postoperative care and pulmonary embolism Flashcards
postoperative period
immediately after surgery until pt is discharged or makes a full recovery
common causes of airway compromise in postop
- obstruction
- hypoxemia
-hypoventilation
nursing management: respiratory complication
- assess airway patency
- assess symmetry, depth and rate of respirations
- assess sputum or mucus
nursing implementation: respiratory complications
- deep breathing and coughing
- incentive spirometer
- reposition q1-2h
- ambulation
- pain control
- hydration
potential alterations in cardiac function postop
- fluid and electrolyte imbalances alter cardiac function
- fluid retention as a result of stress response
- hypokalemia
- DVT
- pulmonary embolism
- syncope
nursing assessment for cardiovascular conditions postop
- VS q15min until stable
- assess apcial-radial pulse
- assess skin colour, temp, moisture
nursing implementations for cardiovascular conditions postop
- intake and output
- labs
- leg exercises
- compression socks
- heparin
- ambulation
potential alterations in psychological function postop
- anxiety
- depression
- confusion
- delirium
nursing implementations for psychological function postop
- observe and evaluate behaviour
- listen and talk with pt
- offer explanations
- include pt in discharge planning
care of postoperative pt on clinical unit
- PACU gives report
- receiving nurse assists with transfer onto bed
- VS
- assessment
- initiation of postop orders
planning for discharge after surgery
- pt must be mobile, alert, and can provide a degree of self care
- controlled pain
- pt near preop functioning
- dietary restrictions or mods
- symptoms to be reported
- instructions for follow-up care
- answer questions and concerns
age related considerations: pt after surgery
- decrease in resp function
- decrease in ability to cough
- decrease thoracic compliance
- compromised cardiac function
- hypertension
- drug toxicity
- postoperative delirium
pulmonary embolism
- blockage of pulmonary arteries
- blocks perfusion to alveoli
CM of a PE
- classic triad - dyspnea, chest pain, hemoptysis
- hypoxemia with low PaCO2
- cough
- crackles
- fever
- tachycardia
- changes in mental status
diagnosis of PE
- spiral CT
- ventilation perfusion (VQ) scan
- D-dimer
- ABG
- chest xray
- ECG
Normal PT and INR
- normal clot formation 10-13 sec
- full anticoagulation therapy is > 1.5-2x control value in seconds
- normal INR: 0.8-1.2
critical PT and INR
- > 20 sec for individuals not on anticoagulants
- INR > 3.6 for pts on anticoagulants
normal aPTT, PTT, platelets
- aPTT 30-40 sec
- PTT 60-70 sec
- platelets 150000-400000
- for pts on anticoag therapy: 1.5-2.5 times control value
critical aPTT, PTT, platelets
- aPTT >70
- PTT > 100
- platelets <50,000 or > 1 mil
ABG normals
- pH: 7.35-7.45
- PaCO2: 35-45
- HCO3: 21-28
- PO2: 80-100
management of PE
- supplemental O2
- turning, coughing, deep breathing
- mechanical ventilation
- pain
- fibrinolytoics to dissolve PE
- IV heparin to prevent future clots
- semi-fowlers
- bedrest
- vitals
- labs: PTT, INR
