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PRINCIPLES > EXAM III - POSTOP ASSESSMENT > Flashcards

EXAM III - POSTOP ASSESSMENT Flashcards

1
Q

CRITERIA FOR LEAVING OPERATING ROOM (3)

A
  1. patent airway (can be nasal trumpet)
  2. adequate ventilation & oxygenation
  3. hemodynamically stable
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2
Q

PACU CARE
ADMISSION PHASE
GENERAL INFO (4)

A
  1. PACU should be notified
  2. Accompanying pt = surgeon, circulating nurse, CRNA
  3. Immediate priority: resp & circulatory adequacy
  4. CRNA must remain w/ pt until PACU RN assumes responsibility
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3
Q

PACU CARE
ADMISSION PHASE
GIVING REPORT (6)

A
  1. pt identification
  2. surgical procedure
  3. previous med history
  4. anesthetic technique
  5. intraop course
  6. postop instruction
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4
Q

PACU CARE
ADMISSION PHASE
PREOP HISTORY (7)

A
  1. NPO status
  2. premeds
  3. allergies
  4. pertinent previous surgical procedures
  5. underlying med illness
  6. pertinent chronic med usage
  7. acute underlying med problems
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5
Q

PACU CARE
ADMISSION PHASE
INTRAOP INFO (11)

A
  1. surgical procedure
  2. type of anesthetic
  3. unexpected events
  4. intraop vital signs
  5. relaxant/reversals
  6. time/amount of opioids given
  7. fluids given
  8. EBL
  9. urine output
  10. intra op lab results
  11. other meds given
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6
Q

PACU CARE
ADMISSION PHASE
POSTOP INSTRUCTIONS (4)

A
  1. acceptable vital sign range
  2. expected airway & ventilatory status
  3. anticipated cardiovascular problems
  4. diagnositc test to be run
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7
Q 
PACU CARE
ADMISSION PHASE
PACU RECOVERY SCORE
-what does it determine
-how often is it repeated
-how many categories
-possible points for each category
-10 =
-8-9 =
-<7 =
A
  1. focus of care & potential problems
  2. q 15 min
  3. 5
  4. 0, 1, 2
  5. best possible condition
  6. safe for transfer to floor
  7. unsafe for transport
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8
Q

PACU CARE
ADMISSION PHASE
PACU RECOVERY SCORE
-Categories (5)

A
  1. ACTIVITY
  2. RESPIRATION
  3. CIRCULATION
  4. CONSCIOUSNESS
  5. COLOR
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9
Q 
PACU CARE
ADMISSION PHASE
PACU RECOVERY SCORE
CATEGORIES
-Activity explanation
A

moves spontaneously or on command
2=all extremites
1=2 extremities
0=unable to control any extremity

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10
Q 
PACU CARE
ADMISSION PHASE
PACU RECOVERY SCORE
CATEGORIES
-Respiration explanation
(rate/depth/effort)
A

2=breathe deeply & cough
1=limited resp effort (dyspnea/splinting)
0=no spontaneous effort

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11
Q 
PACU CARE
ADMISSION PHASE
PACU RECOVERY SCORE
CATEGORIES
-Circulation
A 
2 = BP + 20% of preanesthetic level
1 = BP +/- 20%-49% 
0 = BP +/- 50%
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12
Q 
PACU CARE
ADMISSION PHASE
PACU RECOVERY SCORE
CATEGORIES
-Consciousness level
A 
2 = fully awake
1 = arousable on calling
0 = not responding
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13
Q 
PACU CARE
ADMISSION PHASE
PACU RECOVERY SCORE
CATEGORIES
-O2 Saturation / color
A 
2 = maintain O2 sat >92% on RA
1 = needs O2 inhalation for sat >90%
0 = sat <90% even with O2 support
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14
Q 
PACU CARE
ADMISSION PHASE
MONITORING & ORDERS
-standards established by
-monitoring devices
-vital signs documentation
-orders
A
  • American Society of Post Anesthesia Nurses
  • same as in critical care setting
  • q 15min
  • standardized in addition to orders written by surgeon / anesthesia provider
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15
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
(upper abdominal or thoracic surgery)
(most important postop complication)
-Atelectasis (4)
-to reverse (3)
A

