WK 3: Post-Op & Pulmonary Embolism

Question 1

How is respiratory function altered in the postoperative period

Answer 1

· Patients at particular risk include those who
§ Receive general anaesthesia
§ Are older
§ Have a smoking history or lung disease
§ Are obese
§ Are undergoing thoracic, airway, or abdominal surgery
· Airway obstruction
§ Blockage of airway by patient’s tongue u Supine position
Extremely sleepy patient

Question 2

What factors increase the risk of altered respiratory function

Answer 2

· Obstruction
· Hypoxemia
· Hypoventilation
· Receive general anaesthesia
· Are older
· Have a smoking history or lung disease
· Are obese
Are undergoing thoracic, airway, or abdominal surgery

Question 3

Assessment of respiratory complications in the post-op period

Answer 3

• Frequently monitor vital signs, usually every 15 minutes until stable, Compare to baseline
• Assess apical–radial pulse carefully and report irregularities
• Assess skin colour, temperature, and moisture

Question 4

Potential alterations in cardiovascular function in the postoperative period

Answer 4

· Common complications include hypotension, hypertension, and dysrhythmias
· Greatest risk for persons with altered respiratory function or a cardiac history, older persons, and critically ill patients
· Postoperative fluid and electrolyte imbalances contribute to alterations in cardiovascular function
· Fluid retention the first 2–5 postoperative days can be result of the stress response
· Fluid overload or deficit may occur
· Hypokalemia
· Deep vein thrombosis (DVT)
· Pulmonary embolism
Syncope

Question 5

Post-op Nursing role on the Unit

Answer 5

• PACU nurse gives report to receiving nurse summarizing operative and postanaesthetic periods
• Receiving nurse assists with transfer onto bed.
• Vital signs obtained and compared to report
• After transfer, documentation is completed, and an in-depth assessment is performed.
• Initiation of postoperative orders and required nursing care

Question 6

Post-op Nursing role in Preparation for Discharge

Answer 6

• Preparation for discharge is an ongoing process throughout the surgical experience. Begins during the preoperative period
• The informed patient is prepared as events unfold.
• Gradually assumes greater responsibility for self-care during the postoperative period
• As discharge approaches, patient and caregivers should have the following information:
  -> Dietary restrictions or modifications u Symptoms to be reported
  -> Instructions for follow-up care
  -> Answers to questions or concerns

Question 7

Post-op Nursing Role in Follow up Care

Answer 7

• Follow-up call or visit may be used to assess and evaluate patient after discharge.
• Working with the discharge planner or case manager can facilitate transition of care from hospital-based to community- based care.

Question 8

Pulmonary embolism is defined as?

Answer 8

· Blockage of pulmonary arteries by a thrombus, fat or air embolus, or tumor tissue
· Embolis lodges in small blood vessels and blocks perfusion of the alveoli
· Most arise from DVTs, commonly in femoral and iliac veins
· Less common PEs include fat emboli which can arise from a fractured long bone
· Mortality rate of 30% if not treated

Question 9

Pulmonary embolism clinical manifestations

Answer 9

· Classic triad – dyspnea, chest pain and hemoptysis
· Mild to moderate hypoxemia with low partial pressure of carbon dioxide in arterial blood (PaCO2)
· Cough, pleuritic chest pain, crackles, fever, accentuation of pulmonic heart sound, tachycardia, changes in mental status

Question 10

Diagnostic tests used to evaluate Pulmonary embolism

Answer 10

· Spiral CT scan
○ is the most frequently used test to diagnose PE
· D-dimer
○ measures amount of cross-linked fibrin fragments which are found in circulation after clotting events (not specific nor sensitive)
· ABG
○ important to measure but not diagnostic
○ PaO2 is low d/t inadequate oxygenation in pulmonary vasculature
Ph normal unless respiratory alkalosis develops from prolonged hyperventilation or to compensate for lactic acidosis related to shock

Question 11

Management of Pulmonary embolism

Answer 11

· O2
○ supplemental O2
○ turning, coughing, deep breathing, incentive spirometry
○ mechanical ventilation/intubation in severe cases
· Pain
○ treated with opioids (usually morphine)
· Medications (IV heparin)
○ IV Heparin works to prevent future clots but does not dissolve existing clots, the dose is adjusted based o
· aPTT monitoring with heparin infusions
○ aPTT-activated partial thromboplastin time, Partial thrombop time (PTT), platelet count, used to monitor Heparin therapy
○ Critical
§ aPTT >70 sec.
§ PTT>100 sec
§ Platelets:< 50,000/mm3 or > 1 million /mm3