Week 3 : Post Op Flashcards
PACU/recovery room
pt is in recovery
what does the setting look like in pacu
no individual rooms, no walls, open space ( therefore nurse can watch all )
emergency equipments are in the head of the bed and the sides
if a pt has a problem whats the time frame usually like
1 to 2 hours post op
pacu/recovery room
stay until awake, stable
discharge from pacu if
loc, vs, bleeding/drainage is normal
resp status, 02 sats
reports given
true or false. for a pt to be discharged they have to be back on their loc ( understand, foloow comman,ds tlak )
protect their airway
no access bleeding or drianage
controlled or expected amount ( breathing on their own ) -> back on their own
true
pacu/recovery room
discharge from day surgery
what is the big thing here ?
if they had day surgery ( big thing here is responsible adult with them and take them home, understand and written discharge instructions )
discharge from day surgery
characteristics
- PACU D/C criteria met, IV opioids, N&V
- Voided, ambulate,
- Responsible adult with them, written D/C criteria
what are some thing that dont happen in pacu/rr
visitors, meals and they dont eat here, not up and walking, no consults , no social work would be involve and coming into he recovery area
- 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
- 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
are things for report from or/recovery to clinical unit - on the phone “ get report on the phone”
recall that those are important now give a bit of description
the pt stays in the recovery room until they are ready
caring for the rest of their shift
list of what they need to talk about
preparing for the post op pt on the unit
what are we checking item wise
check ward routine
iv pole, iv pump, kidney basin, mouth swabs
vs record, pen, stethoscope
post op bed
pillows, blanket
are these important when it comes to preparing for the post op pt on the unit ?
- Suction/Oxygen – hook it up, check it…
- Post-op Sponge bath – Assessment**- talk to patient
- IV access, dressings (mark ‘shadowing’), do thorough head to toe and chart it! Get full baseline assessment. What does pt look like NOW?
- Check skin…pressure/redness? Look at their body – you are the nurse!
yes
what is a good thing to do for the pt when u are preparing for the post op patient on the unit
good assesment and putting on a fresh gown and changing sheets
looking at their entire body
turn them on their sides and back
( any pressure or redness ) = skin
a good HEAD TO TOE!!!!
PACU - common problems seen with pts and rns intervene
airway - obstruction
resp insuffiency
*Cardiac issues – BP, rhythm
* Neurological
* Temperature
are pain and n and v in PACU - common problems seen with patients & RNs intervene
yes
why is obstruction or airway a common problem ?
from the block the pts tongue, if they are sedated , there tongues could be closed down
why could resp insufficiency be common problem in pacu
hypoxemia or hypoventilation or hypercapnia
too shallow or too slow and not able to get oxygen or clear c02
why is the typical intervention if the bp is too low when it comes to pacu patient
too low = give iv fluids common thing ( bolus ) 250 or 500 ml ringers lacte or saline
if its too high - pain or needing antihypertensive
we need it normal range
arrhythmia could also be seen
what is an example of neurological that could be a common problem in pacu
emergency delirium
aggressive and med is given is impacting their neurological status ( narcotics or sedatives )
true or false.
alot of adipose tissue= they take longer to wake up
true
initial post op assessment and. are priorities
airway/assess LOC
- 02 per NP
VS- T, P, RR, BP
- rule of 4
fluid - input ( iv) and output ( tubes )
- any kinks? running well? interstitial ?
true or false. this is initially talking about the frequencies when u are checking the fluid.
true
true or false. by the time goes to the unit, the surgeon comes down or change abt iv fluid or watching for those.
true
initial post op assessment and care priorities
surgical site : what undergoes this
small amount blood on drainage is okay - dont change it , can reinforce it
what is okay, during initial post op assessment that could be seen as a ‘risk’ ?
small amount of blood is fine in the dressing
pain assesment/comforrt level
- assess pain and provide analgesic, antiemetics, warm blankets and pillow during initial post op assessment and care
true
as soon as the pt is wake what should we start iniating ?
