Unit 1: Perioperative Care Flashcards
What information from a patient’s health history could be risk factors for complications?
Smoking, alcohol, heart disease, respiratory disease, kidney disease, age, malnutrition, obesity, and previous reactions to anesthsia (malignant HTN).
When does d/c planning begin?
Begins at admission, provider will write in progress notes expected date of discharge. Does the patient have family to help or should they go to rehab, home with homehealth.
What preop instructions are important to review with the patient before surgery?
NPO status, skin prep, what meds needed the morning of surgery
-Insulin, BP meds, did the pt stop taking NSAIDs weeks before surgery or stop anticoagulants.
Discuss consent.
MD explains procedure, nurse witness, 2 nurses witness, 2 nurses witness if blind, speaks another language, phone consnet, or cannot write and sign with an x.
What post op complications will we try to prevent?
Hemorrhage- assess VS, dressing for drainge, drains.
DVT- SCDs, TED hose, ambulation, enoxaprian injections, ROM exercises.
Fluid Volume Excess/ Deficit- Monitor I/Os, vs for changes reflecting fluid status, kidney functions.
Pneumonia- IS, TCDB q 2 hours, fluids, ambulation.
Constipation- fluids, fiber, ambulation.
Paralytic ileus- listen to BS, passing gas? look for increased distention, vomit, no BS. Put down NG tube, make NPO.
dehiscence/ evisceration – look for increased drainage, risk factor
– diabetic, obesity, steroids, malnutrition.
infection – proper dressing changes, assess for odor, purulent drainage, redness, swelling, pain, fever, increased WBC.
-impaired skin integrity: turn, reposition, assess bony prominences, nutrition
What preop drugs can be given?
PPI – reduce stomach acid.
Midazolam – for anxiety.
Morphine – pain.
Anticholinergics – dry up secretions.
Antibiotic – given 1 hour before surgery.
Don’t allow patient to get out of bed after these meds, safety to prevent falls.
List in order the assessments you would make as the PACU nurse.
-ABC
-Pain
-Surgical area
-I/Os, drains
-LOC
-GI
Your patient is 5 days post op. They are complaining of a lot of drainage from their incision site. What could be the problem? What do you do?
Dehiscence – cover and call MD
What considerations do we need to think about when an elderly patient is recovering from surgery?
More confusion, longer to recover from anesthesia – airway problems.
FYI INFORMATION:
When answering NCLEX questions about priorities, especially which patient to see first, think of this acronym:
S - stable / unstable
P - potential / real
E – expected / unexpected
C – chronic / acute