Week 3- Post op complications Flashcards
how to manage post op pain
VS
Assess pain - OPQRSTUV
Administer analgesics regularly and PRN and assess effectiveness
Assess VS: increase HR & BP can indicate pain
Pain is what the patient says it is
RR affected by narcotics
Watch for pain crisis
what is a pain crisis (3)
10/10 pain or >10
can occur gradually or slowly over time
often the pt will be extremely still
hypothermia RF
3
effects of anesthesia
stress response
body temperature loss in the OR
assessment of hypothermia
2
Pt can be shaking, can appear pale or cyanotic (lips, extremities)
intervention for hypothermia
rewarming (blankets, warm fluids, forced-air warmers)
Temp Day 0-2
mild fever (<38): common
- Inflammatory response to surgical trauma
- Hematoma
persistent fever
temp > 38
- Atelectasis: a collapsed lung may become infected
- Specific infections related to the surgery
- Dehydration
days 3-5 temp
Pneumonia
UTI
Sepsis (fever, increased HR, decreased BP)
Wound infection (redness, pain, inflammation)
Phlebitis
Abscess formation
DVT
dizziness and fainting
- increased risk when
- highest risk with
- in first 24-48 hours
- spinal/ epidural as it freezes motor (movement), sensory (feeling) and autonomic (muscle tone) nerves. When the patient stands the vessels do not contract (as they should to prevent blood flow from moving to the feet) so blood flows to feet, blood pressure drops and patient faints
delirium symptoms
5
Acute onset
Fluctuation throughout day
Difficulty focusing attention
Disorganized thinking
Altered LOC
tx of delirium
recognize it
report it
find cause
resp complications post op
NAAAP
- atelectasis
- pneumonia
- ARDS
- Airway obstruction
- Narcotic administration
the first vital sign to be affected if there is a change in cardiac or neurological state.
RR
atelectasis
- Airways become obstructed, usually by bronchial secretions.
- Most cases are mild and may go unnoticed. - - The trapped air is gradually absorbed and there is alveolar collapse.
assessment and prevention of atelectasis
- slow recovery, poor colour, mild tachypnea and tachycardia, sometimes increased temp.
- Decreased air entry heard to lung fields.
Prevention is by preoperative and postoperative physiotherapy
Pneumonia
what
s/s
prevention
tx
- Infection from stasis of secretions
- dullness, productive cough, fever, chills, pleuritic pain, increase WBC.
- Requires antibiotics, and physiotherapy.
- Prevent by early post-op ambulation
ARDS s/s
- breathing
- severe
- other symptoms
- Rapid, shallow breathing
- severe hypoxemia with scattered crackles, but no cough
- chest pains or hemoptysis, appearing 24-48 hours after surgery.
airway obstruction
what is it
- Spasm of bronchus and larynx
- tongue falling back
- aspiration of emesis (Aspiration pneumonitis- rapid onset breathlessness and wheezing, requires urgent bronchial suction, positive pressure ventilation and Abx)
- respiratory depressant meds
- poor cough or ineffective breathing pattern (anaesthesia).
assessment findings of airway obstruction
Assessment data- tachypnea, shallow and wheezing, dyspnea, gasping, increase pulse, irritability
too much narcotics can cause
narcan for RR <
over-sedation
affect rr
Narcan for RR <8/min and ensure supplemental O2 is available
Airway Obstruction:
Risk factors:
Assessment data:
Intervention:
- Spasm of bronchus and larynx, tongue falling back in throat
- Stridor, tachypnea, shallow and wheezing, dyspnea, gasping, increase pulse, irritability
- patient stimulation, positioning, artificial airway
Aspiration:
Risk factors:
Assessment data:
Intervention:
- GERD, pregnancy, hiatal hernia, ulcers, trauma, resp. depressive meds, poor cough
- coughing, crackles, rattling chest, decreased O2
- sit up for feeding & drinking, protection of airway
Atelectasis (alveolar collapse):
Risk factors:
Assessment data:
Prevention:
- Airways become obstructed, usually by bronchial secretions. Most cases are mild and may go unnoticed. The trapped air is gradually absorbed and there is alveolar collapse.
- slow recovery, poor colour, mild tachypnea and tachycardia, sometimes increased temp. Decreased air entry heard to lung fields.
- preoperative and postoperative physiotherapy
Bronchospasms
Risk factors:
Assessment data:
Intervention:
Risk factors: asthma, COPD, intubation, aspiration
Assessment data: wheezing, dyspnea, tachypnea, decrease O2
Intervention: O2 & bronchodilators