start db and cough and leg exercises
what are important as soon as the pt is awake
leg exercises, start flexing and getting to walk soon
anticipated problem & rn care: resp hypoxemia/hypoxia
obstruction from tongue ( if still sedated )
what could out interventions be ?
artificial airway/suction
positioning
recall that obstruction from the tongue is one of the anticipated problem : along with resp hypoxemia/hypoxia
what else?
atelectasis/pneumonia
when u have a pt who has an anticipated problem and are having atelectasis/pneumonia
encourage DB&C ( 10X every hr ) splint with pillow
ambulate/chest physio/position changes/adequate fluids, incentive spirometry
recall that these are encouraged when a pt is having an anticipated problem with resp hypoxemia/hypoxia ( atelectasis/pneumonia)
encourage DB&C ( 10X every hr ) splint with pillow
ambulate/chest physio/position changes/adequate fluids, incentive spirometry
what else?
O2; auscultate
Give Analgesia 1st or patient will be hesitant to do
anything!!
what happens if we do not intervene when a pt is having atelestasis ?
lung will collapse therefore we must facilitate gas exchange ( get rid of C02)
position changes is important and adequate fluid and make sure mucus is not sticky
recall that obstruction from tongue, atelectasis/pneumonia is one of the anticipated problem with resp hypozemia/hypoxia what else are there ?
pulmonary edema
hypoventilation
what undergoes with pulmonary edema anticipated probelm & rn care: resp hypoxemia/hypoxia
do not overload with too much fluid
auscultate chest
give diuretics if needed
02
anticipated problem & rn care : resp hypoxemia/hypoxia
what undergoes hypoventilation
wake pt up
02
recall that an anticipated problem could be pulmoanry edema with resp post op, what chances does it decrease?
decrease the chance of aspiration if they vomit
therefore increasing their hob to maximize their thorax and help their airway
if we hear crackles to our patient post op what could this indicate?
pul edema , its concerning
what are some positioning that could be helpful for the pt when they have woken up
having deep breathing or coughing is expected and this would be painful, we would be giving them analgesic before
splinting is also helpful how is it helpful?
its helpful since couple of thing we are doing is pt is holding their sides together and talking a deep breath and coughing
true or false. splinting helps them cough and less pain.
true
anticipated problem & RN care : CVS
hypotension
hypertension
what undergoes hypotension and hypertension
monitor vs and organs for perfusion
give fluids
may nee to give vasocontrictive agents
hypertension : decreae anxiety or pain
give antihypertensive
or give diurtetic
what happens often in post op
hypotension and ( losing fluid or blood ) so we want to monitor their vs
if they are hypo and not treating they could go into shock ( hypovolemic shock )
what is out intervention when it comes to a hypotension pt ?
if they are hypo and not treating and actively going down ( probably gonna keep on going down and go into shock ) ( we have to give them iv fluids )
what other intervention could we do for hypotension
peripheral clamp down to give higher pressure - vasocontrictive agents treating with oxygen just as nasal prongs or face mask get more oxygen in their oxygen
how do we treat hypertension ( what would our intervention be )
treating that because of sympathethic nervous stimulation ( this could also be a bladder distention )
asking questions when is the last time they voided, how much urine is coming out etc.
why are you giving diuretic ?
