Older Adults Pt 2 > 3.3 Postoperative Care > Flashcards

3.3 Postoperative Care Flashcards

(82 cards)

Study These Flashcards
1
Q

Post-Anesthesia Care

A
  • Patients either go to PACU or Critical Care for recovery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 Phases of Post-Anesthesia Care

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Phase 1

A
  • Intense monitoring and care in the immediate post-op period
    “Intensive Care Setting”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Phase 2

A
  • Transitional period to prepare patients for transport to inpatient units.
  • Patient and family are educated on post-op care and surgeon’s instructions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Phase 3

A
  • Phase 2 and 3 are often combined

- Patient is prepared for self-care and discharged from the facility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PACU Nurse Roles

A
  • Responsible for monitoring/caring for post-op patient
  • Receive hand-off from OR team and anesthesiologist
  • Review pertinent and baseline information upon admission
  • Assess airway, respiratory, cardiovascular function
  • Assess skin color, LOC, ability to respond to commands
  • Re-assess vitals and status every 15 minutes as necessary
  • Administer post-op analgesia
  • Provide handoff to other units or discharge patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PACU Admissions Handoff Report from Anesthesiologist

A

Information
- Name, Age, Surgeon, Procedure, Anesthesia Care Provider, Patient History, Allergies, Major Medical History, Anesthetic’s Used, Pain Medications Given, IV Fluids Given, Urine Output.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Nursing Management in PACU

A
  • On-going evaluation and stabilization of patient
  • Prevent complications after surgery
  • Provide care for patient until recovery from anesthesia complete
  • Resumption of motor/sensory function, orientation, stable VS, absence of hemorrhage or other complications in surgery.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Specific Post-Op Nursing Responsibilities

A
  • Assessment
  • Support of respiratory function
  • Administration of oxygen, coughing, deep breathing
  • Positioning to prevent aspiration
  • Monitoring Vitals
  • Keeping patients warm
  • Assess return of normal bowel sounds and urinary output
  • Preform postoperative teaching
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Post-Op Nurse Outpatient Surgery Responsibility

A
  • Discharge planning/assessment
  • Written instructions for follow-up care
  • Wound care
  • Medications and diet
  • Patients cannot drive home or be discharged alone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Gerontologic Considerations

A
  • Hypoxia, Hypotension, Hypoglycemia more common
  • Frequent monitoring is required
  • Increased confusion occurs (reorientation needed)
  • Dosage of medication should be adjusted
  • Hydration important (maintaining fluid balances more challenging)
  • Increased likelihood of post-op confusion/delirium
  • Older adults may respond differently to pain medication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Assessment

A
  • Airway patency
  • Respiration rate, breath sounds, supplemental pulse, pulse oximetry
  • Pulses, skin color/temperature, capillary refill, ECG, bleeding
  • Take vital signs every 15 minutes.
    ISSUE - Systolic BP less than 90 or greater than 160
    ISSUE - Pulse under 60 or over 120
  • Assess pain levels
  • Assess LOC, movement and sensation, strength
  • Urine output, amount, color, bladder distension
  • Abdominal distension, bowel sounds.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sample PACU Nursing Diagnosis

A
  • Risk of ineffective airway clearance
  • Acute pain
  • Decreased cardiac output
  • Activity intolerance
  • Impaired skin integrity
  • Ineffective thermoregulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Interventions

A
  • Monitor/manage ABC’s
    PRIORITY
  • VS, temperature, gag/swallow reflex, LOC, skin color, capillary refill, pain, surgical site, check all invasive lines/tubes, monitor drainage from tubes, monitor I&O
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

POOR OXYGENATION AND PERFUSION SIGNS

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CNS

A
  • LOC/Mental Status is the first system to be affected by poor oxygenation and perfusion.
  • Restlessness, agitation, muscle twitching, seizure and coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CV

A
  • Hypertension or Hypotension
  • Tachycardia or Bradycardia
  • Dysrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Integumentary

A
  • Cyanosis
  • Prolonged capillary refill
  • Flushed/Moist skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Respiratory

A
  • Use of accessory muscles to breathe
  • Abnormal breath sounds
  • Increased respiratory effort
  • Dropping PaO2 saturation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Renal

A
  • Urinary output is key indicator for poor perfusion

- Output less than 0.5mL/kg/hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Maintaining Patent Airways

