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NRSG 302 > Week 3- Post op complications > Flashcards

Week 3- Post op complications Flashcards

1
Q

how to manage post op pain

A

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

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2
Q

what is a pain crisis

A

10/10 pain or >10
can occur gradually or slowly over time
often the pt will be extremely still

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3
Q

hypothermia RF

A

effects of anesthesia
stress response
body temperature loss in the OR

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4
Q

assessment of hypothermia

A

Pt can be shaking, can appear pale or cyanotic (lips, extremities)

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5
Q

intervention for hypothermia

A

rewarming (blankets, warm fluids, forced-air warmers)

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6
Q

Temp Day 0-2

A

mild fever (<38): common
- Inflammatory response to surgical trauma
- Hematoma

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7
Q

persistent fever

A

temp > 38
- Atelectasis: a collapsed lung may become infected
- Specific infections related to the surgery
- Dehydration

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8
Q

days 3-5 temp

A

Pneumonia
UTI
Sepsis (fever, increased HR, decreased BP)
Wound infection (redness, pain, inflammation)
Phlebitis
Abscess formation
DVT

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9
Q

dizziness and fainting
- increased risk when
- highest risk with

A
  • 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
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10
Q

delirium symptoms

A

Acute onset
Fluctuation throughout day
Difficulty focusing attention
Disorganized thinking
Altered LOC

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11
Q

tx of delirium

A

recognize it
report it
find cause

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12
Q

resp complications post op

A
  • atelectasis
  • pneumonia
  • ARDS
  • Airway obstruction
  • Narcotic administration
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13
Q

the first vital sign to be affected if there is a change in cardiac or neurological state.

A

RR

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14
Q

atelectasis

A
  • 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.
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15
Q

assessment and prevention of atelectasis

A
  • 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

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16
Q

Pneumonia
what
s/s
prevention
tx

A
  • Infection from stasis of secretions
  • dullness, productive cough, fever, chills, pleuritic pain, increase WBC.
  • Requires antibiotics, and physiotherapy.
  • Prevent by early post-op ambulation
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17
Q

ARDS s/s

A
  • Rapid, shallow breathing
  • severe hypoxemia with scattered crackles, but no cough
  • chest pains or hemoptysis, appearing 24-48 hours after surgery.
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18
Q

airway obstruction
- contributing factors
-

A
  • 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).
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19
Q

assessment findings of airway obstruction

A

Assessment data- tachypnea, shallow and wheezing, dyspnea, gasping, increase pulse, irritability

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20
Q

too much narcotics can cause

A

over-sedation
affect rr
Narcan for RR <8/min and ensure supplemental O2 is available

21
Q

Airway Obstruction:
Risk factors:
Assessment data:
Intervention:

A
  • 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
22
Q

Aspiration:
Risk factors:
Assessment data:
Intervention:

A
  • 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
23
Q

Atelectasis (alveolar collapse):
Risk factors:
Assessment data:
Prevention:

A
  • 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
24
Q

Bronchospasms
Risk factors:
Assessment data:
Intervention:

A

Risk factors: asthma, COPD, intubation, aspiration
Assessment data: wheezing, dyspnea, tachypnea, decrease O2
Intervention: O2 & bronchodilators

25
Q

Hypoventilation
Risk factors:
Assessment data:
Intervention:

A

Risk factors: respiratory depression from narcotic/opioid use, poor muscle tone, pain, mechanical restriction,
Assessment data: dec RR, shallow resps, dec PaO2, inc PaCO2, apnea
Intervention: O2, ventilator assistance, stimulation, positioning

26
Q

pneumonia
Risk factors:
Assessment data:
Intervention:

A

Risk factors: hypoventilation, immobility, aspiration, resp issues
Assessment data: Infection from stasis of secretions- dullness, productive cough, fever, chills, pleuritic pain, WBC
Intervention: requires antibiotics, and physiotherapy. Prevent by early post-op ambulation

27
Q

Pulmonary edema
Risk factors:
Assessment data:
Intervention:

A

Risk factors: fluid overload, left ventricular failure, prolonged airway obstruction, sepsis, aspiration
Assessment data: crackles on auscultation, infiltrates on CXR, fluid overload, decreased O2 sats, productive cough with clear to pink sputum
Intervention: diuretics, increase in O2, fluid restriction

28
Q

Pulmonary Embolism(PE):
Risk factors:
Assessment data: a
Intervention:

A

Risk factors: DVT or other peripheral thrombosis, A. Fib, fat emboli, air emboli
Assessment data: acute tachypnea, dyspnea, chest pain, hypotension, decreased O2 sat, SOB,cough, sudden chest or shoulder pain, frothy sputum, pallor, cyanosis, restless, increased RR and pulse, decreased BP, diaphoresis
Intervention: O2 therapy, CVS support, anticoagulation, CXR, raise HOB

29
Q

_______accounts for the majority of cases and has usually arisen from a distant vein and travelled to the lungs via the venous system

A

thrombosis

30
Q

DVT- can lead to
especially with

A

PE, assess for calf pain and redness, especially with orthopedic surgery

31
Q

hemorrhage/bleeding
Risk factors:
Assessment:
Intervention:

A

Risk factors: Trauma, long surgical time, blood thinners
Assessment: Assess patient’s dressing, vital signs and lab values; Assess for increase pulse and symptoms of shock for internal bleeding
Intervention: Change dressings prn after 24-48 hours postop unless directed otherwise
Hold pressure on wound and call for help if needed and notify doctor
Empty and measure drains to assess amounts