to keep blood pressure low to get rid of that circulating volume
what other complications could occur ? ( anticipated problem and rn care )
dysrthimias and dvt
name all the things that could happen in the systems of resp and cvs
- pulmonary edema
2.hypoventilation
cvs:
3.hypotension
4.hypertension
5.dysrythmias
6.dvt
what undergoes dysrthmias when it comes to post op ( an anticipated problem )
monitor and replace electrolytes
- bloodwork - electrolytes , hematocrit, hgb
maintain fluid balance - i & o and edema and weight
what undergoes dvt ( anticiapted problem )
heparin sc or lmw heparin ( dalteparin )
leg position
leg exercises - active move aorund
—– felx and extend joints 10-12 x every 1-2 hours while awake
teds and scds
ambulate
what are the important of electrolytes when we are talking about dysrthmias
potassium, calcium, phosphate, and magensium BUT potassium is major
true or false. prophalaxis or prevention si a big thing here
very effective for preventing dvt- leg positioning ( do not cross ) impeded blood flow
this is important
compression stocking to prevent dvt
true
dvt is often forms in l_____ body positioning is important
decrease perfusion ( had dvt before risk for older ) pevic or gyani surgery ( watch closely for these )
leg veins
and this is a true statement
vital signs - what are potential causes of problems ?
frequency : rule of 4
look at their baseline always, when would be a big change be, what is important in terms of looking for the pt
oxygenation and 02 sats , this is very important
when should we worry about a change in bp ?
if systolic is <90 or >160
hr <60 or >120
if <12
temp <38 after 48h
anticipated problem & rn care
cerebral functioning
motor and sensory after anesthesia
what undergoes thes
cerebral functioning
- loc and slow to awaken
motor and sensory function after anesthesia
what undergoes this
back to baseline ? any signs of stroke
recognize complication of spinal and epidural
- resp dep
-hypo
-epidural hematoma
-infection ( meningitis )
postdural puncture headache
are these typically complications of spinal and epidural ?
recognize complication of spinal and epidural
- resp dep
-hypo
-epidural hematoma
-infection ( meningitis )
postdural puncture headache
nausea and vomiting along with constipation/post-op ileus/paralytic ileus could be seen as anticipated problem?
true
name all the anticipated problem so far that occurs post op
obstruction from tongue
atelectasis/pnemonia
pulmonary edema
hypoventilation
hypotension and hypertension
dysrthymias and dvt
true or false. cerebral functioning and motor and sensory function after anesthesia could be seen as an anticipated problem.
yes this is true
what undergoes nausea and vomiting
keep hydrated with IV , give antiemetic, will decrease/dv iv rate when pt drinking well
n and v this can be common not just one or two drugs given more likely 3 or 4 plus a gas if they are having a problem
this makes them nauseated ( keep them hydrated and antiemetic . gravol or ondasentron is given )
nausea is typically fluctuate when gas leaves the pt ( wet their mouth and keep them hydrated )
true
why would paralytic ileus be a common anticipated problem after
gi system has been sedated ( slower to move ) post op ileic
tenderness and pain to the abdomen
stomach motility 1 to 2 days
bowel motility removes 3 to 5 days
true or false. a pt must not eat or no drink until there bowel sounds have returned
true
how long does paralytic ileus usually laast ?
last 2 to 3 days post op associated with large and small bowels not an obstruction
pt has n and v ) goes away after a few days. wait it out passing stool ( means its improving ), what do we need to get rid of stomach secretions?
what is the possible cause of why this could be worsening ?
ng tube
opioids could also be taking this worse ( look from extra strength Tylenol if thats possible )
true or false. its common to have pain gas ( post op day 2 or 3 ) improve is to get them walking and we have advanced there diet as tolerated usually couple of days
decreasing iv fluids and intake more food orally
true
low urine output/dehydration could also be an anticipated problem
yes
what undergoes low urine otput/dehydration
keep an accurate i and o
may have decreased output in first 48 hours r/t surgical stress
treat with fluids if dehydrated
urinary retention is typically not an anticpated problem post op
it is so false
what undergoes urinary retention that could be an anticipated problem
if no void 8 hrs- must further assess
i and o flowsheet - fluid balance
bladder
stragiht foley or foley cateter
true or false. it is not normal for a pt to have decrease output.
false it is normal l to have decreased output because due to the stress - but should still be atleast 30 mls per hour
recall that it is normal to have decreased output due to stress - however it should still be atleast 30 mls per hour, what are we going to do if not?