A
  • Provide supplemental oxygen as needed
  • Assess breathing by placing hand over face to feel air movement
  • Keep head elevated 15-30 degrees unless contraindicated
  • Suctioning as required
  • Turn patient to side if vomiting occurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Positioning

A
  • Unconscious patients should be kept in lateral recovery position
  • Reduces risk of aspiration and airways open
  • Once conscious reposition to supine with HOB elevated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hypoxemia

A
  • PaO2 less than 60 mmHg

- Most common causes in post-op is atelectasis, pulmonary edema, pulmonary embolism, aspiration, bronchospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Atelectasis

A
  • Most common cause of hypoxemia
  • Thick secretions stimulated by anesthetics that block bronchioles with collapse of alveoli
  • SOB, cough, Low Grade Fever
    IMMEDIATE ACTIONS
  • Humidified O2 Therapy
  • Deep breathing and coughing
  • Incentive Spirometry
  • Early Mobilization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Pulmonary Edema
- Buildup of fluid in alveoli (limits gas exchange) - Results from fluid overload, left ventricle failure, prolonged airway obstruction - Decreased O2 Saturation, crackles, infiltrates on chest x-ray IMMEDIATE ACTIONS - Elevate HOB (if not related to airway obstruction) - O2 Therapy - Diuretics - Fluid Restriction
26
Pulmonary Embolism
- Thrombus lodged into pulmonary arterial system - Results from hemoconcentration, left ventricular failure, prolonged immobilization. - Acute tachypnea, dyspnea, tachycardia, hypotension, decreased o2 saturation, bronchospasm IMMEDIATE ACTIONS - Elevated HOB - O2 Therapy - Cardiopulmonary Support and O2 Therapy - Anticoagulants
27
Aspiration
- Inhalation of gastric content into lungs - May cause laryngospasm, infection, and pulmonary edema - Unexplained tachycardia, decreased o2 saturation, bronchospasm, atelectasis. PREVENTION IS GOAL IMMEDIATE ACTIONS - Elevate HOB - Cardiopulmonary Support - Antibiotics
28
Bronchospasm
- Increased smooth muscle tone with closure of small airways - Wheezing, dyspnea, tachypnea, decreased O2 sat, use of accessory muscles, hypoxemia IMMEDIATE ACTION - O2 Therapy - Bronchodilators - IV anti-cholinergics - IV steroids IF TREATMENT RESISTANT IV EPINEPHRINE SHOULD BE ADMINISTERED
29
Airway Obstruction
- Muscular flaccidity with decreased LOC - Tongue falls backwards and occludes pharynx due to anesthesia or muscle relaxants - Use of accessory muscles, snoring respirations, decreased air movement, laryngospasm, crowing respirations, inspiratory stridor. IMMEDIATE ACTIONS - Head tilt/Jaw Lift - Reintubation
30
Hypoventilation
- Respiratory depression from anesthesia, or mechanic restriction from position, dressing, obesity. - Shallow respirations, decreased breath sounds, decreased oxygen saturation, rising CO2 levels IMMEDIATE ACTIONS - PREVETION IS GOAL - Elevate HOB - Administer O2 - Reverse Opioids - Mechanical Ventilation
31
Cardiovascular Stability
- Monitor CV status - Assess IV lines - Recognize potential hypotension and shock - Systolic less than 90 mmHg should immediately be reported - BP with downward trend of 5 mmHg each 15 minutes should also be reported
32
Hypovolemic Shock
- Low BP - Decreasing pulse pressure - Rapid/Weak/Thready Pulse - Cool/Moist Skin - Pallor/Cyanosis - Rapid Respirations - Altered Mental Status - Decreased and Concentrated Urine
33
Pain Signs
- Increased pulse/bp - Increased RR - Diaphoresis - Restlessness - Moaning/Crying - Confusion (Especially in older adults)
34
Patient-Controlled Analgesia
- Common for acute post-op patients - Ordered by provider or anesthesiologist - Managed by anesthesia in non-surgical patients - Mostly opioids are used (morphine, fentanyl, hydromorphone) - Delivers calculated preset continuous infusion - Patient can click a button to deliver pre-set bolus dose of analgesics - Proxy can be designated to use the PCA - There is a lock-out time after clicking button to prevent overdose
35
PCA
- Shown to be more effective then intermittent IV or IM dose - Gives patients sense of control over pain management - Decreases anxiety/depression
36
Role of Nurse in PCA