32
Q

Hematoma
what
assessment
intervention

A

Area immediate to surgical site that continues to swell, filling with blood
Assessment: Watch for firmness, swelling, discolouration (bruising), mark it with a pen
Intervention: Apply pressure dressing, call surgeon if continues, occasionally needs to be drained

33
Q

Hypotension
RF
Assessment
interventions

A

Risk factors: fluid/blood loss, fluid deficit, peripheral pooling of blood, vasodilation from anaesthetic (also decreases BP), medications
Assessment: Decreased LOC and BP, dizzy, nausea, pale
* Hypovolemic Shock decrease BP, increase pulse, cold, clammy, pale
* Patient can develop orthostatic hypotension when changing from lying to standing too quickly.
Interventions: replace lost fluids (insure strict I&O measuring)

34
Q

HTN
causes
assessment

A

Causes: pain, delirium, hypoxia, gastric or bladder distention, fluid overload
Assessment: regularly according to policy and PRN- BP, pulse, cap. refill, absence of chest pain, RR, extremities, crackles, edema

35
Q

normal
prehigh
high
BP

A

120/80 or less
121-139/81-89
140/90 or higher

36
Q

cardiac dysfunction

A
  • Myocardial infarctions/ischemia
  • CVA/TIA
  • Dysrhythmias
  • Hypo/hypertension
  • Pulmonary embolism
37
Q

cardiac dysfunction
causes
assessment
interventions

A

Causes: effects of drugs (pre, intra, & post op), prolonged surgical time, trauma, co-morbidities, acid/base - fluid/electrolyte imblaances
Assessment: Monitor VS as per protocol, telemetry/ECG monitor (depending on acuity/surgery), CWMS, I&O balance,
Interventions: ?cardiac/DVT heparin protocol, replace/excrete fluids & electrolytes,

38
Q

Fluid and Electrolyte Imbalances:

A

Hypo/hypervolemia (fluid)
Hypo/hypercalcemia (Ca)
Hypo/hyperkalemia (K+)
Hypo/hypernatremia (Na+)

39
Q

Fluid and electrolyte imbalances
Causes:
Assessment:
Intervention:

A

Causes: trauma, blood loss, too much fluid replacement in OR, prolong surgical time, drugs, gastric losses
Assessment: Monitor for signs and symptoms, full CVA assessment, lab values, telemetry/ECG monitoring, monitor I&O
Intervention: Treatment based on levels – fluid replacement/diuretics, electrolyte replacement/excretion

40
Q

N/V
Causes:
assessment:
Intervention:

A

Causes: Anesthetic, drugs, pain, NPO status
Assessment: monitor – like pain, it is what they say it is; monitor I&O
Intervention: administer anti-emetics, HOB elevated to prevent aspiration of emesis, slow progression of diet (CF, FF, regular)

41
Q

paralytic ileus
causes
assessment
interventions

A

Causes: delayed return of GI peristalsis
Assessment: assess for presence of bowel sounds, abd. distention, abd. pain, N/V, diminished peristalsis
Interventions:
Encourage early ambulation of patients to prevent ileus – bowel motility and patient mobility
Use splinting of abdomen for any abdominal surgeries to protect incision
Starting bowel protocol with patients early on esp. with narcotic use
Keep patient on fluids until active BS

42
Q

urinary retention

causes
assessment
intervention

A
  • Inability to void 6-8 hours post-op
  • This is a common immediate postoperative complication that can often be dealt with conservatively with adequate analgesia. If this fails, catheterization may be needed.
  • Causes: Anaesthetic, trauma to bladder, spasm of sphincters from pain or anxiety, spinal and epidural anaesthesia delays the recovery of autonomic bladder reflexes
  • Assessment – inability to void, distended bladder, discomfort. patients post-op for void ie. Bladder scan
  • Intervention: regular toileting, fluids, decrease use of narcotics, catheter if needed
43
Q

UTI
causes
assessment
intervention

A

Causes: very common, more in women, and elderly may not present with typical symptoms
Assessment: I&O, monitor urine (frequency, cloudy urine, burning), fever, delirium (can cause disorientation and mental changes in the elderly)
Intervention: Treat with antibiotics if needed and encourage adequate fluid

44
Q

infection of wound
causes
assessment
intervention

A

Causes: poor aseptic technique, poor post-op cleansing, poor patient hygiene, on rare occasions contamination in OR
Assessment: redness around wound site of >2cm, purulent drainage, fever, warmth at site, growth from C&S swab of clean wound base
Intervention: Treat with antibiotics, also silver antimicrobial dressings can be used

45
Q

Dehiscence

A
  • Inadequate wound closure, stress on incision from coughing or vomiting, distention, decreased circulation
  • affects about 2% of midline laparotomy wounds
  • is a serious complication with a mortality of up to 30%
  • usually occurs between 7 and 10 days postoperatively
46
Q

dehiscence
causes
assessment
intervention

A

Causes: Malnutrition, obesity, older age
Assessment: monitor site
Intervention: Initial management includes sterile dressing to the wound, opiate analgesia, fluid resuscitation and early return to OR for re-suture; Removing alternate sutures/staples during removal decreases likelihood of occurrence

47
Q

evisceration
intervention

A
  • Cover entire area with sterile NS soaked dressing and cover dressing.
  • Monitor for signs of shock, place pt. in bed with knees to chest and call surgeon immediately
  • Cover entire area with moist sterile dressing and monitor for signs of shock, call surgeon
48
Q
A

NRSG 302 (5 decks)

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