Week 2: Week 2: Postoperative Care

Question 1

What are the postanesthesia phases a patient must make it through before being discharged?

Answer 1

Phase 1: care during the immediate postanesthesia period where the goal is to prepare the patient for safe transfer to phase 2 or inpatient

Phase 2: surgery patient is ambulatory and the goal is to prepare the patient for transfer to extended care environment or home with discharge teaching

Extended observation: ongoing care for patients who will be admitted to the unit and those who require observation or interventions with the goal to prepare the patient for self care

Question 2

What are the priority care pieces for a patient in the PACU?

Answer 2

monitoring/management of respiratory/cardiac functions, pain, temperature, surgical site, sedation score

Question 3

What is the goal of the PACU

Answer 3

to identify actual and potential patient complications that may arise as a result of anesthesia and surgical interventions

Question 4

Initial airway PACU assessment

Answer 4

latency
oral or nasal airway
laryngeal mask airway
endotracheal tube with ventilator settings

Question 5

Initial breathing PACU assessment

Answer 5

respiratory rate and quality
auscultated breath sounds
technology monitoring if needed
supplemental O2

Question 6

Initial Circulation PACU assessment

Answer 6

ECG monitoring (rate and rhythm)
BP
hemodynamic pressure readings if applicable
temperature
cap refill
color, temperature moisture of skin
apical and peripheral pulses

Question 7

Initial Neurological PACU assessment

Answer 7

LOC
orientation
sensory and motor status
pupil size and reaction

Question 8

What is the first sense to return after losing consciousness?

Answer 8

Hearing

Question 9

Surgical Site initial PACU assessment

Answer 9

dressings and visible incisions
drains (type patency, and drainage)
IV assessment (location, condition, solutions)

Question 10

Urinary system initial PACU assessment

Answer 10

intake, output
fluid balance

Question 11

GI initial PACU assessment

Answer 11

N/V
intake
output
bowel sounds

Question 12

Patient specific needs PACU assessment

Answer 12

return hearing aids, glasses etc.
patient positioning
fall risk assessment
pain

Question 13

What are common PACU postoperative conditions?

Answer 13

airway compromise
respiratory insufficiency
cardiac compromise
neurological compromise
hypothermia
pain
nausea/vomiting

Question 14

What are the most common airway complications in the PACU?

Answer 14

airway compromise (obstruction, hypoxemia, hypoventilation)

the tongue is the most common obstructive agent

Question 15

What patients are at risk for respiratory complications in the PACU?

Answer 15

general anesthesia
older age
smoking history
lung disease
obesity
airway/thoracic/abdominal surgery

Question 16

What to assess in the PACU with respiratory complications

Answer 16

airway patency
chest symmetry
depth
rate
characteristic of respirations
accessory muscles
breath sounds
sputum characteristics

Question 17

What are common clinical alterations regarding the respiratory system?

Answer 17

Atelectstasis
Pneumonia

Question 18

Nursing interventions in the PACU for respiratory

Answer 18

proper patient positioning in the lateral recovery position (keeps airway open and reduces risk of vomiting aspiration) once conscious HOB raised to maximize thoracic expansion

Question 19

What are the nursing interventions in the clinical unit for respiratory system?

Answer 19

deep breathing to facilitate gas exchange
Incentive spirometer
coughing to move secretions (reduces risk of aveolar collapse)
Positional changes to allow full chest expansion and increase perfusion of both lungs

Question 20

Post op assessment ABCD

Answer 20

Airway
Breathing
Circulation
Disability/dextrose (LOC)

Question 21

Post op Assessment EFGHI

Answer 21

Environment/expose
Full set of VS (including near)
Give comfort
Head to toe
inspect the posterior (PI? Pooling blood?)

Question 22

What complications can a reduced diet lead to?

Answer 22

malnutrition
impaired wound healing
electrolyte imbalance
cardiac changes
dehydration
neurological changes

Question 23

What complications can occur from the use of anesthetic or sedative medications?

Answer 23

thromboembolism
respiratory complications
reduced mobility (skin breakdown, PE, loss of muscle mass)

Question 24

What ways can we treat pain?

Answer 24

assess patient throughout day for pain
give fast acting analgesic before activities
give PRN analgesics Q3-6 hrs
use effective combination of analgesics

Question 25

What is fast tracking?

Answer 25

admitting ambulatory patients who have received general, regional or local anesthesia directly to phase 2 care

Question 26

What are CNS signs of inadequate oxygen?

Answer 26

Restlessness
agitation
muscle twitching
seizures
coma

Question 27

What are cardiovascular manifestations of inadequate oxygen?

Answer 27

Hypertension
Hypotension
Tachycardia
Bradycardia
Dysrhythmias

Question 28

What are the integumentary manifestations of inadequate oxygen?

Answer 28

cyanosis
prolonged capillary refill
flushed and moist skin

Question 29

What are the respiratory manifestations of inaequate oxygen?

Answer 29

alterations ranging from decreased to absent respiratory effort
accessory muscles
abnormal breath sounds
abnormal arterial blood gases

Question 30

What are renal manifestations of inadequate oxygen?

Answer 30

urinary output of 30mL/hr

Question 31

What are the main complications seen in the PACU regarding the cardiovascular functioning?

Answer 31

Hypotension
Hypertension
Dysrhythmias

Question 32

What are the clinical manifestations of hypotension?

Answer 32

disorientation
Loss of consciousness
chest pain
olguria
anuria

Question 33

What is the common reason hypotension occurs in the PACU?

Answer 33

unreplaced intraoperative fluid and blood loss or post surgical internal hemorrhage

Question 34

What is the common reason for HTN in the PACU?

Answer 34

most commonly caused from SNS stimulation resulting from pain, anxiety, bladder distension, or respiratory compromise

Question 35

What is the common cause of dysrhythmias in the PACU?

Answer 35

often the result of an identifiable cause other than myocardial injury (hypokalemia, hypoxemia, hypercarbia etc)

Question 36

What is the commonly seen cardiovascular alteration seen on the clinical unit?

Answer 36

postoperative fluid and electrolyte imbalances contributing to the alteration in cardio function

Question 37

Why do fluid and electrolyte imbalances occur postoperatively?

Answer 37

consists of the bodys normal stress response to surgery, excessive fluid losses and improper IV fluid replacement

Question 38

What nursing assessment needs to be done for cardiovascular alterations?

Answer 38

every 15 minutes VS

Question 39

The anesthesiologist or surgeon should be notified if any of these VS alterations occur (6 things)

Answer 39

1. Systolic BP less than 90 or greater than 160
2. Pulse rate less than 60 beats
3. pulse pressure narrows
4. Bp gradually decreases during several consecutive readings
5. Irregular cardiac rhythm develops
6. significant variation from preoperative readings

Question 40

What is the max dose of acetaminophen?

Answer 40

4000 mg/day
650 Q4
1000 Q6
650-1300 Q8

Question 41

What are NSAIDs for

Answer 41

mild-moderate pain

Question 42

Why is postoperative N/V a risk?

Answer 42

unpleasant
prevents mobilization
risk of aspiration
dehiscence