Exam 2 Flashcards
(145 cards)
Preoperative
Begins when the decision
to have surgery is made
and ends with transfer
onto the Operating Room
(OR) bed
Intraoperative
Begins when pt is transferred onto the PR bed and ends with admission to the PACU
Post-operative
Begins when patients is admitted to the PACY and ends with a follow-up eval in clinic or home
Pre-op nursing interventions
Patient safety, manage nutrition and fluid-status (npo), prepare bowel if abdominal or pelvic surgery, prepare the skin, admin meds, maintain pre-op record, patient warming to prevent hypothermia, coordinate with family
Urinary post-op complications
-unable to void 8-10 hrs post op
-palpable bladder
-frequent, small amount of voiding
-pain in the suprapubic area
respiratory post-op complications
atelectasis and pneumonia
atelectasis
-dyspnea
-tachypnea
-dec. breath sounds
-asymm chest movement
-tachycardia
-increased restlessness
pneumonia
-rapid respirations
-shallow respirations
-fever
-wet breath sounds
-asymm chest movements
-productive cough
-hypoxia
-tachycardia
-leukocytosis
circulatory post-op complications
pulmonary embolism and hypovolemic shock
-monitor for fluid deficit or volume excess
-Foley needs at least 30mL/hr
-voiding at least 240 mL/8hr
-labs (HGB, HCT, lytes, Cr, BUN
-encourage PO fluid replacement
pulmonary embolism
-chest pain
-dyspnea
-increased resp. rate
-tachycardia
-increased anxiety
-diaphoresis
-dec. orientation
-dec. BP
-blood gas changes
hypovolemic shock
-dec urine
-dec BP
-weak pulse
-cool clammy
-restlessness
-increased bleeding
-increased thirst
-dec. CVP
wound post-op complications
infection, dehiscence, evisceration
infection
-redness
-purulent drainage
-fever
-tachycardia
-leukocytosis
dehiscence
-disruption of surgical incision/wound
-sutures give way (infection, distention, cough, older age, poor nutritional status)
-can be prevented by: abd. binder, pillow when coughing, using leg muscles not bd muscles
evisceration
-evidence of bowel through incision
-increased pain + vomiting
-moist NS dressings
-NPO
-will be returning to OR
G.I complications
gastric dilation, paralytic ileus
gastric dilation
-nausea and vomiting
-abd distention
paralytic ileus
-dec. bowel sounds
-no stool or flatus
-nausea
-vomiting
-abd distention
-abd tenderness
gastric dilation
-nausea + vomiting
-abd distention
on arrival to the med-surg unit, nurse must assess:
-pt’s appearance
-vital signs
-neuro
-cardiac
-respiratory
-CSMT
-surgical site
-toileting
-GI > bowel sounds > nausea
-pain level
-drains
-IVs
treatment of pulmonary issues
- early AMBULATION!
-must re-expand lungs
-turn, cough, deep breathe, I/S, acapella (“pickle”)
-clear secretions
-splinting of incision
-pain management
urinary retention
-anesthetics, anticholinergics, opioids
-abd. pelvic, hip surgeries= increased likelihood
-pt should void within 8 hours
-must be assessed on arrival to unit and freqently
-bladd scan and possible catheterization if cannot void
bowel function post-op
-constipation very common
-assess bowl sounds, monitor BMs, flatus, hiccups, burping, N/V, distention
-decreased mobility, oral intake, opioid analgesics
-irritation/gastric dilation
-manipulation of bowel, trauma
-best course: ambulation, turning/repositioning, prophylactic stool softeners, improved dietary intake
-no BM for 2-3 days = notify
VTE to DVT
-stress response from surgery makes blood hypercoagulable
-dehydration, low cardiac output
-immobility (blood pooling in extremities)
DVT!