A. “sighless resp” during GA & immediate postop
B. inappropriate surfactant function
C. Inc surface tension leads to Dec recoil & stiff lung
D. Dec compliance leads to Dec alveolar volumes leads to Dec FRC

  1. sustained maximal inspiration
  2. coughing maneuver
  3. repositioning patient
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16
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
AIRWAY OBSTRUCTION
Incomplete recovery from GA - most common
-what is the obstruction
-how treat
A
  1. soft tissues & tongue may relax and obstruct airway in supine patient
  2. jaw thrust
    oral / nasal airways
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17
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
AIRWAY OBSTRUCTION
Laryngospasm
-describe
-treatment (2)
A

Partial vs complete (stridor vs absence of ventialtion
100% O2 under positive pressure
succinylcholine 10-20mg

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18
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
AIRWAY OBSTRUCTION
Laryngeal edema
Note: determin edema vs spasm
-more common in
-treatment (4)
A

infants & children

upright position
humidified oxygen
nebulized racemic epi 
(-0.5mlof 2.25% solution in 3ml NS)
Decadron - up to 0.5mg/kg
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19
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
AIRWAY OBSTRUCTION
Wound Hematoma
-procedures causing this (4)
-complication
-treatment
A
  • head / neck / thyroid / carotid
  • tracheal deviation
  • open wound relieves tracheal compression
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20
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
AIRWAY OBSTRUCTION
Vocal cord paralysis
(unilateral vs bilateral)
-procedures causing this
A

-head / neck / thyroid

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21
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
AIRWAY OBSTRUCTION
-gauze in..
A

packing in hypopharynx

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22
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
HYPOVENTILATION
-PaCO2 \_\_
-clinical significant PaCO2 \_\_or pH \_\_
A

> 45
60
< 7.25

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23
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
HYPOVENTILATION
RESIDUAL EFFECTS OF ANESTHETIC AGENTS
-opioid induced considerations (1)
-benzodiazepine-induced considerations (1)
-residual muscle relaxation (5)
A

OPIOID
-caution w/ antagonsim - watch for renarcotization

BENZO
-caution with reversal

MUSCLE RELAXATION

  • inadequate reversal
  • overdose of reversal
  • hypothermia
  • renal or hepatic dysfunction
  • pharmacologic interaction w/ “mycin” abx or Mg therapy
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24
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
HYPOVENTILATION
-other causes (3)
A
  1. splinting due to excessive pain
  2. abdominal distension
  3. tight abdominal dressings
25
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
HYPERCABIA
-increased CO2 production d/t (3)
-underlying disease (3)
A

shivering / hyperthermia / sepsis

pulmonary / neuromuscular / neurologic

26
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
HYPOXEMIA
-is this common in PACU
-s/s
-due to
A
  • yes - unless supplemental oxygen administered during emergency
  • hypoventilation or Diffusion hypoxia (N2O)
27
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
HYPOXEMIA
CAUSES (2)
A

intrapulmonary shunting

bronchospasm

28
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
HYPOXEMIA
INTRAPULMONARY SHUNTING (5)
A 
atelectasis
parenchymal infiltrates
large pneumothorax
pulmonary embolism
pulmonary edema
29
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
HYPOXEMIA
INTRAPULMONARY SHUNTING
PULMONARY EDEMA DUE TO (3)
A

