Quiz #2 Post op Flashcards
What is the first sense to return in the unconscious patient
Hearing
In the immediate post anaesthetic period what are the three main causes of airway compramise
Obstruction
Hypoxemia
hypoventilation
What is the most common obstruction when the patient is in the PACU
The patient’s own tongue
What surgeries have the highest outcomes for atelectasis and pneumonia
Abdominal or thoracic surgery since it makes it harder for patient to deep breath and cough
What are common causes for hypotension in the PACU unit
-Unreplaced intraoperative fluids
-post surgical internal hemorrhaging
If a patient with hypotension is not responding to fluid administration what is the most likely cause of the hypotension
Cardiac dysfunction
What urine output generally indicates adequate renal function
30 mL/h
Why is the postoperative patient at such an increased risk for blood clots
because the stress response that surgery induces causes the body to produce more platelets making the blood clot easier
What blood pressure parameters should be reported to the MRP
systolic less than 90 or greater than 160; or a steady decline of blood pressure across multiple readings
what heart rate parameters should be reported to the MRP
heart rate of less than 60 or greater than 120
When would hypotension be a major concern and would require immediate intervention
when it is accompanied by skin that is
-cold
-clammy
-pale
as this might indicate hypovolemic shock
What would the first step of treatment be in a patient with hypotension
applying supplemental oxygen to oxygenate underperfused tissues as much as possible
What is the most common cause of postoperative agitation
hypoxemia
A patient is experiencing deep visceral pain what may this be a sign of
-Intestinal distention
-Internal bleeding
-Abscess formation
(since the internal viscera only responds to pressure and not from the actual cutting of the surgery)
What is the definition of hypothermia
when the patients core temperature drops below 35 C
What does a MILD elevation of temperature usually reflect within the first 48 hours after surgery
usually just indicates a stress response from surgery
Within the first 48 hours after surgery what does a MODERATE elevation in temperature usually indicate
most frequently this is caused by atelectasis or respiratory congestion
after the first 48 hours what does an elevation in temperature usually indicate
after the first 48 hours temperature increases usually indicate infection
If there are no other contraindication when my a surgical patient resume oral intake
as soon as the gag reflex returns
how long should it take after surgery for a patients normal urine output to return
2-3 days
how much redness in cm in the periwound area would be a concerning finding
redness for more than 2cm around the periwound area is abnormal any less than this is a normal finding after surgery
What finding may indicate that a wound is about to dehiscence
sudden increase of discharge from the wound
What are the three ways that the body compensates after surgery
-SNS activation
-RAAS system activation
-Pancreas alterations (increased glucagon decreased insulin)
What receptors does the SNS stimulate
-Alpha 1
-Beta 1
-Beta 2
what does alpha 1 stimulation do
increases smooth muscle contraction and therfore increases BP
What does Beta 2 stimulation do
increases
-bronchodilation
-respiratory rate
What does angiotensin 2 do
-Causes vasoconstriction
-releases aldosterone (which causes sodium and water reuptake)
-releases ADH
What are the 6 criteria required for a patient to be ward ready
-Can regulate their own temperature
-Pain is under control
-can maintain their own airway
-Respiratory stability
-Nausea/vomiting under control
-Hemodynamically stable
In what order do you preform a post operative assessment
-Airway
-Breathing (WOB accessory muscle use etc)
-Circulation (Bleeding CWMS cap refill)
-Disability or dextrose or discomfort
-Environment/equipment
-Full set of vital signs
-Give comfort (pain meds warm blanket)
-Head to toe assessment
-inspect the posterior (pools of blood? coccyx wound?)
What types of surgeries are most likely to have a complication of thrombosis
Large orthopedic surgeries
what body structures do orthopedic surgeries include
-bones
-joints
-ligaments
-muscles
-tendons
-nerves
what is the maximum dose of tylenol in 24 hours
4 g
what type of antiemetic is dimenhydrinate
histamine blocker
what type of antiemetic is metoclopramide
Dopamine blocker
What type of antiemetic is ondansetron
Serotonin blocker
between neuro abdominal and orthopedic surgeries order them from which has the most to least amount of blood loss
-Abdo surgeries tend to have the most
-orthopedic surgeries have moderate amount
-neuro surgeries have very little
What are the main reasons that someone’s temperature could be elevated after surgery
The 5 W’s
-atelectasis: Wind (or lack of)
-UTI: Water
-DVT: walking
-Post op infection: Wound
-Adverse reaction to drugs: Wonder drugs
When is an increased WBC count concerning
when the patient is presenting with other signs and symptoms of infection (some people can just develop high WBC counts and doesn’t mean they have an infection)
What are the most common reasons for neurological changes in a patient
AEIOUTIPS
-A:Alcohol
-E:Epilepsy
-I:Insulin
-O:Overdose
-U:Underdose
-T:Trauma or traumatic experience
-I:Infection
-P:Psychosis
-S:Stroke or schock
