Postoperative Nursing Part II

Question 1

What is a classic example of continuous, ongoing pain?

Answer 1

Post-op pain

Question 2

Post-op patients are good candidates for what type of medication dosing?

Answer 2

ATC dosing

Question 3

What should nurses vigilantly monitor for in post-op patients on medications, esp. opioids?

Answer 3

Side effects (watch for respiratory depression in patients on narcotics, esp. if opioid naive)

Question 4

Nursing interventions for post-op pain

Answer 4

Pharmacologic and non-pharmacologic interventions (non-pharmacologic interventions should supplement pharmacologic ones)

Document relief/pain status

Question 5

Do patients have hyperthermia or hypothermia DURING surgery?

Answer 5

HYPOthermia

Hypothermia may occur during surgery as body heat is lost during the procedure

Question 6

In regards to temperature changes, what is an EXPECTED finding in the first 48 hours after surgery?

Answer 6

Mild fever less than or equal to 100.4F

Question 7

Temperature changes in the first 48 hours after surgery

Answer 7

Mild fever (less than/equal to 100.4F)
Moderate fever (greater than 100.4F)

Question 8

What does a mild fever (less than/equal to 100.4F) in the first 48 hours after surgery indicate?

Answer 8

Inflammatory response due to surgical stress–this is an EXPECTED finding

Question 9

What does a moderate fever (>100.4F) indicate in the first 48 hours after surgery?

Answer 9

Lung congestion (intervention: pulmonary toilet)
Dehydration (intervention: increase fluid intake)

Question 10

What should we be concerned for if the post-op patient has a fever >100F 48 hours AFTER surgery?

Answer 10

Infection (try to determine the source-wound, urinary, respiratory?)

Question 11

Potential post-op GI complications

Answer 11

Gas/distension
Nausea
Constipation
Paralytic ileus

Question 12

What can cause a paralytic ileus?

Answer 12

Manipulation of bowels during abdominal surgery

Question 13

How long can it take for large intestine motility to resume after surgery?

Answer 13

Large intestine motility may take 2-7 days to resume

Question 14

How long can it take for small intestine motility to resume after surgery?

Answer 14

Small intestine motility resumes within hours

Question 15

S/s of paralytic ileus

Answer 15

Distended abdomen
Absent/high pitched bowel sounds
Pain/tenderness

Question 16

What is the most likely cause of absent bowel sounds 24-48 hours after surgery?

Answer 16

Peristalsis that has not yet returned. Likely NOT due to a paralytic ileus but just the fact that peristalsis has yet to return (monitor for return of BS/flatulence)

Question 17

Interventions for paralytic ileus

Answer 17

NG to low wall suction, stomach decompression, and wait for paralytic ileus to subside-which it will

Question 18

Nursing interventions to prevent GI complications

Answer 18

Assess/treat nausea (antiemetics)
Gradually advance diet
Monitor/document dietary intake
Ambulation
Hydration 
Monitor/compare bowel sounds each shift
Provide privacy to use the bathroom
Ensure patient is on stool softeners if on narcotics

Question 19

Examples of advancing diet

Answer 19

1. NG -> low wall suction
2. NPO with ileus -> clear liquids -> full liquids

Collaborate with the patient to see if they can tolerate advancing diet (if they become nauseous after advance, go back to a less advanced diet)

Question 20

What is a common SE of narcotics?

Answer 20

Constipation

Question 21

What is the only SE of opioids that a patient cannot develop a tolerance to?

Answer 21

Constipation

Question 22

How does hydration help prevent GI complications?

Answer 22

Hydration helps with GI motility/bowel movements

Question 23

Potential post-op urinary complications

Answer 23

Urinary retention

UTI (remove Foley ASAP, monitor for s/s)

Question 24

What is often the first indication of a UTI in an elderly patient?

Answer 24

New-onset confusion

Question 25

Nursing interventions to prevent urinary problems

Answer 25

Monitor I/O and ensure urine output >30 mL/hr
Assess urge to void
Palpate bladder/use bladder scanner as needed
Encourage voiding in a normal position
Obtain order for catheterization (us. for intermittent cath) if no voiding within 6-8 hours after surgery
Examine quantity/quality of urine
Assist in voiding (i.e., leave water running)

Question 26

What should urine output be?

Answer 26

> 30 mL/hr

Question 27

What is a great indicator of renal perfusion?

Answer 27

Urine output (urine output=renal perfusion)

Decreased CO -> decreased BP -> decreased renal perfusion -> decreased urine output

Question 28

Potential post-op integument complications

Answer 28

Infection
Dehiscence (incision reopening)
Evisceration (incision opening and abdominal organs protruding out of the incision)

Question 29

Interventions for a post-op skin infection

Answer 29

Assess for wound pain, drainage (amount, color, odor, consistency), surrounding erythema

Question 30

Nursing interventions to prevent integument problems

Answer 30

Assess risk for skin issues (higher risk if obese, elderly, and coughing frequently)
Monitor wound at least each shift
Protect with appropriate dressing/keep clean and dry/meticulous aseptic technique
Enhance nutrition (increased carbs, proteins, calories, vitamins, hydration)
Impeccable infection control when managing tubes/drains/catheters

Question 31

Drains/catheters post-op patients may have

Answer 31

Indwelling urinary catheter
Suprapubic urinary catheters
Ostomies (GI)
G-tube to foley bag to drain until bowel wakes up
Tenckhoff catheter (peritoneal tube for dialysis)
Rectal tubes/fecal management systems
NG tube (suction)
Wound vac
Wound drain (Penrose)
Closed suction drain (Hemovac, Jackson-Pratt)
T-tube (in common bile duct)
Chest tubes (pleural or mediastinal)-pigtails, pleurXcatheters