- Determine patients baseline pain levels, vs, LOC, mental status, level of sedation - Assess for prior opioid use and medical allergies - Immediate access to naloxone (Narcan) - Patient teaching on how and why to use PCA
37
ON-Q Pump
- Sub-Q pain management system - Delivers local anesthetic to surgical site - Rate is determined by physician
38
On-Q Pump
- Less need for narcotics - Quicker return to normal activities - Less chance of grogginess - Greater mobility and ambulation
39
Aldrete Score
- Monitored every 10 minutes during phase 1 PACU - Used to assess if a patient can be discharged to inpatient unit or phase 2 PACU - Criteria include consciousness, stable vital signs, no excess bleeding or drainage, no respiratory issues, o2 saturation over 90%
40
Handoff Report to Floor/Unit Nurse
``` Should follow SBAR S - Situation B - Background A - Assessment R - Recommendations ```
41
Inpatient Unit
- Upon arrival, assist to bed - Vital signs - Assessment compared to PACU report - Oriented to room, call bell, lowered bed - VS measured every 15 minutes for an hour
42
Prevention of Respiratory Complications
- Deep breathing to prevent alveolar collapse - Inhale deeply through nose, hold, and exhale completely through mouth - Patient hands should be slightly above abdomen - Do this 10 times every hour while awake - Change positions every 1-2 hours - Ambulation as soon as possible - Adequate Analgesia - Adequate hydration to keep secretions thin and loose
43
Effective Coughing
- Deep breath, hold for 2-3 seconds, and use abdominal muscles to forcefully expel air - Abdominal/chest incisions should be splinted with pillow, arms, or hands to decrease pain.
44
Prevention of CV Complications
- Leg exercises to maintain blood flow - Sequential Compression Devices to prevent blood clots - Anti-coagulants for high risk patients
45
Postoperative Neurological Assessment
- Focused on orientation and LOC - Glasgow coma scale if indicated - Pupillary check - Sensory and Motor Status
46
Urinary Assessment
- Assess color, amount, retention and oliguria - Consistency and odor (infection such as UTI) - Output should be 0.5mL/kg per hour with indwelling catheter - 30mL/Hr at least - Assess for bladder distension, bladder scan, and catheterize patient if they have not voided in 6-8 hours.
47
GI Assessment
- Resume oral intake once gag and swallow reflex return - While NPO IV fluids maintain needs - Frequent mouth care - Ambulation encourage gastric motility
48
Nausea
- Immediately turn patient to their side to promote mouth drainage and prevent aspiration - Administer antiemetic's or prokinetic drugs
49
Postop Ileus
- Temporary impairment of gastric and bowel motility after major abdominal surgery. - Assess for distension due to decreased peristalsis
50
NG Tubes
- Inserted during surgery to drain stomach, promote GI rest, allow GI tract to heal, provide route for enteral feeding, monitor gastric bleeding, prevent intestinal obstruction - Drained material assessed for 8 hours and counted as patient output
51
Altered Temperature
- Temp should be measured every 4 hours - Asepsis with surgical wounds and IV sites - If fever develops obtain culture - Chest X-ray may be needed - Antibiotics - Antipyretic medications
52
Progressive Ambulation
- Early ambulation is most significant nursing care measure to prevent post-op complications - Allow patient to sit in high fowler - Help patient sit and dangle legs off side of bed - Evaluate symptoms of orthostatic hypotension or hypotension
53
First Dressing
- Surgeons are usually the one to change original dressing | - If you note bleeding, reinforce the dressing and mark the area of bleeding
54
Drainage
- Note the type, amount, color, consistency, and odor of drainage on dressing - Expected to change from sanguineous to serosanguineous to serous - Drainage is recorded as output
55
Dressing Change
- Sterile technique - Determine type of dressing material required before removing existing dressing - Assess for infection, number of drains, overall appearance of wound - Note drainage at time of dressing change
56
Montgomery Straps
- Used when frequent dressing changes are anticipated | - Prevents skin irritation from tape removal
57
Surgical Drains
