Week 12 post-op Flashcards
When can someone leave the PACU/recovery room?
When they are awake and stable
When can someone be discharged from PACU to surgical unit?
- Awake
- VS stable
- no excessive bleeding/drainage
- resp status, O2 status >90%
- report given
When can someone be discharged from Day surgery?
- PACU d/c criteria met
- no opioids for 30 min
- minimal N&V
- Voided
- ambulate to baseline
- responsible adult with Pt
- written d/c instructions read & understood
What does the post-op handoff report from OR/recovery to clinical unit include?
- 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
What things should we have ready for incoming patient?
- 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…
What is the PRIORITY focused assessment post-op?
Airwary & LOC
What is the rule of 4 for vitals?
Q15 min for 1 hr
Q30 min for 2 hours
Q60 min for 4 hours
When do we start encouraging DB& coughing & leg excercises with patient?
As soon as they are awake
What are the 6 post-op checks we must do?
- Airway/LOC
- Vitals
- Fluid - IV (check everything)
- Surgical site and tubes
- Pain assess/comfort level
- DB &C - Leg exercises
What are the 18 anticiapated post-op problems?
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
How do we position someone if they are still sedated post-surgery?
Side lying
What must we give patients before we do any kind of ambulating/exercise post op?
analgesia
what are some ways the patient can avoid atelectasis/ PN?
DB&C- hold pillow to help
ambulate, position changes
adequate fluids
spirometry
supplimental O2 (not too much)
What do we give someone who is fluid overloaded (pulmonary edema)?
diuretics
supplimental O2
What 4 things do we do if someone is in hypoventilation?
- wake the patient
- DB&C
- supplimental O2
- Incentive spirometry
What do we do if someone has hypotension post op?
1.monitor VS and organs for perfusion
2. check urine output >30ml/hr
3. Give fluids
4. maybe vasoconstrictive agents
Why do we not give vasoconstrictors before fluids?
“Fill the tank, then squeeze the pipes.”
What do we do if someone has hypertension post op?
- decrease anxiety/pain
- give antihypertensive
- diruetic
What do we do to prevent dysrhythmias post op?
- monitor for them
- replace electrolytes IV (b/c fluids given intraop can throw off electrolyte balance)
What do we do to prevent DVT post -op?
- heparin or LMW heparin
- leg exercises
- TEDs and Sequential devices
- ambulate
- flex and extend joints 10-12x every hour while awake
Post op, what BP numbers are we concerned about?
<90 or >160
25% change from baseline
What pulse are we concerned about post-op?
<60 or >120 bpm
What resp count are we worried about post op?
<12
What temp are we concerned about post-op?
> 38 after 48 hrs
<36
What does hyperthermia that lasts over 48 possibly indicate?
infection
When should we notify the anesthetist?
When someone is slow to wake up
if someone has a spinal or epidural, what do we want to monitor for?
- baseline
- signs of stroke
- respiratory depression
- hypotention
- epidural hematoma
- infection (meningitis)
- Postdural puncture headache
what machine do we use to monitor problematic GU system post-op?
bladder scan after a few hours
- should void after 6-8 hours
When do we decrease IV rate post op?
When oral intake increases
If there are no bowel sounds post-op after some time, what intervention do we do?
NG - decompress
When actively warming someone who has decreased temp, how often should we take their temp?
Q15-30 min
What is the nurse’s role post op with pain control?
titrate drug to allow optimal pain management with fewest adverse effects
- monitor for adverse effects (resp. depression, hypotension, constipation)
- NSAIDS
What are some non-pharmacological options to help patient with pain?
TV
back massage
distraction (talk)
What are the important elements of discharge teaching?
Wound/dressing/drains
hygiene
meds
activity/restrictions
diet/nutrition
follow up apt
what to do if emergency
What two types of shock can happen with surgery?
- anaphylactic shock
- hypovolemic shock
What mediator is immediately released in anaphylactic shock?
histimine
What are the Early signs of anaphylactic shock?
-Anxiety sense of impending doom
-Swelling of lips, tongue larynx
-Difficulty swallowing, breathing
-Skin flushed, urticaria hives
-HR will increase
-BP will decrease
What are Late signs of anaphylactic shock? (not likely to survive)
-Cold clammy, mottled
-Bradycardia and decreased BP
-Increased serum lactate “acidotic”
-Anuria,
- ischemic gut,
- DIC – disseminated intervascular coagulation (bleeding + clotting)
what is the first line treatment of anaphylactic shock and what are other options?
*Epinepherine
- Benadryl, Bronchodilators
-Corticosteroids
-Fluid replacement – in order
-2 large bore IVs
-Isotonic Crystalloids (0.9% NS)
-Colloids (Albumin)
-Blood
What do we use to monitor someone’s cardiac function with anaphylactic shock?
telemetry
Do we insert a foley catherter during anaphylactic shock?
Yes, it can be indicated
Hypovolemic shock is caused by what 3 reasons?
- blood loss
- vomiting/diarrhea
- fluid shifts
What are the 3 early signs of hypovolemic shock?
-Agitation/restless
-HR rate will increase BP will decrease
-Decrease UO
What are the late signs of hypovolemic shock?
-cold Clammy, Mottled
-Bradycardia and decreased BP – trend downward
-Increased Lactate
-Anuria,
- Ischemic gut,
- DIC
what stage of shock do hypovolemic and anaphylactic shock have the same symptoms?
late stage
What are the 3 things we give for anaphylacic shock that we don’t do for hypovolemic shock?
*Epinepherine
- Benadryl, Bronchodilators
- Corticosteroids
What is the first line of treatment for hypovolemic shock?
*Airway-Give Oxygen
Fluid replacement
-2 large bore IVs
- Isotonic Crystalloids (0.9% NS)
-Colloids (Albumin)
-Blood
