Postoperative Care and Complications Flashcards
When in the OR, who is managing the patients care?
When does this change?
Does this qualify as a transfer of care?
Jointly being managed by anesthesia and surgery together
Once surgery is over transferred PACU care is resumed by surgerical team
Yes
When should you use post-op order sets?
Whenever possible, in order not to omit necessary details
In a post-op patient what criteria is required for an ICU admission?
Who makes this decision?
If the patient requires ventilator assistance or circulatory support (vasopressors) and more intensive staffing require admission to ICU
Critical Care Provider (Attending)
What is another name for pulmonary toilet?
What is the goal?
Pulmonary hygiene, previously known as pulmonary toileting, refers to exercises and procedures that help to clear your airways (trachea and bronchial tree) of mucus and other secretions. Ensures pulmonary function and that alveolies are filled appropriately.
What is a low residue diet?
Low fiber diet; used often in many GI post-op patients
What considerations should be taken account for in a post-operative patient?
Considerations for:
* Level of consciousness
* Dangers of aspirations
* Presence of NGT or OGT
* teeth/dentures
* Intra-op degree of manipulation of bowels
Evaluation by provider from the surgical team should be completed within how many hours of surgery?
Post-op check within 4-6 hours
Surgical drains can allow for early detection of what complication?
Early warning of a surgical leak
Surgical drains allow for collapse in what space?
Surgical dead space
What are the common drain types?
- Jackson-Pratt
- Blake
- Penrose
- Wound Vac
What are some rules of thumb for drains?
- All drains are potentially dangerous (infection risk)
- For every drain, there must be a reason
- When the reason is gone, the drain should be gone
- Drain should not exit through the surgical incision
- Drain should be firmly secured
What are some factors affecting severity of pain post-operatively?
Can patient anxiety cause pain?
- Duration of surgery
- Type of anesthesia
- Degree of operative trauma
- Type and location of incision
- Organ manipulation
- Magnitude of intra-operative retraction
Yes
Why can inadequate pain management lead to pneumonia post-operatively?
Due to pain patient does take deep breaths/cough to move bacteria
What are some objective ways to measure pain?
- Increased HR
- Increased RR
- Does patient appear to be uncomfortable and does it match report
What opioid is considered the gold standard?
Morphine
When prescribing opioids what should be ordered along side it?
Naloxone for reversibility if there is an urgent need
What are side effects of all opioids?
- Sedation
- Confusion
- Respiratory depression
- Delayed gastric emptying
- N/V
- Pruritius
- Constipation
- Urinary retention
What receptors do opioids work on?
MU Receptors in the brain and spinal cord
MU 1 receptors are responsible for analgesia
MU 2 receptors are responsible for respiratory depression
When utilizing a patient-controlled analgesia (PCA) who can push the button?
ONLY THE PATIENT
What are some benefits to epidural anesthesia?
What are some risks/complications to consider?
- Better pain control than IV narcotics
- Earlier recovery of bowel function vs. systemic opioids
- Less need for systemic opioids (narcotics) and less nausea
- Easier breathing resulting from better pain control
- Easier and earlier participation in PT
Hypotension, headache, and leg weakness
How often should a fentanyl patch be changed/removed?
What about Lidoderm patches?
Every 72 hours
Every 12 hours (on 12 hours, off for 12)
When used for > 5 days what are the associated side effects of NSAIDs?
- Gastric irritation, peptic ulcer, GI bleeding
- Precipitation of bronchospasm in asthmatics
- Renal dysfunction
- Platelet dysfunction, bleeding
There is increased efficacy if Acetaminophen is taken when and how?
Taken via a scheduled dose within the 1st few days post-op (vs PRN)
What are the Five W’s of Post-Op Fever?
Wind: atelectasis
Wound: infections
Water: UTI
Walking (lack thereof): DVT
Wonder drug: medciation reactions
