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H & Illness 4: A & C illness > Week 3 : Post Op > Flashcards

Week 3 : Post Op Flashcards

1
Q

PACU/recovery room

A

pt is in recovery

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2
Q

what does the setting look like in pacu

A

no individual rooms, no walls, open space ( therefore nurse can watch all )
emergency equipments are in the head of the bed and the sides

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3
Q

if a pt has a problem whats the time frame usually like

A

1 to 2 hours post op

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4
Q

pacu/recovery room
stay until awake, stable
discharge from pacu if

A

loc, vs, bleeding/drainage is normal
resp status, 02 sats
reports given

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5
Q

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

A

true

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6
Q

pacu/recovery room
discharge from day surgery
what is the big thing here ?

A

if they had day surgery ( big thing here is responsible adult with them and take them home, understand and written discharge instructions )

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7
Q

discharge from day surgery
characteristics

A
  • PACU D/C criteria met, IV opioids, N&V
  • Voided, ambulate,
  • Responsible adult with them, written D/C criteria
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8
Q

what are some thing that dont happen in pacu/rr

A

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

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9
Q
  • 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

A

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

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10
Q

preparing for the post op pt on the unit
what are we checking item wise

A

check ward routine
iv pole, iv pump, kidney basin, mouth swabs
vs record, pen, stethoscope
post op bed
pillows, blanket

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11
Q

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!
A

yes

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12
Q

what is a good thing to do for the pt when u are preparing for the post op patient on the unit

A

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!!!!

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13
Q

PACU - common problems seen with pts and rns intervene

A

airway - obstruction
resp insuffiency
*Cardiac issues – BP, rhythm
* Neurological
* Temperature

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14
Q

are pain and n and v in PACU - common problems seen with patients & RNs intervene

A

yes

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15
Q

why is obstruction or airway a common problem ?

A

from the block the pts tongue, if they are sedated , there tongues could be closed down

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16
Q

why could resp insufficiency be common problem in pacu

A

hypoxemia or hypoventilation or hypercapnia
too shallow or too slow and not able to get oxygen or clear c02

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17
Q

why is the typical intervention if the bp is too low when it comes to pacu patient

A

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

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18
Q

what is an example of neurological that could be a common problem in pacu

A

emergency delirium
aggressive and med is given is impacting their neurological status ( narcotics or sedatives )

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19
Q

true or false.
alot of adipose tissue= they take longer to wake up

A

true

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20
Q

initial post op assessment and. are priorities

A

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 ?

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21
Q

true or false. this is initially talking about the frequencies when u are checking the fluid.

A

true

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22
Q

true or false. by the time goes to the unit, the surgeon comes down or change abt iv fluid or watching for those.

A

true

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23
Q

initial post op assessment and care priorities
surgical site : what undergoes this

A

small amount blood on drainage is okay - dont change it , can reinforce it

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24
Q

what is okay, during initial post op assessment that could be seen as a ‘risk’ ?

A

small amount of blood is fine in the dressing

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25
Q

pain assesment/comforrt level
- assess pain and provide analgesic, antiemetics, warm blankets and pillow during initial post op assessment and care

A

true

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26
Q

as soon as the pt is wake what should we start iniating ?

A

start db and cough and leg exercises

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27
Q

what are important as soon as the pt is awake

A

leg exercises, start flexing and getting to walk soon

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28
Q

anticipated problem & rn care: resp hypoxemia/hypoxia

obstruction from tongue ( if still sedated )
what could out interventions be ?

A

artificial airway/suction
positioning

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29
Q

recall that obstruction from the tongue is one of the anticipated problem : along with resp hypoxemia/hypoxia

what else?

A

atelectasis/pneumonia

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30
Q

when u have a pt who has an anticipated problem and are having atelectasis/pneumonia

A

encourage DB&C ( 10X every hr ) splint with pillow
ambulate/chest physio/position changes/adequate fluids, incentive spirometry

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31
Q

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?

A

O2; auscultate
Give Analgesia 1st or patient will be hesitant to do
anything!!

