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NURS 3512 acute & chronic > Week 12 post-op > Flashcards

Week 12 post-op Flashcards

1
Q

When can someone leave the PACU/recovery room?

A

When they are awake and stable

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2
Q

When can someone be discharged from PACU to surgical unit?

A
  • Awake
  • VS stable
  • no excessive bleeding/drainage
  • resp status, O2 status >90%
  • report given
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3
Q

When can someone be discharged from Day surgery?

A
  1. PACU d/c criteria met
  2. no opioids for 30 min
  3. minimal N&V
  4. Voided
  5. ambulate to baseline
  6. responsible adult with Pt
  7. written d/c instructions read & understood
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4
Q

What does the post-op handoff report from OR/recovery to clinical unit include?

A
  • Patient’s Name/ Age/Surgeon/Procedure
    ▫ Reason for Surgery/comorbidities/Past history/Allergies
    ▫ Type of Anesthetic /Blood loss and fld replacement totals
    ▫ Any complications in OR or in PACU
    ▫ Most recent report of LOC/Vital Signs/02 sats
    ▫ IV Fluid, blood given in OR
    ▫ Urine output
    ▫ Surgical site/drsg
    ▫ Lines/tubes /drains and amount drained
    ▫ Lab results if taken
    ▫ Pain and Nausea control and what was given for it
    ▫ Family present and where they are
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5
Q

What things should we have ready for incoming patient?

A
  • Check ward routine
  • IV pole, IV pump, kidney
    basin, mouth swabs
  • VS record, pen,
    stethoscope
  • Post-op bed
  • Pillows, blanket
  • Suction/Oxygen – hook it
    up, check it…
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6
Q

What is the PRIORITY focused assessment post-op?

A

Airwary & LOC

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7
Q

What is the rule of 4 for vitals?

A

Q15 min for 1 hr
Q30 min for 2 hours
Q60 min for 4 hours

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8
Q

When do we start encouraging DB& coughing & leg excercises with patient?

A

As soon as they are awake

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9
Q

What are the 6 post-op checks we must do?

A
  1. Airway/LOC
  2. Vitals
  3. Fluid - IV (check everything)
  4. Surgical site and tubes
  5. Pain assess/comfort level
  6. DB &C - Leg exercises
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10
Q

What are the 18 anticiapated post-op problems?

A

Respiratory
1. Obstruction from tongue
2. Atelectasis/Pneumonia
3. Pulmonary Edema
4. Hypoventilation

Cardiovascular
5. Hypotention
6. Hypertention
7. Dysrythmias
8. DVT

CNS
9. Cerebral functioning
10. Motor & sensory function after spinal/epidural anethesia

Urinary (GU)
11. Low urine output/dehydration
12. Urinary retention

GI
13. N&V
14. Constipation/Post-op Ilieus/Paralytic ileus

Temp
15. Decreased temp (hypothermia)
16. Increased Temp (Hyperthermia)

Pain
17. Pharmacological
18. non-pharmacological

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11
Q

How do we position someone if they are still sedated post-surgery?

A

Side lying

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12
Q

What must we give patients before we do any kind of ambulating/exercise post op?

A

analgesia

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13
Q

what are some ways the patient can avoid atelectasis/ PN?

A

DB&C- hold pillow to help
ambulate, position changes
adequate fluids
spirometry
supplimental O2 (not too much)

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14
Q

What do we give someone who is fluid overloaded (pulmonary edema)?

A

diuretics
supplimental O2

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15
Q

What 4 things do we do if someone is in hypoventilation?

A
  1. wake the patient
  2. DB&C
  3. supplimental O2
  4. Incentive spirometry
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16
Q

What do we do if someone has hypotension post op?

A

1.monitor VS and organs for perfusion
2. check urine output >30ml/hr
3. Give fluids
4. maybe vasoconstrictive agents

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17
Q

Why do we not give vasoconstrictors before fluids?

A

“Fill the tank, then squeeze the pipes.”

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18
Q

What do we do if someone has hypertension post op?

A
  1. decrease anxiety/pain
  2. give antihypertensive
  3. diruetic
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19
Q

What do we do to prevent dysrhythmias post op?

A
  1. monitor for them
  2. replace electrolytes IV (b/c fluids given intraop can throw off electrolyte balance)
20
Q

What do we do to prevent DVT post -op?

