Postoperative Nursing Part I Flashcards
Units for post-operative care
PACU, ICU
Do you continue preoperative orders into postoperative care?
No, preoperative orders are not carried over into post-op care–orders must start from scratch
PACU hand-off report components
General information about the patient
Patient history
Intraoperative management and events (includes most recent VS and lab/test results, how much blood the patient lost, etc.)
Initial PACU assessment is about…
Airway Breathing Circulation Neurological status (LOC?) Surgical and IV site Genitourinary (GU) Gastrointestinal (GI) Pain Patient safety needs
Potential GASTROINTESTINAL problems in the post-op patient
Delayed gastric emptying Distension and flatulence Hiccups Nausea/vomiting Paralytic ileus
Potential RESPIRATORY problems in the post-op patient (more common with hx of respiratory issues or if smoker)
Airway obstruction Aspiration Atelectasis Bronchospasm Hypoventilation Hypoxemia Pulmonary edema Pneumonia Pulmonary embolism
Potential NEUROPSYCHOLOGIC problems in the post-op patient
Delirium Fever Hypothermia Pain Post-op cognitive dysfunction
Potential URINARY problems in the post-op patient
Infection (commonly from urinary catheter)
Retention
Potential CARDIOVASCULAR problems in the post-op patient (worse if patient has cardiac history)
Dysrhythmias Hemorrhage Hypertension Hypotension Superficial thrombophlebitis Venous thromboembolism
Potential INTEGUMENTARY (incision site) problems in the post-op patient
Dehiscence
Hematoma
Infection
Potential FLUID AND ELECTROLYTES problems in the post-op patient
Acid-base disorders
Electrolyte imbalances
Fluid deficit
Fluid overload
Post-op problems
Respiratory Cardiovascular Neurologic and psychologic Pain Temperature changes GI Urinary Integument
Potential post-op RESPIRATORY complications
Hypoxia (due to shallow breaths, anesthesia, obesity, airway obstruction, respiratory depression, laryngospasm)
Atelectasis
Pneumonia
Nursing interventions to prevent respiratory problems
Consider positioning: elevate HOB to increase ventilation
Monitor vitals/O2 saturation Provide oxygen, suctioning if necessary Teach effective coughing techniques (i.e. splint if abdominal/thoracic incision) Incentive spirometry Turn q2h Early ambulation Pain management
What type of pain medication regimen should be used for post-op pain?
Around-the-clock (ATC) dosing
ATC dosing is indicated because post-op pain is considered ongoing/predictable pain
ATC dosing is indicated depending on how severe the surgery was
What does splinting when coughing prevent in patients with an abdominal or thoracic incision?
Splinting prevents coughing from pulling on an abdominal or thoracic incision
Technique for splinting incision when coughing
Hold a pillow against the abdomen when coughing to prevent pulling of incision
Can post-op patients choose not to cough if it causes too much pain?
No. Coughing post-operatively, particularly in patients who underwent abdominal or thoracic surgery, is MANDATORY to prevent atelectasis or pneumonia.
Potential post-op CARDIOVASCULAR complications
Decreased cardiac output
Deep ven thrombosis (DVT)
Pulmonary embolus (PE)
What should you monitor with a DECREASED CO?
Blood pressure
Heart rate
Pulses
Skin temperature/color (these indicate peripheral perfusion status)
What is a term used to collectively refer to a DVT and PE?
Venous Thromboembolism (VTE)
Nursing interventions to prevent cardiovascular problems
Monitor vital signs (trend them and compare to baseline values)
Encourage leg/ankle exercises
What are some leg/ankle exercises the patient can do to prevent cardiovascular problems?
Dorsiflexion
Plantarflexion
Circumduction
What is the purpose of leg/ankle exercises?
Dorsiflexion, plantarflexion, and circumduction mimic walking -> promote skeletal muscle contraction -> increase venous return