cardiogenic
ARDS
negative pressure

30
Q 
PACU CARE
INTERMEDIATE PHASE
RESPIRATORY SYSTEM
HYPOXEMIA
-treatment(2)
-guided by (2)
-CXR to see (3)
A

underlying problem
supplemental O2

therapy guided by SpO2 & ABGs

lung volume / heart size / pneumothorax

31
Q 
PACU CARE
INTERMEDIATE PHASE
CARDIAC SYSTEM
HYPOTENSION
-conditions that DEC cardiac output (6)
A 
absolute hypovolemia
relative hypovolemia
myocardial ischemia/infection
myocardial depression
myocardial failure
dysrhythmia (tachy / brady)
32
Q 
PACU CARE
INTERMEDIATE PHASE
CARDIAC SYSTEM
HYPOTENSION
CONDITIONS
-Absolue hypovolemia causes (7)
A 
preop fasting
pre-existing dehydration
pre-existing hemorrhage
operative blood loss
intraop evaporative losses
third space lesions
urinary output
33
Q 
PACU CARE
INTERMEDIATE PHASE
CARDIAC SYSTEM
HYPOTENSION
CONDITIONS
-Relative hypovolemia causes (6)
A 
Dec SNS outflow
sympathetic blockade
vasodilation-med induced or blood component
histamine release
intra-abdominal vena caval compression
increased intrathoracic pressure
34
Q 
PACU CARE
INTERMEDIATE PHASE
CARDIAC SYSTEM
HYPOTENSION
CONDITIONS THAT DEC SVR (4)
A

sepsis
vasodilation
blood/colloid reaction
histamine release

35
Q 
PACU CARE
INTERMEDIATE PHASE
CARDIAC SYSTEM
HYPOTENSION
CONDITIONS-causing spurioius hypoTN (4)
A

BP cuff too large
damped or occluded A-line system
severe hypothermia
significant peripheral arterial vasoconstriction

36
Q 
PACU CARE
INTERMEDIATE PHASE
CARDIAC SYSTEM
HYPOTENSION
Treatments (3
Things to measure / assess (3)
Diagnostics (3)
A

increase IV fluids: crystalloids/colloid/blood
supplemental O2
treat dysrhythmias

validate blood pressure
determinecardiac rate & rhythm
listen to breath sounds

12-lead EKG / CXR / ABG

37
Q 
PACU CARE
INTERMEDIATE PHASE
CARDIAC SYSTEM
HYPERTENSION
-note: degree of preop control influences postop pressure
-Causes (5) & treatments
A
  1. incisional pain - narcotics, NSAIDs
  2. intubation - titrate sedation
  3. hypercapnia - treat cause/may need intubation & positive pressure ventilation
  4. hypoxemia
  5. excessive intraop fluids - short acting anthiHTN, time, diuretics if severe
38
Q

PACU CARE
INTERMEDIATE PHASE
OTHER COMPLICATIONS

A 
PONV
PAIN
DELAYED EMERGENCE
EMERGENCE DELIRIUM
OLIGURIA
HYPERGLYCEMIA / HYPOGLYCEMIA
SHIVERING
39
Q 
PACU CARE
INTERMEDIATE PHASE
OTHER COMPLICATIONS
PONV
-risk factors (5)
-increases risk for ?
-treatment (2)
A

female / h/o motion sickness / surgical procedure / narcotics / anesthetic agents

aspiration

supplemental oxygen / medications

40
Q 
PACU CARE
INTERMEDIATE PHASE
OTHER COMPLICATIONS
PAIN
-what must balance
-treatment (3)
A

adequate analgesia vs excessive sedation

narcotics - morphine/dilaudid/demerol

NSAIDs - ketorolac

Regional block

41
Q 
PACU CARE
INTERMEDIATE PHASE
OTHER COMPLICATIONS
DELAYED EMERGENCE
-due to (7)
A 
preop meds
inhalation anesthetics (hypoventilation)
(tissue uptake, agent solubility, duration)
IV anesthetics
intraop narcotics
hypothermia
marked metabolic disturbances
perioperative stroke
42
Q 
PACU CARE
INTERMEDIATE PHASE
OTHER COMPLICATIONS
DELIRIUM
-causes (7)
A 
withdrawal psychosis
functional psychosis
circulatory & resp causes
altered thermoregulation
anxiety
pain
visceral distension
43
Q 
PACU CARE
INTERMEDIATE PHASE
OTHER COMPLICATIONS
DELIRIUM
-anesthetic exposure (6)
-meds (8)
A

ketamine / local anesthetics / butyrophenones / naloxone / N2O / anesthetic agents

anticholinergics / abx / antituberculosis / anticonvulsants / antiarrythmics / antihistamines / antipsychotics / narcotics