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32
Q

what happens if we do not intervene when a pt is having atelestasis ?

A

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

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33
Q

recall that obstruction from tongue, atelectasis/pneumonia is one of the anticipated problem with resp hypozemia/hypoxia what else are there ?

A

pulmonary edema
hypoventilation

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34
Q

what undergoes with pulmonary edema anticipated probelm & rn care: resp hypoxemia/hypoxia

A

do not overload with too much fluid
auscultate chest
give diuretics if needed
02

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35
Q

anticipated problem & rn care : resp hypoxemia/hypoxia

what undergoes hypoventilation

A

wake pt up
02

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36
Q

recall that an anticipated problem could be pulmoanry edema with resp post op, what chances does it decrease?

A

decrease the chance of aspiration if they vomit
therefore increasing their hob to maximize their thorax and help their airway

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37
Q

if we hear crackles to our patient post op what could this indicate?

A

pul edema , its concerning

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38
Q

what are some positioning that could be helpful for the pt when they have woken up

A

having deep breathing or coughing is expected and this would be painful, we would be giving them analgesic before

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39
Q

splinting is also helpful how is it helpful?

A

its helpful since couple of thing we are doing is pt is holding their sides together and talking a deep breath and coughing

40
Q

true or false. splinting helps them cough and less pain.

A

true

41
Q

anticipated problem & RN care : CVS

A

hypotension
hypertension

42
Q

what undergoes hypotension and hypertension

A

monitor vs and organs for perfusion
give fluids
may nee to give vasocontrictive agents

hypertension : decreae anxiety or pain
give antihypertensive
or give diurtetic

43
Q

what happens often in post op

A

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 )

44
Q

what is out intervention when it comes to a hypotension pt ?

A

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 )

45
Q

what other intervention could we do for hypotension

A

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

46
Q

how do we treat hypertension ( what would our intervention be )

A

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.

47
Q

why are you giving diuretic ?

A

to keep blood pressure low to get rid of that circulating volume

48
Q

what other complications could occur ? ( anticipated problem and rn care )

A

dysrthimias and dvt

49
Q

name all the things that could happen in the systems of resp and cvs

A
  1. pulmonary edema
    2.hypoventilation
    cvs:
    3.hypotension
    4.hypertension
    5.dysrythmias
    6.dvt
50
Q

what undergoes dysrthmias when it comes to post op ( an anticipated problem )

A

monitor and replace electrolytes
- bloodwork - electrolytes , hematocrit, hgb
maintain fluid balance - i & o and edema and weight

51
Q

what undergoes dvt ( anticiapted problem )

A

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

52
Q

what are the important of electrolytes when we are talking about dysrthmias

A

potassium, calcium, phosphate, and magensium BUT potassium is major

53
Q

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

A

true

54
Q

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 )

A

leg veins
and this is a true statement

55
Q

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

A

oxygenation and 02 sats , this is very important

56
Q

when should we worry about a change in bp ?

A

if systolic is <90 or >160

hr <60 or >120

if <12

temp <38 after 48h

57
Q

anticipated problem & rn care

cerebral functioning

motor and sensory after anesthesia

what undergoes thes

A

cerebral functioning
- loc and slow to awaken

58
Q

motor and sensory function after anesthesia
what undergoes this

A

back to baseline ? any signs of stroke
recognize complication of spinal and epidural
- resp dep
-hypo
-epidural hematoma
-infection ( meningitis )
postdural puncture headache

59
Q

are these typically complications of spinal and epidural ?

A

recognize complication of spinal and epidural
- resp dep
-hypo
-epidural hematoma
-infection ( meningitis )
postdural puncture headache

60
Q

nausea and vomiting along with constipation/post-op ileus/paralytic ileus could be seen as anticipated problem?

A

true

61
Q

name all the anticipated problem so far that occurs post op

A

obstruction from tongue
atelectasis/pnemonia
pulmonary edema
hypoventilation
hypotension and hypertension
dysrthymias and dvt

62
Q

true or false. cerebral functioning and motor and sensory function after anesthesia could be seen as an anticipated problem.

