GI Disorders and PeriOperative Care Flashcards
(177 cards)
1
Q
What is delegation?
A
Transfer of authority, responsibility to a competent individual. The nurse remains ACCOUNTABLE
2
Q
Benefits of Delegation
A
- nurse can perform more complex tasks
- delegate builds new skills, develops trust
- more time for undelegable tasks
- less overtime, more productivity
3
Q
What are the 6 elements of delegation?
A
1, No judgement based on nursing knowledge needed
- Results predictable
- safely performed with no alterations
- no complex observation/clinical decision needed
- does not require repeat nursing assessment
- consequence of improper performance non life-threatening
4
Q
What are the principles for delegation?
A
- nurse must assess patient before delegating
- task must be routine
- nurse must know delegation policies
- nurse must know variations in ability/training
- nurse must foster communication, teaching, learning
5
Q
4 Steps of Delegation
A
- Assessment/planning
- is this the right task to delegate? - Communication
- communicate expectations - surveillance/supervision
- is task being done correctly? - evaluation/feedback
- any problems? job well done!
6
Q
5 Rights of Delegation
A
- Right task
- Right circumstance
- Right person
- Right direction/communication
- Right supervision/evaluation
7
Q
What is civil law?
A
rights and duties of private persons, they usually want compensation
8
Q
Tort
A
A civil wrong against an individual or individuals property
9
Q
Unintentional Tort Types
A
Negligence: deviates from what a normal person would do in a similar situation
Malpractice: professional negligence
10
Q
What must you prove for malpractice?
A
- Duty: relationship between patient and provider existed
- Breach of Duty: act or omission that violates standard of care
- foreseeability: could you see it would cause harm?
- causation: did act cause harm?
- injury
11
Q
What are types of Intentional tort?
A
- Assault: creating apprehension
- Battery: touching w/o permission
- false imprisonment
12
Q
Some things to remember about law
A
- NPA is state law
- document!
- obtain liability insurance
13
Q
What is pancreatitis?
A
inflammation of pancreas - located LUQ behind stomach
autodigestion of pancreas, trypsin released too early
Can be acute (interstitial edamatous) or chronic (necrotizing, permanent)
14
Q
What are the possible causes of pancreatitis?
A
Gallstone - most common - blocks bile duct
Alcoholism
15
Q
Risk factors for pancreatitis
A
T: toxic - metabolic (alcohol) I: idiopathic (unknown) G: genetic A: autoimmune R: recurrent/sever acute pancreatitis
O: obstructive: gallstone, fat, tumor, duct scars
16
Q
Symptoms of acute pancreatitis
A
- mid epigastric pain to upper back
- abdominal distention
- hypoactive bowel sounds D/T ileus
- tachycardia D/T hypovolemia
- hypotension D/T hypovolemia
- jaundice
17
Q
Symptoms of chronic pancreatitis
A
- pain localized in LUQ
- anorexia D/T nausea/pain
- N/V D/T distention
- steatorrhea D/T lack of enzymes
- grey turners and cullens sign D/T blood seepage
18
Q
complications of pancreatitis
A
- cysts and absesses
- SIRS: inflammation through whole body! tachycardia, hypotension, low or high temp, low or high WBC, monitor vitals
- Respiratory complications: ARDS - monitor SPO2
- renal/hepatic failure
- pancreatic infection
- malabsorption/diabetes
- hypovolemia
19
Q
Laboratory Tests for Pancreatitis
A
- increased WBC
- increased amylase
- increased lipase
- increased bilirubin
- increased AST
- increased ALT
- increased triglycerides
20
Q
Diagnostic Tests for Pancreatitis
A
- U/S: to see if gallstones and size
- CT: gallstone, infection
- ERCP: down bile duct through throat
- MRCP: type of MRI, detailed image
21
Q
Pharmacotherapy Pancreatitis
A
- NSAID
- first line
22
Q
Pharmacotherapy Pancreatitis
A
NSAID (1st line), opioid analgesic, H2 Blockers, Proton Pump Inhibitor, Antibiotic (preventative), Pancreatic Enzymes
23
Q
Diclofenac NA
A
NSAID for pancreatitis
24
Q
Morphine, Hydromorphine
A
Opioid analgesic, morphine given first than dilauded
25
H2 Blockers
- Reduce the production of gastric acid
- treat ulcers, GERD, esophogitis
- administer according to recommended time difference between meals
- separate drug and antacid therapy by 1 hour
- maitenance drug therapy given at bedtime
- famotidine ( pepcid)
- cimetidine ( tagemet)
26
Proton Pump Inhibitors
- blocks final step in acid production w/o blocking histamine 2 . decreases hydrogen (acid) production
- administer before meals
- omeprazole (prilosec)
- esomeprazole ( nexium)
- iansoprazole ( prevacid)
- pantoprazole (protonix)
27
impenem (primaxin)
antibiotic
28
Pancreatic Enzymes
- creon (pancreas)
- pancreatin (cotazym)
- pancrelipase (viokase)
29
Nursing Management Pancreatitis
- Rest pancreas NPO
- NG tube, prevent intraabdominal pressure
- TPN
- high carb, high protein, low fat diet
- IV access
- Prevent hypovolemia (watch for fluid overload)
- assess I/O, skin turgor
- CIWA protocol
30
Goals of patient care with pancreatitis
- decrease pain
- adequate fluid/nutrition
- increase respiratory function
- behavior modification (diet)
31
What is cholecystitis?
