Week 2- Post op Flashcards
3 compensatory mechanisms post op
1) SNS (fight, flight, freeze)= heart, lungs, GI, pancreas, brain, kidney, liver
body releases epinephrine acting on alpha and beta receptors
2) RAAS= first blood will shunt away then go back
Renin-angiotensinogen-angiotensin1, angiotensin 2 (increase BP and afterload)
3) pancreas= increase f=glucagon, slow insulin production to give energy to run away
diabetic will be hyperglycemic normal body response
Alpha receptors
increase smooth muscle contraction= increases afterload and increase BP
beta1 and beta2 receptors
1- acts on heart, increase contractility, increase HR
2- increase RR, bronchodilate
PACU is
requires advanced training
give report to general surgical unit
when is pt ward ready
6
1- maintain airway (conscious enough)
2- respiratory stability (include Spo2), NP is kind of where we want them
3- hemodynamically stable (BP, rhythm/HR, Cwms)
4- temperature regulation
5- N/V (aspiration is the biggest risk)
6- Pain (comfortable
post op assessment order
Airway
Breathing
Circulation
Disability/Dextrose/Discomfort (LOC)
Environment/Expose
Full-set of VS (including neuro)
Give comfort
Head-to-toe
Inspect the posterior
airway assessment
talking,
snoring is a warning because pt might not be able to maintain airway= put in recovery)
breathing assessment
(chest wall movement, WOB, accessory muscles, can you hear sounds without stetoscope)
circulation assessment
CWMS, diaphoretic, bleeding)
disability/dextrose/discomfort assessment
LOC
assess pain quickly
env assessment
(is the patient safe and are you safe, Chest tube
inspect posterior for
bleeding
wounds
reduced diet before or after surgery
4
- Impaired Healing- leading to infection,
- anemia
- dehydration (electrolyte imbalances),
- constipation
Use of anesthetic/sedative/analgesic medications
7
can lead to
- Delirium or decrease LOC
- falls
- constipation
- ileus
- N/V
- urinary retention
- respiratory impairment
surgical incision complications
Infection, bleeding, dehiscence, evisceration, proper post op support (splinting, sternal precautions)
use of IV fluid complications
3
Fluid shifts
fluid overload (renal and cardiac patients more at risk)
electrolyte imbalances,
pain can lead to
Prevent full expansion (atelectasis), DVT from immobility, poor sleep, pain crisis (BP, HR increase, Spo2 decrease)
neuropsychological complications
delirium
fever
hypothermia
pain
postoperative cognitive dysfunction
Gi complications
delayed gastric emptying
distension and flatulence
hiccups
N/V
postoperative ileus
urinary complications
infection
retention
respiratory complications
post op
a
a
a
b
h
h
p
p
p
- airway obstruction
aspiration
atelectasis
bronchospasms
hypoventilation
hypoxemia
pneumonia
pulmonary edema
pulmonary embolus
cardiovascular complications
- dysrhythmias
hemorrhage
hypertension
hypotension
superficial thrombophlebitis
venous thromboembolism
integumentary (incision site) complications
dehiscence
hematoma
infection
fluid and electrolyte complications
- acid base disorders
electrolyte imbalances
fluid deficit
fluid overload
Pain can slow
recovery
pts unable to perform activities to promote recovery
complications with unmanaged pain
- not mobilizing
- state of stress and discomfort
- activate SNS and will impact healing shunt blood away from site
NSAID
Watch for
most common
bleeding
Kidneys
Ketorolac is most common 3 times up to 15 mg each time
Pt at high risk for bleeding and kidney damage probably shouldn’t give
Post-operative complications: Nausea/vomiting
Biggest problem is aspiration
Increases pressure in the body don’t want to do this after surgery
Histamine blockers:
Dopamine blockers:
Serotonin:
- Gravol (dimenhydrinate)
- Metoclopramide (maxceran)
- ondansetron (Zofran)
marijuana
ativan
can be used for n/v
increase hunger
can get nauseous when really stressed
surgery with most amount of blood loss
abdominal surgeries
treatment for blood loss
apply direct pressure
blood products
life threatening bleed
apply pressure
call for help
bigger bleed more pressure
5W
higher temperature
- wind- atelectasis
- water- UTI or urine
- Walking- DVT (warm, red swollen)
- wound- post op infection
- wonder drugs - (adverse reactions)
complications of atelectasis
pneumonia
high WBC count what to do next
look for other signs of infection, how do they feel, wound characteristics
high WBC could be an inflammatory response
electrolytes we want to watch
what they do
sodium - think brain first
potassium- (works with action potential affect contractility of the heart and muscles)= think heart first
magnesium (pulls K and ca in)
calcium contractility of the muscles
CBC post op
- Hgb (will decrease)
- Hct (decrease or stay the same) [ ] of RBC
- RBC (decrease)
will expect some blood loss
- if hgb low and hct high= dehydration
What surgeries at most risk of dehiscence
abdominal
what to do if you see dehiscence
Call for help
Cover with saline-soaked sterile gauze
post op neuro complications
delirium
causes of delirium
- withdrawl psychosis
- toxic psychosis
- circulatory and respiratory causes
- functionla psychosis
metabolic distrubances - pain
- viseceral distentions
- rule out hypoxemia (treat cause, consider sedation, mainatin patient safety)
- anxiety
- altered thermoregulation
- medications
- ## anaesthetic exposure
types of delirium
hypoactive (sleepy, can be A and Ox3, one of the first things is that guy is a little weird , use family as a resource)
hyperactive (super obvious)
post op neuro complications
Dizzy, lightheaded, fainting
postural changes
vagal
drugs, blood loss
something unrelated to surgery
cardiac issues
AEIOUTIPS
cause of altered mental status
A- alcohol
E- epilepsy (seizures)
I- Insulin (too much or too little),
O- overdose
U- underdose
T- trauma
I- infection
P- psychosis
S- stroke, shock
Causes of altered mental status
assessing preload in post op \
HYPERvolemia
HYPOvolemia
↑ volume
Treatment:
Cause
Severity
↓ volume
Treatment:
Cause
Severity
lab work for DVT
D dimer
Coags
CBC
Doppler US and or CT angio