A

yes this is true

63
Q

what undergoes nausea and vomiting

A

keep hydrated with IV , give antiemetic, will decrease/dv iv rate when pt drinking well

64
Q

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 )

A

true

65
Q

why would paralytic ileus be a common anticipated problem after

A

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

66
Q

true or false. a pt must not eat or no drink until there bowel sounds have returned

A

true

67
Q

how long does paralytic ileus usually laast ?

A

last 2 to 3 days post op associated with large and small bowels not an obstruction

68
Q

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 ?

A

ng tube
opioids could also be taking this worse ( look from extra strength Tylenol if thats possible )

69
Q

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

A

true

70
Q

low urine output/dehydration could also be an anticipated problem

A

yes

71
Q

what undergoes low urine otput/dehydration

A

keep an accurate i and o
may have decreased output in first 48 hours r/t surgical stress
treat with fluids if dehydrated

72
Q

urinary retention is typically not an anticpated problem post op

A

it is so false

73
Q

what undergoes urinary retention that could be an anticipated problem

A

if no void 8 hrs- must further assess
i and o flowsheet - fluid balance
bladder
stragiht foley or foley cateter

74
Q

true or false. it is not normal for a pt to have decrease output.

A

false it is normal l to have decreased output because due to the stress - but should still be atleast 30 mls per hour

75
Q

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?

A
  • 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 )
76
Q

when should urine output become normal

A

normal post op day 2 or 3

77
Q

what would out last resort be if they have urinary retention?

A

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 )

78
Q

delayed healing could also be an anticipated probelm what could help this ? or what could be making this ?

A

nutrition, oxygen theraphy/keep warm , manage underlying health issues
edema - skin condiiton
smoking

79
Q

why is good nutrition important in terms of delayed healing good nutrition is important ?

A

( this is very serious problem for diabetes type 2 pts, or have any vascular or perfsuion problem ) so need to watch out for that

80
Q

true or false. Bleeding/ Hemorrhage/ Wound Dehiscence could an anticipated problem ?

A

true

81
Q

what are assessing that undergoes the anticpated problem of Bleeding/ Hemorrhage/ Wound Dehiscence

A

dressings and drains- color amount
trends in bloodwork ( hgb , wbc )

82
Q

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

A

yes this is true

83
Q

what do we want to look for in bleeding/hemorrage/wound dehiscnece

A

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 )

84
Q

what is wound dehiscence?

A

wound dehescence- when the wound is separated ( not healing ) surgeons would have to look at again or possible stitch up

85
Q

infection is also an anticipated risk , what undergoes this ?

A

Assess dressing, pain, edema
Dressing post op stays on for min 48 hrs – surgeon to 1st remove

86
Q

what should we monitor in terms of infection?

A

look for infection, monitor wbc, temp and energy and fatigue level

87
Q

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 )

A

true

88
Q

decreased temp and increased temp is also seen as an anticipated problem what are the interventions ?

A

monitor temp q4h post surgery
apply warm blankets/bair hugger
opoids may help suppress shivering

89
Q

we need to take temp q15-30 while actively warming ?

A

yes to increase the temp since in this case the pt is hypothermia

90
Q

what undergoes increased temp what are we doing in terms of interventions

A

 Normal for first 48 hrs post- op
 After 48 hrs - find source & treat infection
* Antibiotics, fluids, antipyretics

91
Q

are these something you’d be doing if a pt has increased temp

A

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 )
92
Q

what is a bair hugger - forced warm air into paper thin blanket

A

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

93
Q

pain should decrease over time, but what is it doesnt what are some pharmacological and non pharmacological

A

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

94
Q

what are typucally the iv narcotics we are giving the pt if pain is not decreased ?

A

fentanyl or morphine

95
Q

what are t3s good for ?

A

nsaids is also giving
t3s very good for dental or orthopedic pain

96
Q

how bad is the pain and where is it should be a concern?

A

isit csurgical pain or calf pain ( having a dvt ) or chest pain ( heart attack )

97
Q

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

A

H & Illness 4: A & C illness (21 decks)

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