Postoperative Nursing Part II Flashcards
What is a classic example of continuous, ongoing pain?
Post-op pain
Post-op patients are good candidates for what type of medication dosing?
ATC dosing
What should nurses vigilantly monitor for in post-op patients on medications, esp. opioids?
Side effects (watch for respiratory depression in patients on narcotics, esp. if opioid naive)
Nursing interventions for post-op pain
Pharmacologic and non-pharmacologic interventions (non-pharmacologic interventions should supplement pharmacologic ones)
Document relief/pain status
Do patients have hyperthermia or hypothermia DURING surgery?
HYPOthermia
Hypothermia may occur during surgery as body heat is lost during the procedure
In regards to temperature changes, what is an EXPECTED finding in the first 48 hours after surgery?
Mild fever less than or equal to 100.4F
Temperature changes in the first 48 hours after surgery
Mild fever (less than/equal to 100.4F) Moderate fever (greater than 100.4F)
What does a mild fever (less than/equal to 100.4F) in the first 48 hours after surgery indicate?
Inflammatory response due to surgical stress–this is an EXPECTED finding
What does a moderate fever (>100.4F) indicate in the first 48 hours after surgery?
Lung congestion (intervention: pulmonary toilet) Dehydration (intervention: increase fluid intake)
What should we be concerned for if the post-op patient has a fever >100F 48 hours AFTER surgery?
Infection (try to determine the source-wound, urinary, respiratory?)
Potential post-op GI complications
Gas/distension
Nausea
Constipation
Paralytic ileus
What can cause a paralytic ileus?
Manipulation of bowels during abdominal surgery
How long can it take for large intestine motility to resume after surgery?
Large intestine motility may take 2-7 days to resume
How long can it take for small intestine motility to resume after surgery?
Small intestine motility resumes within hours
S/s of paralytic ileus
Distended abdomen
Absent/high pitched bowel sounds
Pain/tenderness
What is the most likely cause of absent bowel sounds 24-48 hours after surgery?
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)
Interventions for paralytic ileus
NG to low wall suction, stomach decompression, and wait for paralytic ileus to subside-which it will
Nursing interventions to prevent GI complications
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
Examples of advancing diet
- NG -> low wall suction
- 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)
What is a common SE of narcotics?
Constipation
What is the only SE of opioids that a patient cannot develop a tolerance to?
Constipation
How does hydration help prevent GI complications?
Hydration helps with GI motility/bowel movements
Potential post-op urinary complications
Urinary retention
UTI (remove Foley ASAP, monitor for s/s)
What is often the first indication of a UTI in an elderly patient?
New-onset confusion
Nursing interventions to prevent urinary problems
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)
What should urine output be?
> 30 mL/hr
What is a great indicator of renal perfusion?
Urine output (urine output=renal perfusion)
Decreased CO -> decreased BP -> decreased renal perfusion -> decreased urine output
Potential post-op integument complications
Infection
Dehiscence (incision reopening)
Evisceration (incision opening and abdominal organs protruding out of the incision)
Interventions for a post-op skin infection
Assess for wound pain, drainage (amount, color, odor, consistency), surrounding erythema
Nursing interventions to prevent integument problems
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
Drains/catheters post-op patients may have
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
