Postoperative Flashcards
When does the postoperative phase begin and end?
Out of the door of the OR to the last doctors visit with surgeon
What’s important to know about the patient when waking them up from anesthesia?
What they like to be called.
What is the PACU connected to?
The surgical unit
What is the care ratio of nursing staff to patient during the first 15-20 minutes after surgery?
2 nurses to 1 patient
After the initial 20 minutes in the PACU what is the nurse to patient ratio?
1:1
What does the patient need to regain before they can be transferred out of the PACU?
Motor function, sensory function, orientation, and stable vital signs.
What does the patient need to show no evidence of before they can be moved from the PACU?
Hemorrhage or other complications.
How many phases occurs in the PACU?
3
How often does the patients vital signs need to be assessed while in the PACU?
Every 15 minutes or sooner
How many points is possible to get on the Aldrete Score system?
10
A patient needs a score of what on the aldrete score system to leave the PACU?
7
What 5 things does the Aldrete Score Systems check on?
- Respirations
- Oxygen saturation
- Consciousness
- Circulation
- Activity
When does discharge planning begin?
DAY 1
When going over written discharge instructions what does the nurse need to do?
Verbally go over the written instruction
In terms of prescriptions what needs to be discussed upon discharge?
Actions to be taken if complications occur
What happens if no one can drive the patient home upon discharge?
They will be transferred to the hospital or other care facility.
True or false:
If the patient only had out patient surgery it is okay to discharge the patient even if they will be home alone.
False:
A patient is never to be discharged if they are going home alone.
What is the most important reflex and needs to be in place in order to be discharged from the PACU?
The gag reflex
When maintaining the patient airway in the PACU what degree must the patients bed be adjusted to?
15-30 degrees.
What does ABCs stand for?
Airway
Breathing
Circulation
What is the primary consideration for a patient in the PACU?
Maintain ventilation and oxygen
If a patient begins vomiting in the PACU what should you do?
Turn the patient on their side- suction after if necessary.
When does a patient need to be suctioned in the PACU?
The patient is not swallowing yet.
Why would swelling of the throat be a risk after surgery?
The throat may be cut after intubation
What do you need to do with the head and jaw to position it properly for opening the airway?
Head tilt-chin lift
What is the first sign of hypovolemia?
Systolic is less than 90 unless this is normal for their baseline
If the patient has blood loss of 5L or more what needs to be done?
Blood and fluid replacement
What is the indicator for hypotension-shock?
Elevated pulse with low blood pressure
What is the MOST important complication to look for after surgery?
SHOCK
What is the number one goal in the PACU?
Pain management
When is the family allowed to see the patient after surgery?
When the patient is stable
In terms of the cardiac system what are its symptoms of shock?
Rapid, weak, threads pulse
Decreasing pulse pressure
Low blood pressure
In terms of the respiratory system what are its signs of shock?
Rapid respirations
Cyanosis
What are the other signs of shock?
Pallor
Cool moist skin
Concentrated urine
When taking control in the environment to relieve pain and anxiety of a patient what should be done?
Reduce stimuli-
Quite, low lights, reduced noise levels
A patient who has undergone a lumbar fusion reports severe pain and as a result is unwilling to cough, turn, or deep breathe. You check the chart and find the pain medication cannot be given for another hour. What assessment would you carry out?
Check lung sounds
A patient who has undergone a lumbar fusion reports severe pain and as a result is unwilling to cough, turn, or deep breathe. You check the chart and find the pain medication cannot be given for another hour. How would you deal with this situation?
Reposition, distraction, and try relaxation techniques.
When should you intervene if a patient states they are nauseous after surgery?
At first mention
When controlling nausea and vomiting how does nutrition evolve?
Clear liquids to a regular diet
True or False:
The most important nursing intervention when vomiting occurs postoperatively is to turn the patients head to prevent aspiration of vomitus into the lungs.
True!
What is important to watch for in the elderly patients after surgery?
Hydration
How much urine per hour should be passed postoperatively?
30 ml/h
True or False:
Elderly patients have a decreased likelihood of postoperative confusion and delirium.
False:
They need to be reoriented often
What is the adverse reaction to wound healing where excess scar tissue is present?
keloidscar
What medication decreases wound healing?
prednisone
Why is it important to avoid prolonged antibiotic use?
To avoid contracting C.diff
True or False:
Older adults have a delayed inflammatory response
True
What is exudate?
Material that has escaped from blood vessels that is deposited in or on tissues
What are the three types of exudate?
Serous
Purulent
Sanguineous
What is the mixed exudate called?
Serosanguineous
Which of the following occurs during the inflammatory stage of wound healing? A. Blood clot forms B. Granulation tissue forms C. Fibroblasts leave wound D. Tensile strength increases
A. Blood clot forms
Is a penrose drain stitched into the skin?
No
How do penrose drains work?
The Doctor pulls out a little each day so the wound heals from the inside out.
How do Jackson Pratt drains work?
Squeeze it really tight and close the cap.
It gradually pulls the fluid out while it expands.
What do you need to document when looking at a wound?
All sutures or staples present, the measure of the incision from end to end, any bruising, oozing or discoloration.
Why would silver be used during wound healing?
It is a great antimicrobial
When should you assess for pain postoperatively?
Every 4 hours
What is dehiscence?
The wound opens
What is evisceration?
The wound skin and muscle opens. Organs come out.
The nurse caring for a postoperative client who received general anesthesia. Which assessment finding should the nurse immediately report to the primary healthcare provider?
- Mild hypertension
- Complaints of nausea
- Decreased oral intake
- Rising body temperature
- Could be late effects of malignant hyperthermia
The nurse is caring for a postoperative client who began experiencing confusion. Which assessment should be the nurses priority action?
- Cardiac rhythm
- Level of anxiety
- Level of consciousness
- Status of airway
- Status of airway
- if the patient is not getting enough oxygen to their brain confusion begins
