Week 2: Week 2: Postoperative Care Flashcards
What are the postanesthesia phases a patient must make it through before being discharged?
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
What are the priority care pieces for a patient in the PACU?
monitoring/management of respiratory/cardiac functions, pain, temperature, surgical site, sedation score
What is the goal of the PACU
to identify actual and potential patient complications that may arise as a result of anesthesia and surgical interventions
Initial airway PACU assessment
latency
oral or nasal airway
laryngeal mask airway
endotracheal tube with ventilator settings
Initial breathing PACU assessment
respiratory rate and quality
auscultated breath sounds
technology monitoring if needed
supplemental O2
Initial Circulation PACU assessment
ECG monitoring (rate and rhythm)
BP
hemodynamic pressure readings if applicable
temperature
cap refill
color, temperature moisture of skin
apical and peripheral pulses
Initial Neurological PACU assessment
LOC
orientation
sensory and motor status
pupil size and reaction
What is the first sense to return after losing consciousness?
Hearing
Surgical Site initial PACU assessment
dressings and visible incisions
drains (type patency, and drainage)
IV assessment (location, condition, solutions)
Urinary system initial PACU assessment
intake, output
fluid balance
GI initial PACU assessment
N/V
intake
output
bowel sounds
Patient specific needs PACU assessment
return hearing aids, glasses etc.
patient positioning
fall risk assessment
pain
What are common PACU postoperative conditions?
airway compromise
respiratory insufficiency
cardiac compromise
neurological compromise
hypothermia
pain
nausea/vomiting
What are the most common airway complications in the PACU?
airway compromise (obstruction, hypoxemia, hypoventilation)
the tongue is the most common obstructive agent
What patients are at risk for respiratory complications in the PACU?
general anesthesia
older age
smoking history
lung disease
obesity
airway/thoracic/abdominal surgery
What to assess in the PACU with respiratory complications
airway patency
chest symmetry
depth
rate
characteristic of respirations
accessory muscles
breath sounds
sputum characteristics
What are common clinical alterations regarding the respiratory system?
Atelectstasis
Pneumonia
Nursing interventions in the PACU for respiratory
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
What are the nursing interventions in the clinical unit for respiratory system?
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
Post op assessment ABCD
Airway
Breathing
Circulation
Disability/dextrose (LOC)
Post op Assessment EFGHI
Environment/expose
Full set of VS (including near)
Give comfort
Head to toe
inspect the posterior (PI? Pooling blood?)
What complications can a reduced diet lead to?
malnutrition
impaired wound healing
electrolyte imbalance
cardiac changes
dehydration
neurological changes
What complications can occur from the use of anesthetic or sedative medications?
thromboembolism
respiratory complications
reduced mobility (skin breakdown, PE, loss of muscle mass)
What ways can we treat pain?
assess patient throughout day for pain
give fast acting analgesic before activities
give PRN analgesics Q3-6 hrs
use effective combination of analgesics
What is fast tracking?
admitting ambulatory patients who have received general, regional or local anesthesia directly to phase 2 care
What are CNS signs of inadequate oxygen?
Restlessness
agitation
muscle twitching
seizures
coma
What are cardiovascular manifestations of inadequate oxygen?
Hypertension
Hypotension
Tachycardia
Bradycardia
Dysrhythmias
What are the integumentary manifestations of inadequate oxygen?
cyanosis
prolonged capillary refill
flushed and moist skin
What are the respiratory manifestations of inaequate oxygen?
alterations ranging from decreased to absent respiratory effort
accessory muscles
abnormal breath sounds
abnormal arterial blood gases
What are renal manifestations of inadequate oxygen?
urinary output of 30mL/hr
What are the main complications seen in the PACU regarding the cardiovascular functioning?
Hypotension
Hypertension
Dysrhythmias
What are the clinical manifestations of hypotension?
disorientation
Loss of consciousness
chest pain
olguria
anuria
What is the common reason hypotension occurs in the PACU?
unreplaced intraoperative fluid and blood loss or post surgical internal hemorrhage
What is the common reason for HTN in the PACU?
most commonly caused from SNS stimulation resulting from pain, anxiety, bladder distension, or respiratory compromise
What is the common cause of dysrhythmias in the PACU?
often the result of an identifiable cause other than myocardial injury (hypokalemia, hypoxemia, hypercarbia etc)
What is the commonly seen cardiovascular alteration seen on the clinical unit?
postoperative fluid and electrolyte imbalances contributing to the alteration in cardio function
Why do fluid and electrolyte imbalances occur postoperatively?
consists of the bodys normal stress response to surgery, excessive fluid losses and improper IV fluid replacement
What nursing assessment needs to be done for cardiovascular alterations?
every 15 minutes VS
The anesthesiologist or surgeon should be notified if any of these VS alterations occur (6 things)
- Systolic BP less than 90 or greater than 160
- Pulse rate less than 60 beats
- pulse pressure narrows
- Bp gradually decreases during several consecutive readings
- Irregular cardiac rhythm develops
- significant variation from preoperative readings
What is the max dose of acetaminophen?
4000 mg/day
650 Q4
1000 Q6
650-1300 Q8
What are NSAIDs for
mild-moderate pain
Why is postoperative N/V a risk?
unpleasant
prevents mobilization
risk of aspiration
dehiscence