A
  1. heparin or LMW heparin
  2. leg exercises
  3. TEDs and Sequential devices
  4. ambulate
  5. flex and extend joints 10-12x every hour while awake
21
Q

Post op, what BP numbers are we concerned about?

A

<90 or >160
25% change from baseline

22
Q

What pulse are we concerned about post-op?

A

<60 or >120 bpm

23
Q

What resp count are we worried about post op?

A

<12

24
Q

What temp are we concerned about post-op?

A

> 38 after 48 hrs
<36

25
Q

What does hyperthermia that lasts over 48 possibly indicate?

A

infection

26
Q

When should we notify the anesthetist?

A

When someone is slow to wake up

27
Q

if someone has a spinal or epidural, what do we want to monitor for?

A
  1. baseline
  2. signs of stroke
  3. respiratory depression
  4. hypotention
  5. epidural hematoma
  6. infection (meningitis)
  7. Postdural puncture headache
28
Q

what machine do we use to monitor problematic GU system post-op?

A

bladder scan after a few hours
- should void after 6-8 hours

29
Q

When do we decrease IV rate post op?

A

When oral intake increases

30
Q

If there are no bowel sounds post-op after some time, what intervention do we do?

A

NG - decompress

31
Q

When actively warming someone who has decreased temp, how often should we take their temp?

A

Q15-30 min

32
Q

What is the nurse’s role post op with pain control?

A

titrate drug to allow optimal pain management with fewest adverse effects
- monitor for adverse effects (resp. depression, hypotension, constipation)
- NSAIDS

33
Q

What are some non-pharmacological options to help patient with pain?

A

TV
back massage
distraction (talk)

34
Q

What are the important elements of discharge teaching?

A

Wound/dressing/drains
hygiene
meds
activity/restrictions
diet/nutrition
follow up apt
what to do if emergency

35
Q

What two types of shock can happen with surgery?

A
  1. anaphylactic shock
  2. hypovolemic shock
36
Q

What mediator is immediately released in anaphylactic shock?

A

histimine

37
Q

What are the Early signs of anaphylactic shock?

A

-Anxiety sense of impending doom
-Swelling of lips, tongue larynx
-Difficulty swallowing, breathing
-Skin flushed, urticaria hives
-HR will increase
-BP will decrease

38
Q

What are Late signs of anaphylactic shock? (not likely to survive)

A

-Cold clammy, mottled
-Bradycardia and decreased BP
-Increased serum lactate “acidotic”
-Anuria,
- ischemic gut,
- DIC – disseminated intervascular coagulation (bleeding + clotting)

39
Q

what is the first line treatment of anaphylactic shock and what are other options?

A

*Epinepherine
- Benadryl, Bronchodilators
-Corticosteroids
-Fluid replacement – in order
-2 large bore IVs
-Isotonic Crystalloids (0.9% NS)
-Colloids (Albumin)
-Blood

40
Q

What do we use to monitor someone’s cardiac function with anaphylactic shock?

A

telemetry

41
Q

Do we insert a foley catherter during anaphylactic shock?

A

Yes, it can be indicated

42
Q

Hypovolemic shock is caused by what 3 reasons?

A
  1. blood loss
  2. vomiting/diarrhea
  3. fluid shifts
43
Q

What are the 3 early signs of hypovolemic shock?

A

-Agitation/restless
-HR rate will increase BP will decrease
-Decrease UO

44
Q

What are the late signs of hypovolemic shock?

A

-cold Clammy, Mottled
-Bradycardia and decreased BP – trend downward
-Increased Lactate
-Anuria,
- Ischemic gut,
- DIC

45
Q

what stage of shock do hypovolemic and anaphylactic shock have the same symptoms?

A

late stage

46
Q

What are the 3 things we give for anaphylacic shock that we don’t do for hypovolemic shock?

A

*Epinepherine
- Benadryl, Bronchodilators
- Corticosteroids

47
Q

What is the first line of treatment for hypovolemic shock?

A

*Airway-Give Oxygen
Fluid replacement
-2 large bore IVs
- Isotonic Crystalloids (0.9% NS)
-Colloids (Albumin)
-Blood

NURS 3512 acute & chronic (29 decks)

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