TOPIC 2 - post op Flashcards
what is the purpose of the PACU recovery room
ongoing evaluation and stabilization of patients to anticipate, prevent, and manage complications after surgery
what are patients at risk for in the postoperative period
pneumonia, shock, cardiac arrest, respiratory arrest, DVT, and bleeding or clotting
assessment data in the PACU includes
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
what kind of handoffs do PACU nurses give and recieve
verbal handoff
after report, PACU nurses…
review the medical record for history, pre-surgical symptom conditions, and emotional status
skills of PACU nurses
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
respiratory system assessment
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
cardiovascular assessment
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
neurologic system assessment
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
fluid, electrolyte, and acid-base balance assessment
I/O, hydration status, IV fluids, vomitus, urine, wound drainage, NG tube drainage, acid-base balance
how and when do patients lose fluid during and after surgery
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
renal/urinary system assessment
check for urine retention, consider other sources of output (sweat, vomit, diarrhea), report urine output of 30 mL/hr
when does urine control resume after surgery
may be immediate or may take hours
what is a BAIR hugger used for
to restore heat when patients are hypothermic after surgery
prevention is important
what does shivering increase the risk of?
shivering increases oxygen demand and can induce hypoxemia
highest incidence of hypoxemia after surgery occurs on the second post-op day
gastrointestinal system assessment
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
meds used to reduce nausea and vomiting after surgery
ondansetron, meclizine, scopolamine patch
purpose of NG tubes during surgery
decompress and drain the stomach, promote GI rest, allow lower GI tract to heal, provide enteral feeding route, monitor gastric bleeding, prevent intestinal obstruction
how often and when should NG tube drainage be assessed
look for amount and color changes every 8 hrs
skin assessment
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
abnormal wound healing and risk factors
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
interventions for dehiscence or evisceration
have the patient lie supine with knees bent to reduce intra-abdominal pressure and apply sterile, non-adherent, or saline dressing
what do drains help prevent
deep infection and abscess formation
who performs the first dressing change
the surgeon to assess the wound, remove packing, and advance or remove drains
types of surgical drains
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
what is used when frequent dressing changes are anticipated
montgomery straps (prevent skin irritation from frequent removal)
discomfort and pain assessment
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
physical and emotional signs of acute pain
increased pulse and BP, increased RR, profuse sweating, restless, confusion, wincing, moaning, crying
pain interventions
drug therapy
CAMS-positioning, massage, relaxation/diversion techniques
lab assessment
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)
highest incidence for hypoxemia
day 2 after surgery
interventions for hypoxemia
airway maintenance, monitor O2 sat, semi-fowlers position, oxygen therapy, breathing exercises, mobilization ASAP
assessment of wound infection and delayed healing
assess dressing and drains
provide exit route for air, blood, and bile to help prevent deep infections and abscess formation
interventions for wound healing
drug therapy, irrigation to treat infection, debridement, surgical management is needed for wound opening
teaching plan for client and family after surgery includes
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.
interventions for proper recovery after surgery
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.
assess the home environment for
safety, cleanliness, and availability of caregivers to determine the patients needs
after bowel surgery, what indicator is the best assessment of intestinal activity
passage of feces or stool
what is the priority assessment when a patient is admitted to PACU
airway and gas exchange
interventions related to positioning to decrease pain in post-op patients
reposition at least every 2 hours
