Postoperative Care Flashcards
Factors Affecting Wound Healing?
age (geriatric) wound infection obesity hydration non-compliant with Dr. orders *diabetic *PVD
Types of wound healing?
Primary
secondary
Primary intention wound healing?
Tissue surfaces approximated
Minimal or no tissue loss
Example: surgical wound
Secondary intention wound healing?
Edges can not be approximated
Involves considerable tissue loss
Example: decubitus ulcer, cut from piece of glass
Tertiary intention?
wound has dehisced (opened up)
Phases of Wound Healing?
- Inflammatory: initial occurrence; 4-6 days after hemostasis; phagocytosis is happening
- Proliferation: 4-21 days, fibroblasts make collagen which gives wound tensile strength; max 80%
- Maturation/Remodeling: 21 days spent in recovery
Complications of Wound Healing?
Hemorrhage → bleeding of large volume >500 mL
Dehiscence → wound opens up; caused by infection, obesity
Evisceration → abdominal organs come out of incision; caused by lifting, movement, smoking, dehydration
Infection → show up between 4-7 days of Sx
Main nutrients of wound healing?
protein
vitamin c
How PROTEIN is primarily lost in a surgical patient?
with loss of blood or edema
Keloid?
buildup of scar tissue
Hematoma?
buildup of blood under skin (associated with low HGB count)
COMFORT MEASURES for NAUSEA & VOMITING?
antiemetic head of bed upright ice chips dim lights cool compress breathing techniques Dimenhydrinate (gravol) Metoclopramide (maxeran)
Nursing Assessment & Care of Patient on Admission to Clinical Unit?
Record time of patient’s return to unit and indentify patient
ABCs (compare with baseline)
Vital signs and O2 sat
Assess neurologic status → including LOC & movement of extremities (to verbal command and spontaneously)
Assess color and temperature of skin
Assess wound, dressing, drainage tubes
Note type & amount of drainage
Connect tubing to gravity or suction
Assess urinary status
Note time of voiding
Note presence of catheter and total output
Check bladder for distention or urge to void
Note catheter patency
Assess pain and discomfort
Note last dose and type of pain control
Note current pain intensity
Position for airway maintenance, comfort & safety
(bed in low position, side rails up)
Check IV infusion
Verify type of solution
Note amount of fluid remaining
Verify flow rate
Check integrity of insertion site(s)
Attach call light within reach & reorient patient to use of call bell
Ensure that emesis basin and tissues are available
Assess emotional condition and support
Check for presence of family member or significant other
S&S of hip fracture?
External rotation Muscle spasm Shortening of the affected extremity Pain, usually severe Tenderness in the region of the fractured site
Hip Pinning - ORIF?
line bone up properly + stabilize
Internal fixationinvolves stabilizing broken bones with surgical screws, nails, rods, or plates. This type of surgery is usually for people who havefracturesin which the bones can be properly aligned. This may also be called “hip pinning.”
Hip pinning surgery to repair a hip fracture involves two main steps:
- Reduction (getting the bone lined up correctly)
- Internal Fixation (stabilizing broken bones)
Hemiarthroplasty?
replaces the ball portion of the hip joint (femoral head)
Total hip replacement (THR)?
ball & socket are replaced.
Cemented- older adults
Uncemented- younger adults (allows tissue to grow around)
Preop Teaching - #hip?
Moving unaffected leg and both arms – method & frequency Trapeze bar & Using opposite side rail Discuss mobility/physio involvement Getting out of bed & transferring to chair Weight bearing status Plans for discharge Rehab Home
Post operative Care?
Care as for any surgery
Neurovascular assessment – 7Ps
Alignment of extremity
Abductor splint, pillow
Preventing movements that may cause dislocation
crossing legs, scissoring of legs
Slipper Bedpan
Ambulation on day 1 or 2 or as per doctor’s orders
no internal rotation + no hip abduction
Avoid daily activities that may produce these positions:
Putting on shoes or socks
Crossing legs or feet while seated/lying
Assuming side lying positions incorrectly
Standing up or sitting down while body is flexed relative to the chair
Sitting on low seats – especially low toilet seat
Neuro Assessment?
sensation
motor function
Vascular assessment?
colour
temperature
cap. refill
peripheral pulses
7 p’s?
pain pallor pulses polythermia (temp.) puffiness (edema) paresthesia (nerve sensation) paralysis (movement)