44
Q 
PACU CARE
INTERMEDIATE PHASE
OTHER COMPLICATIONS
DELIRIUM
-Treatment (4)
A

rule out hypoxemia
treat cause
consider sedation
consider pt safety

45
Q 
PACU CARE
INTERMEDIATE PHASE
OTHER COMPLICATIONS
OLIGURIA
-causes (4)
A
  • renal response to hypovolemia or hypoTN
  • serious problem w/ renal func 2ndary to surgical procedure
  • inability to void - cath
  • patency of urinary catheter
46
Q 
PACU CARE
INTERMEDIATE PHASE
OTHER COMPLICATIONS
OLIGURIA
-treatment (3)
A

correct underlying problem
increase IV fluids
diuretic only if normovolemic first

47
Q 
PACU CARE
INTERMEDIATE PHASE
OTHER COMPLICATIONS
HYPERGLYCEMIA
-moderate
-severe
-treatment
A

-150-250 mg/dL
usually resolves on its own
no significant effect

> 250 mg/dl
osmotic diuresis
insulin deficiency - diabetic ketoacidosis

titration of regular insulin
(bolus or infusion)

48
Q 
PACU CARE
INTERMEDIATE PHASE
OTHER COMPLICATIONS
HYPOGLYCEMIA
-cause
-treatment
A

excessive insulin administration or secreated

bolus D50 followed by glucose infusion

49
Q 
PACU CARE
INTERMEDIATE PHASE
OTHER COMPLICATIONS
SHIVERING
-causes (4)
-treatment (2)
A
  • cold room
  • prolonged open would
  • cold irrigation
  • long use of high [ ] volatile anesthetics
  • warm patient
  • meperidine
50
Q 
PACU CARE
DISCHARGE PHASE (3)
A

postop teaching
follow up visit
discharge criteria

51
Q 
PACU CARE
DISCHARGE PHASE
DISCHARGE CRITERIA
-WHEN
-MINIMUM CRITERIA (PARS>9)
A

at least 30 min after last dose of narcotic

PARS

  • easily arousability
  • fully oriented
  • maintain & protect airway
  • stable vital signs
  • able to call for help
  • no obvious surgical complications
  • pain controlled
  • resolution of sensory & motor blockade
52
Q

PACU CARE
DISCHARGE PHASE
“SAFE DISCHARGE” CRITERIA (9)

A 
alert & oriented to time / place / person
stable vital signs
pain controlled by PO analgesics
nausea & emesis controlled
able to walk w/o dizziness
no unexpected bleeding
discharge instructions & Rx received
patient accepts readiness for discharge
responsible excort
53
Q 
PACU CARE
DISCHARGE PHASE
SCORING SYSTEM
CRITERIA (5)
-possible scores for each
A 
vital signs
activity level
N&V
pain
surgical bleeding
2, 1, 0
54
Q 
PACU CARE
DISCHARGE PHASE
SCORING SYSTEM
CRITERIA
-Vital signs
A 
2 = Within 20% of preoperative baseline
1 = Within 20-40% of preoperative baseline
0 = >40% of preoperative baseline
55
Q 
PACU CARE
DISCHARGE PHASE
SCORING SYSTEM
CRITERIA
-activity level
A 
2 = Steady gait, no dizziness, at preoperative level
1 = Requires assistance
0 = Unable to ambulate
56
Q 
PACU CARE
DISCHARGE PHASE
SCORING SYSTEM
CRITERIA
-nausea and vomiting
A 
2= Minimal, treated with oral medication
1 = Moderate, treated with parenteral medication
0 = Continues with repeated medication
57
Q 
PACU CARE
DISCHARGE PHASE
SCORING SYSTEM
CRITERIA
-pain - 3 questions
A

(minimal or none, acceptable to pt, controlled with oral meds)
2=yes
1=no
0=severe pain

58
Q 
PACU CARE
DISCHARGE PHASE
SCORING SYSTEM
CRITERIA
-surgical bleeding
A 
2 = Minimal: no dressing change required
1 = Moderate: up to two dressing changes
0 = Severe: three or more dressing changes

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