Surgical Assessment- EXAM 2 Flashcards
3 stages of preoperative care
Preoperative
Intraoperative
Postoperative
Post anesthesia care unit
Receives general anesthesia patients after surgery
Intensive care unit
Receives patients who are critical after surgery
airway patency is the priority!!!
EKG monitor, vitals, pulse ox and pain meds are done
Postop assessment
Patient airway, airway hygiene, O2, SAT, ventalation
Seeing ability to move limbs and regain sensation from anesthesia
Watch cardio status
Ensure safety, bed rails, bed alarm
Fluid status
What do you assess and report immediately, Post-op
Decreased level of consciousness or unresponsivness
Respiratory rate less than 10 breaths per minute
O2 stat below 92%
Tachycardia or bradycardia
Hyper or Hypo tension
Weak/absent pulse
Urine output < 30 ml per hour
Excessive bleeding at incision site
Post-Op Medication types
Antimetic and pain meds
Antimetic meds
Used in post-op to decrease nausea and vomitting
Zafron
Reglan
Decadron
Pain meds
To relieve pain, lower b/p and pulse
Dilaudid
Morphine
Fentanyl
What to do in an unstable patient, airway
Remain intubated, transferred to ICU and placed on ventilator
What to do to a stable patient, airway
Extubated before transferred to post op care
Placed in sitting positioning sternum rub may be required
What do you use to reverse respiratory depression caused by narcotics
Narcan
JP and Hemovac drain
Work by suction
Placed during surgical prod=cedure to collect fluids from inside the surgical area
Penrose drain
Placed inside the suture
Suture types and when used
Staples: faster, skin heals better but is more expensive
Sutures: absorbable/non, using depends on tissue being sutured
Steri strips: used on not so deep indications
How do you prevent postoperative complications
Incentive spirometer
TED stockings
Coughing and deep breathing
Wound care
Managing constipation
Managing pain
Infection prevention
Compression socks
Prevent DVT with ambition
Need to be properly fitted
Incentive spirometer
Used to prevent complications of pneumonia or atelectasis
Induces long slow deep breathing
Promotes lung expansion
Safety considerations done before surgery is conducted
Check right person, right site and right procedure
Make sure patient is awake and aware
Patient has to be able to acknowledge and sign documents
Doctor will initial area needing surgery
Malignant hyperthermia
Temperature goes above 100F
Rare and life threatening, caused by inherited gene
Can occur during anesthesia, during recovery shortly after surgery
S&S: muscle rigidity, JAW TIGHTENING will be first symptom, increasing calcium in the blood, high fever, fast heart rate, shallow breathing problems with low oxygen
Immediate treatment to malignant hyperthermia
Dantrolene, stops the release of calcium in the muscle
Malignant hypothermia
Temperature goes below 95F, results from defect in the storage of calcium
Occurs during surgery
More common in patients at extreme ages, undergoing abdominal surgery or procedures of a long duration
Treatment of malignant hypothermia
With forced air warming device
Heating blankets too can restore body temp
Patient teachings during discharge
Take medication as ordered
Avoid alcohol while taking meds
Change dressing as ordered to prevent infection
Report any increase in redness, swelling, pain or discharge from the incision or draining site
Increase activity as ordered
Get adequate sleep, nutrition and hydration
Follow up with post-op doctor appointment
Preop teachings done to avoid post op complications
Cough and deep breathing: splinting
Caring for surgical incision
Pain managment
Managment of constipation
Advance diet as directed
Increase activity according to orders
FOLLOW UP with post op appt.
What do you establish in care of infants
Full or pre term
Pre-terms are more prone to respiratory complications
Special care to reparatory status, glucose regulation, fluid and electrolytes balance
