

Question 34

when postop pt returns to floor how often do you do vitals

Answer 34

Vitals q15 for first hour and q30 min for next 2 hours..temp is monitored 4 hours for the first 24 hours.

Question 35

after first 24hrs postop how does nursing care shift

Answer 35

• Shift is quick from intense physiological management, symptomatic relief of adverse effects of analgesia to regaining independence and prep for discharge

Question 36

how to prevent resp complications

Answer 36

* Crackles = sign of static pulm secretions = need for deep breathing + coughing, IS, freq position changes at least q1hr…prevents pneumonia + atelactasis * Splinting helps to reduce pt fear during coughing * Pain meds given to facilitate more effective coughing

Question 37

2 types of hypoxemia risks for getting it

Answer 37

• 2 kinds of possible hypoxemia: subacute + episodic o Subacute = constant low O2 sat but breathing appears norma o Episodic = sudden, pt at risk for cerebral dysfx, myocardial ischemia, cardiac arrest o Risks for this: sx (esp abdominal), obesity, existing pulmonary problems

Question 38

are eipidurals commonly used in chest sx

Answer 38

•• Epidural infusions are used with caution in chest procedures because may ascend into spinal cord and affect respiration

Question 39

how can pain contribute to pulmonary embolus

Answer 39

• Pain activates stress response: adversely affects cardiac and IR; vasoconstriction and muscle tension resulting from pain inc O2 demands; also inc platelet aggregation + blood viscosity = inc risk for PE

Question 40

wat could you teach pt about mobility that would encourage them to mobilize what should you teach if cant stand up how else can you physically assist them to mobilize

Answer 40

* Less pain + shorter stay if ambulating * Remind pt that early ambulation = prevention of complications * Mobility stimulates peristalsis – limits GI distension • Help patient get sit up in bed with head of bed elevated and encourage to splint if needed, position upright and swing legs over, help patient stand beside the bed -encourage them to do self care • If cant stand up, bed exercises are encouraged

Question 41

what do if pt has v low body temp

Answer 41

report to dr tx may include, 02, hydrate, nutrition. monitor for dysrhythmias give blankets

Question 42

how much mobility does pt need in order to be d/c

Answer 42

must be able to toilet self, get in and out of bed, walk certain distance

Question 43

instructions DB and C

Answer 43

abdominal (diaphragmatic) and pursed lip breathing o semi-sitting in bed or chair or,.klying in bed w one pillow o flex knees to relax muscles of the abdomen o place 1 or 2 hands on abdomen just below ribs breathe in deep through nose, keep mouth closed o concentrate ion feeling abd rise as far as possible. don’t arch back, relax. don’t use chest and shoulder muscles o if difficult to raise abd take quick forceful breath\ o purse lips as though to whistle. make whoosh sound wout puffing cheeks o concentrate on feeling abd fall or sink. tighten abd muscles while breathing out to enhance exhalation. count to 7 o use every 2hrs or whenever SOB. inc to 5-10min 4xdaily controlled coughing use upright position. • 2 full deep breaths, inhale and hold breath for count of 3 cough 2-3x wout inhaling between • if pt has incision teach them to place hands or pillow over incisional area. press gently

Question 44

hgb hct k na

Answer 44

Hgb 136-170 g/L HCT 0.40-0.52 L/L Na 135-145 mmol/L K 3.5-5.0 mmol/L

Question 45

nutrients to support wound healing

Answer 45

Min 1500 kcal/day Protein Vitamin A and C Zinc

Question 46

considerations about bowel fx postop

Answer 46

* constipation is common after sx * Dec activity, intake and opioids cause this. * If abdm is not distended and BS are present and patient has not had a bowel movement on 2nd or 3rd day the physician should be notified (laxative will be given)

Question 47

how will persons GI tract feel after sx

Answer 47

Gynaecological sx are worst for causing abdominal pain • Manipulation of GI tract can cause less peristalsis for 24-48 hours post-op and swallowed air can get trapped and cause distention and fullness want pt to reposition, ambulate to prevent this

Question 48

reintroducing feeding postop who should you not feed

Answer 48

Listen to BS before feeding people. when they are heard it indicates full peristalsis Want them to pass flatus start w clear fluids • Diet should be resumed as early as possible  stimulates gastric secretions + peristalsis; eating will speed normal GI fx Dont feed anyone w abdominal surgery

Question 49

what could happen if GI peristalsis doesnt return | whats this called

Answer 49

• Paralytic ileus + intestinal obstruction = possible complications

Question 50

which drugs interfere with urination

Answer 50

• Anesthetics, anticholinergics + opioids interfere with perception of bladder fullness, urge to urinate, and ability to initiate urinating

Question 51

tricks to get people to pee

Answer 51

• Aided by water running + warmth over perineum

Question 52

DVT s/s

Answer 52

• DVT = pain or cramp, followed by swelling of limb, fever, chills, diaphoresis

Question 53

1 thing that should be encouraged to prevent delirium and 1 note about the environment they shoud be in

Answer 53

o Keeping pt in well lit room close to nursing unit can help prevent sensory deprivation o Physical deterioration exacerbates it – don’t neglect physical activity

Question 54

how to maint safe environment post op how often to check on pt

Answer 54

Assess LOC and blood pressure before ambulating CALL BELLS within reach!! Side tables within reach. Restore senses (glasses, hearing aids, etc.) Ambulate “with” at first Never leave alone in the bathroom until certain they won’t faint Check your patient Q1H