``` Penrose - Passive drainage onto dressing Jackson Pratt (JP) - Non-mechanical vacuum bulb Hemovac - Non-mechanical vacuum chamber ```
58
Hematomas
- Pooling of blood outside blood vessel | - Develops when drainage blood accumulates under incision
59
Dehiscence
- Separation of previously approximated wound edges - May occur with wound infection - Brown, pink, or clear drainage may precede dehiscence - Wound cultures should be obtained - Surgeon should be notified immediately
60
Evisceration
- Protrusion of abdominal organs from opened incision | - Cover area with sterile dressing soaked in sterile saline and notify surgeon immediately
61
Fentanyl (Sublimaze, Duragesic)
- 100 times more potent than morphine. | - Synthetic opioids like fentanyl are the most common drug involved in overdose deaths
62
Sublimaze (Parenteral)
- Used for severe pain | - Used for moderate sedation
63
Duragesic (Transdermal)
- Patch activated by body heat | - New patch over non-bony area every 72 hours
64
Transmucosal
``` - Absorbed across mucous membrane Actiq - Lozenge on a stick Onsolis - Buccal Film Fentora - Buccal Tablet Abstral - Sublingual Tablets ```
65
Meperidine (Demerol)
- No longer frequently used - Significant toxic metabolite so use with caution - Used for post-operative shivering
66
Methadone
- Used for treatment of pain and opioid addicts
67
Hydromorphone, Oxymorphone, Levorphanol
- Semi-synthetic opioid analgesic - More potent than morphine but shorter duration - Greater sedation - Available in parenteral and oral forms - Moderate to Severe Pain
68
Codeine
- 10% converted to morphine in liver - Used for pain and cough suppression - Usually administered orally but can be parenteral - 30 mg codeine equals 325 mg acetaminophen
69
Oxycodone
- Long-acting analgesic Roxicodone - Immediate release OxyContin - Controlled release
70
Hydrocodone
- Most widely prescribed pain medication in the US - Used in combination with aspirin, acetaminophen, ibuprofen - Available as tablets, capsules, syrups
71
Tapentadol (Nucynta)
- Analgesic equivalent to oxycodone but causes less constipation
72
Agonist-Antagonist opioid
- Effective as analgesic with less potential abuse
73
Pentazocine (Talwin)
- Incomplete reversal of cardiovascular, respiratory, and behavioral depression induced by morphine - 50 mg orally equates to analgesics of 60 mg of codeine
74
Nalbuphine (Nubain)
- Buturphanol - Used during labor for pain - 7 day patch or sublingual film (Suboxone)
75
Clinical Issues with Opioids
- Physical Dependence - Abstinence syndrome when withdrawn (not addiction) - Abuse - Drug use inconsistent with medical or social norms - Addiction - Behavioral pattern by continued use of psychoactive drugs despite physical, psychological, or societal harm
76
Naloxone (Narcan)
- Antagonist to opioids with onset within 2 minutes - Metabolized in liver and can cross placenta - 0.4mg - 2mg original dose via IV - Can also be Sub-Q or IM - Endotracheal, Nasal, Sublingual, Intralingual, and submental routes - Reversal of Opioid Overdose
77
Non-Opioid Centrally Acting Analgesics
- Provide pain relief unrelated to opioid receptors | - Do not cause respiratory depression, physical dependence, or abuse
78
Tramadol (ultram)
- Combination of Opioid and Non-Opioid Mechanisms - Has potential for abuse Adverse Effects - Drowsiness, Sleep Pattern Changes, Mood Alterations - Shaking, Muscle Tightness, Nervousness - May increase suicidal thoughts
79
Clonidine (Duraclon)
- Alpha 2 adrenergic Agonist - Used in combination with opioids - Analgesic by blocking pain signal transmission - Epidural, Oral, Transdermal, Extender Release Adverse Effects - Cardiovascular (hypotension, rebound hypertension, bradycardia)
80
Antiemetic and Prokinetic Medication
- Antiemetic medications help with nausea and vomiting that occurs with anesthesia - Can also be used for patients receiving chemotherapy - Prokinetic drugs also help with nausea
81
Metoclopramide
- Peripheral cholinergic agonist and dopamine antagonist | - Most commonly used antiemetic/prokinetic drug
82
Prokinetic Drugs
- Improve esophageal and gastric motility - Decrease gastric reflux - Accelerate gastric emptying - Limited to upper GI tract, esophagus, and stomach
Older Adults Pt 2
flashcards
Decks in class (17)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions