TOPIC 2 - post op

Question 1

what is the purpose of the PACU recovery room

Answer 1

ongoing evaluation and stabilization of patients to anticipate, prevent, and manage complications after surgery

Question 2

what are patients at risk for in the postoperative period

Answer 2

pneumonia, shock, cardiac arrest, respiratory arrest, DVT, and bleeding or clotting

Question 3

assessment data in the PACU includes

Answer 3

LOC, temp, pulse, RR, O2 sat, BP, evaluation of surgical area

VS and heart sounds are assessed on admission and every 15 minutes until stable

observations and interventions are critical for safety and quality

Question 4

what kind of handoffs do PACU nurses give and recieve

Answer 4

verbal handoff

Question 5

after report, PACU nurses…

Answer 5

review the medical record for history, pre-surgical symptom conditions, and emotional status

Question 6

skills of PACU nurses

Answer 6

care of patients with multiple medical and surgical problems

in depth knowledge of A&P, anesthesia, pharmacology, pain management, surgical procedures, and cardiac life support

are able to make quick decisions while working closely with anesthesiologist and surgeon

Question 7

respiratory system assessment

Answer 7

patent airway, adequate gas exchange, note any artificial airways, rate/pattern/depth of breathing, breath sounds, accessory muscle use, snoring and stridor, respiratory depression or hypoxemia, complications such as atelectasis/pneumonia/pulmonary embolism

begin by checking airway and breathing effectiveness, monitor O2 sat every hour, keep suction/O2/artificial breathing equipment near PACU

Question 8

cardiovascular assessment

Answer 8

vital signs, heart sounds, cardiac monitoring, peripheral vascular assessment (because anesthesia and positioning during surgery may impair peripheral circulation and contribute to clotting and venous thromboembolism), monitor complications such as hypovolemic shock and venous thromboembolism

Question 9

neurologic system assessment

Answer 9

observe for lethargy, restlessness, or irritability and test coherence and orientation

motor and sensory function is assessed for all patients who receive general or regional anesthesia

monitor cerebral functioning, LOC, and level of cognition

Question 10

fluid, electrolyte, and acid-base balance assessment

Answer 10

I/O, hydration status, IV fluids, vomitus, urine, wound drainage, NG tube drainage, acid-base balance

Question 11

how and when do patients lose fluid during and after surgery

Answer 11

fasting before and during surgery with the loss of fluid and blood during the procedure affect the patients fluid and electrolyte balance

acid-base balance is affected by the patients respiratory status before and during surgery, metabolic changes during surgery, and losses of acids or based in drainage

Question 12

renal/urinary system assessment

Answer 12

check for urine retention, consider other sources of output (sweat, vomit, diarrhea), report urine output of 30 mL/hr

Question 13

when does urine control resume after surgery

Answer 13

may be immediate or may take hours

Question 14

what is a BAIR hugger used for

Answer 14

to restore heat when patients are hypothermic after surgery

prevention is important

Question 15

what does shivering increase the risk of?

Answer 15

shivering increases oxygen demand and can induce hypoxemia
highest incidence of hypoxemia after surgery occurs on the second post-op day

Question 16

gastrointestinal system assessment

Answer 16

post-op nausea and vomiting is common, peristalsis may be delayed up to 24 hours, monitor for bowel sounds, monitor for complications such as paralytic ileus and gastric dilation

Question 17

meds used to reduce nausea and vomiting after surgery

Answer 17

ondansetron, meclizine, scopolamine patch

Question 18

purpose of NG tubes during surgery

Answer 18

decompress and drain the stomach, promote GI rest, allow lower GI tract to heal, provide enteral feeding route, monitor gastric bleeding, prevent intestinal obstruction

Question 19

how often and when should NG tube drainage be assessed

Answer 19

look for amount and color changes every 8 hrs

Question 20

skin assessment

Answer 20

normal would healing - assess tissue integrity frequently
a clean surgical wound heals in about 2 weeks in the absence of trauma, connective tissue disease, malnutrition, infection, or the use of certain drugs such as steroids
complete healing may take up to 6 months to 2 years

Question 21

abnormal wound healing and risk factors

Answer 21

risk factors- smokers, older adults, obese patients, diabetic patients, and those with reduced immunity

impaired would healing (dehiscence, evisceration, infection) will show between 5 and 10 days after surgery

Question 22

interventions for dehiscence or evisceration

Answer 22

have the patient lie supine with knees bent to reduce intra-abdominal pressure and apply sterile, non-adherent, or saline dressing

Question 23

what do drains help prevent

Answer 23

deep infection and abscess formation

Question 24

who performs the first dressing change

Answer 24

the surgeon to assess the wound, remove packing, and advance or remove drains

Question 25

types of surgical drains

Answer 25

gravity drains - penrose (drain directly through a tube from the surgical area)
jackson pratt drains are in closed wound drainage system by a collecting vessel by means of compression and re-expansion

Question 26

what is used when frequent dressing changes are anticipated

Answer 26

montgomery straps (prevent skin irritation from frequent removal)

Question 27

discomfort and pain assessment

Answer 27

pain and discomfort are expected after surgery

pain after surgery is related to the surgical wound, tissue manipulation, drains, positioning, and presence of an endotrachel tube

Question 28

physical and emotional signs of acute pain

Answer 28

increased pulse and BP, increased RR, profuse sweating, restless, confusion, wincing, moaning, crying

Question 29

pain interventions

Answer 29

drug therapy
CAMS-positioning, massage, relaxation/diversion techniques

Question 30

lab assessment

Answer 30

analysis of electrolyte, CBC, specimens for C&S, ABGs, urine and renal lab tests, procedure specific labs (glucose for diabetics and serum amylase for pancreatic surgery)

Question 31

highest incidence for hypoxemia

Answer 31

day 2 after surgery

Question 32

interventions for hypoxemia

Answer 32

airway maintenance, monitor O2 sat, semi-fowlers position, oxygen therapy, breathing exercises, mobilization ASAP

Question 33

assessment of wound infection and delayed healing

Answer 33

assess dressing and drains
provide exit route for air, blood, and bile to help prevent deep infections and abscess formation

Question 34

interventions for wound healing

Answer 34

drug therapy, irrigation to treat infection, debridement, surgical management is needed for wound opening

Question 35

teaching plan for client and family after surgery includes

Answer 35

prevention of infection,
care and assessment of the surgical wound,
management of drains or catheters,
diet therapy,
pain management,
drug therapy,
and progressive increase in activity schedule.

Instruct the patient and family about the clinical manifestations of complications and when to seek assistance.

Question 36

interventions for proper recovery after surgery

Answer 36

Encourage early ambulation when appropriate, but stress the need for following the activity restrictions prescribed by the surgeon.
Allow the patient to verbalize feelings about any change in physical appearance or lifestyle as a result of surgery.
Teach the patient about any drugs to be continued after discharge from the facility.
Reassure patients that taking pain medication when needed, even opioids, does not make them drug abusers.

Question 37

assess the home environment for

Answer 37

safety, cleanliness, and availability of caregivers to determine the patients needs

Question 38

after bowel surgery, what indicator is the best assessment of intestinal activity

Answer 38

passage of feces or stool

Question 39

what is the priority assessment when a patient is admitted to PACU

Answer 39

airway and gas exchange

Question 40

interventions related to positioning to decrease pain in post-op patients

Answer 40

reposition at least every 2 hours