Wk 3 Postoperative Care Flashcards
When someone comes out of the order, all orders need to be
rewritten by the surgeon
What should a PACU hand off report look like?
General information
Patient history
intraoperative management and evens
What does intraoperative management and events include?
Most recent vital signs, lab and test results, how much blood the patient has lost
What is included in the initial PACU assessment? (6 things)
ABCs Neurological Surgical and IV site GU/GI Pain Patient safety needs
Why is hypoxia a potential complication for post op patients? (4 things)
Shallow breathing, anesthesia, resp depression
Obesity
Airway obstruction
Laryngospasm
What are two other potential respiratory complications to be aware of for post op patients?
Atelectasis
Pneumonia
What are nursing interventions for hypoxia?
Reposition if can Keep head of bed elevated VS O2 sat Oxygen Suctioning Coughing, splint prn Incentive spirometry Turn q2 Early ambulation Pain management
What is splinting?
Keep pressure of incision site, such as squeezing a pillow when coughing or keeping the incision together with hands
What are possible cardiovascular issues for a post op patient?
Decreased CO
DVT/PE
What should the nurse monitor for decreased CO?
BP
HR
Pulses
skin temp/color
DVTs are most often seen in patients who are…
Elderly
Obese
Immobilized
What is a good technique to teach patients to promote venous return?
Dorsi/plantar flexion, and circumducting feet
What BP should you notify the provider of?
Less than 90, greater than 160
What should you do for a patient with hypotension with a normal pulse, and warm/pink skin who is post op?
Just monitor, this is usually vasodilation from anesthesia
What should you do for a patient who is hypotensive with rapid or weak pulse, and cold/clammy skin?
They need immediate intervention, notify HCP, could be hypovolemic shock
If a patient has an abnormally low BP but is asymptomatic…
Compare to baseline, you may not need to notify provider if that is normal for them
You should notify the provider of a pulse of…
Less than 60 or greater than 120, depending on other signs and symptoms
What is pulse pressure?
Difference between systolic and diastolic pressure
What does it mean if someone has a narrow (small) pulse pressure?
Could be an indication of hemodynamic compromise
A blood pressure that gradually increases or decreases over several readings should… or a change in heart rhythm should….
Catch your eye!
How to prevent cardiovascular post op problems (4 things)
SCDs
Ambulation
Phlebitis assessment
Monitor and protect wound
Why are SCDs more often used than TEDs?
Because if the TED hose doesn’t fit correctly it can lead to pressure injuries
Restless patients… Always think __
Hypoxia
What is emergence delirium?
Short term neurological change
What are s/s of emergence delirium in post op patients?
Restlessness
Disorientation
Thrashing
Shouting
What can emergence delirium possibly be related to? (3)
Anesthetic agents
Pain
Presence of ET tube
Postop delirium is most common in the
Elderly
What is a psychological issue to watch for in post op patients?
Post-op depression
What should you do to prevent neurological and psychological problems in a post op patient?
Assess LOC, orientation, memory, ability to follow commands, movement of extremities
Post-op pain is the classic example of
continuous ongoing pain
What is a treatment for post op pain?
ATC dosing, be vigilant for side effects such as respiratory depression
Who is at risk for respiratory depression?
A patient who hasn’t taken opioids before, someone on IV morphine
What are interventions for post op pain? (3)
Pharmacologic and non-pharmacologic ,documentation of pain
During surgery the body often has a low
temperature
What is an expected finding concerning temperature for a patient 48 hours post op
Mild fever, less than 100.4 (due to inflammatory response to surgery)
If a patient’s temperature is greater than 100.4 post op, what should you think of?
Lung congestion or dehydration
When should you be concerned about a low grade fever after surgery?
If it’s been longer than 48 hours
What is the best thing you can do for a patient who is experiencing gas/abdominal distention after surgery?
Early ambulation
What is the most common reason for a patient experiencing paralytic ileus?
Surgical manipulation of the bowel
What are 4 potential GI problems for a post op patients
Gas/distention
Nausea
Constipation
Paralytic ileus
How long might large intestine motility take to resume in a post op patient?
2-7 days
How long might small intestine motility take to resume in a post op patient?
within hours
What are presentations of a patient with a paralytic ileus? (3)
Distended abdomen
High pitch bowel sounds
Pain
What do we do for a patient who does develop a paralytic ileus?
NG insertion to decompress the abdomen and then let them “ride it out”
You should gradually advance a patient’s diet, for example
NG to low wall suction
NPO with ileus
What is the only side effect of opioids that a patient cannot develop tolerance to?
Constipation
Prevention of constipation is especially important in patients who underwent
abdominal surgery, if they have to bear down and push it can be really painful for them
What are potential urinary complications of post op
Urinary retention
UTI
What should be the goal for urinary output for a post op patient?
Greater than 30mls an hour
Urine output =
Renal perfusion
If a patient has decreased cardiac output, or has hypotension
Urine output will go down due to low perfusion
When should a patient be catheterized after surgery?
If they haven’t voided in 6-8 hours
What should you assess when looking at a wound or incision? (5)
Pain Erythema Drainage - amount, color, consistency, odor Dehiscence Evisceration
What is a Tenckhoff catheter?
Peritoneal tube for dialysis
What is a wound drain?
Penrose
What is a Hemovac or a Jackson-Pratt?
Closed suction drain
What is T-tube used for?
Common bile duct
What are pigtails or pleurXcatheters?
Chest tubes