- need to look at treatments if not
- ordering more iv fluids ( bolus or increase their running rate ) check their electrolytes as well
hemoglobin and dressings they have ( make sure they are not bleeding )
when should urine output become normal
normal post op day 2 or 3
what would out last resort be if they have urinary retention?
usually urinated after surgery 200 mls if they do not have catheter in
catheter last resort carries infection last resort ( that is why it is the last resort )
delayed healing could also be an anticipated probelm what could help this ? or what could be making this ?
nutrition, oxygen theraphy/keep warm , manage underlying health issues
edema - skin condiiton
smoking
why is good nutrition important in terms of delayed healing good nutrition is important ?
( this is very serious problem for diabetes type 2 pts, or have any vascular or perfsuion problem ) so need to watch out for that
true or false. Bleeding/ Hemorrhage/ Wound Dehiscence could an anticipated problem ?
true
what are assessing that undergoes the anticpated problem of Bleeding/ Hemorrhage/ Wound Dehiscence
dressings and drains- color amount
trends in bloodwork ( hgb , wbc )
manage their underlying condition could also be a lot of edema ( hard for the skin to recvoer for the skin to heal )
even smoking. is this true
yes this is true
what do we want to look for in bleeding/hemorrage/wound dehiscnece
we wantto look at the drains, amount of fluids, make sure the volume ( time and date ) compare and shw i to anotehr nurse
signs and symptoms of blood loss ( vital signs )
what is wound dehiscence?
wound dehescence- when the wound is separated ( not healing ) surgeons would have to look at again or possible stitch up
infection is also an anticipated risk , what undergoes this ?
Assess dressing, pain, edema
Dressing post op stays on for min 48 hrs – surgeon to 1st remove
what should we monitor in terms of infection?
look for infection, monitor wbc, temp and energy and fatigue level
true or false. insertion or internal organs coming out of the incision is not common but could happen due to infection ( so assessing is important )
true
decreased temp and increased temp is also seen as an anticipated problem what are the interventions ?
monitor temp q4h post surgery
apply warm blankets/bair hugger
opoids may help suppress shivering
we need to take temp q15-30 while actively warming ?
yes to increase the temp since in this case the pt is hypothermia
what undergoes increased temp what are we doing in terms of interventions
Normal for first 48 hrs post- op
After 48 hrs - find source & treat infection
* Antibiotics, fluids, antipyretics
are these something you’d be doing if a pt has increased temp
over 38 degress
normal stress response
after 48 hrs we want to start thnking abt infection
- treat them and urianry infection or resp infeciton like pneminia or wound ( swab chest xray, cultures )
what is a bair hugger - forced warm air into paper thin blanket
heated paper with blanket ( machine blows warm air ) increase pts temerpature
this is a little bit more aggressive if a pt needs this they should be in icu
pain should decrease over time, but what is it doesnt what are some pharmacological and non pharmacological
Pharmacological
IV narcotics for severe post –op pain
Titrate drug
Monitor for adverse effects (resp depression, hypotension)
May give NSAIDS to enhance pain relief
“common meds” specific to type of surgery
Non-Pharmacological
distraction (phone, TV, visiting), back rub, lotion, mouth care, shave
what are typucally the iv narcotics we are giving the pt if pain is not decreased ?
fentanyl or morphine
what are t3s good for ?
nsaids is also giving
t3s very good for dental or orthopedic pain
how bad is the pain and where is it should be a concern?
isit csurgical pain or calf pain ( having a dvt ) or chest pain ( heart attack )
imporant discharge teaching : Important Elements
Wound/dressings
Hygiene
Medications
Activity
Diet/nutrition
Follow-up
Family/friends…
What is “good/normal/expected” and what is not! What to do in case of emergency.
Hot line/ Health Links ER, ambulance
dont memorize just know it