inflammation of the gallbladder
located RUQ, under liver
gallbladder full of bile will empty after meal
32
Cholelithiasis
gallstones
33
Choledocholithiasis
bile duct stones
34
choleangitis
duct inflammation
35
cholecystits
gallbladder inflammation
36
Risk factors for cholecystitis
```
Female
Forty
Fertile
Fat
Family
```
37
Prevention of cholecystitis
weight loss
diet low fat low cholesterol
certain meds cause GBD like estrogen, clofibrate
38
Cholecystitis signs and symptoms
```
RUQ pain, cramping
Fat intolerance
N/V
Jaundice
Clay colored stool
```
39
Cholecystitis Complications
```
Empyema (puss)
Gangrene
Peritonitis
Pancreatitis
Sepsis
```
40
What is murphys sign?
take a deep breth while palpating RUQ and if pain murphys sign is positive
41
Cholecystitis Lab Values
Increased WBC
increased serum bilirubin
increased amylase
increased lipase
42
What is the normal value for bilirubin?
1.2
43
Cholecystitis Diagnostic Tests
U/S: gallstone?
Cholecystogram: pic of gb with contrast tablet
HIDA Scan: cystic duct obstruction, cholcystitis
44
GBD Pharmacology
NSAID (1ST LINE), Opioids, antiemetic, antibiotic (preventative), gallstone solubizing agents
45
Celecoxib (celebrex), Ketorlac (toradol)
NSAID to treat GBD
46
Antiemetic
Prevent and treat N/V
- promethazine (phenergan) - push slowly or dilute
- ondansetron (zofan)
- metocolopramide (reglan)
- scopolamine ( transderm-scop)
- dimethydrinate (dramamine)
- diphenhydromine ( benadryl)
- granisetron (kytril)
47
Gallstone Solubilizing Agents
- ursodiol (actigal)
- chenodiol (chenix)
- dissolve gallstone
48
Nursing Management GBD
```
- Diet
NPO or SFF
low saturated fat, high fiber, high calcium
- IV access
- NG tube for gastric decompression
```
49
Surgery for GBD
```
- laparoscopic cholecystectomy
treatment of choice
removal of GB
- cholecystectomy, T-TUBE
when stones lodged
drainage bag post op
- ERCP
small stones
captures stones
```
50
Goals for GBD
- decrease pain
- adequate fluid and nutrition
- improve respiratory function
- behavior/mood
51
Types of TPN
Central: more easily tolerated
Peripheral: Short term, nutritional needs less, used as a supplement
52
Indications for TPN
catabolic state, can't eat enough to maintain positive nitrogen balance
needs cannot be met with oral/tube feeding or other IV nutrition
53
Carbs TPN
dextrose
energy & calories
3000-4000 cal/24 hr
54
Amino Acid TPN
for protein
55
Fat Emulsion TPN
prevent or reverse a fatty acid deficiency and provide calories
use non PVC bag or glass/piggyback
56
electrolytes, vitamins, trace elements, medications TPN
- electrolytes: Na, K, Ca, Cl Ph
- Vitamines ADEK, C, B
- trace: zinc, copper, chromium, magnese, selenium
- meds: insulin, heparin, histamine receptor agonist
57
Complications of TPN
- hyperglycemia: dry mouth, HA, nausea, flush skin, thirst, increased urine
- increase rate over several hours
- check sugar every 4-6 hours
- hypoglycemia: cold, clammy skin, weakness, hunger, tachycardia, dizziness
- keep rate accurate, taper rate when D/C, if next bag is not available run D5W or D10W
- infection
- strict asepsis
- redness, swelling, tenderness, drainage, fever, chills
- air embolism
- trendelenburg during cather insertion
- use clamps or valsava maneuver during tube change
- fluid overlad/electroyte imbalance
- refeeding syndrome
- cardiac arrest
- physco aspect
- hallucination with taste/smell
58
Peptic Ulcer Disease Patho
Disruption of the mucosal barrier of the stomach due to H Pylori or ulcer of the lining of the stomach, duodenum, lower esophagus
mucosal injury D/T increaed gastric acid HCL and Pepsin
59
etiology of PUD
- NSAID use (most common cause)
- alcohol, smoking, stress, antbiotic (docucycline, clindomycin)
- zollinger-ellison (tumor in pancrease which incrase hormone that stimulates stomach acid
60
Avoid with PUD
- chocolate
- coffee
- brined/fermented
- fatty
- spicy
- acidic
61
S&S of PUD
```
bloating, belching D/T distention
N/V
weight loss
anemia D/T bleeding
guaic positive ( check H&H)
```
62
gastric ulcer characteristics
```
superficial
"gas" pain
pressure in LUQ
pain 1-2 hours after meal
common in low social status
relieved by eating
```
63
duodenal ulcer characteristics
```
penetrating
cramping pain
pressure in midepigastric and upper abdomen
pain 2-4 hours after meal
stress and disease
```
64
Diagnostic Tests for PUD
```
CBC - check H&H
Fecal Analysis (blood, H. Pylori)
barium swallow
C-Urea (breath in bag, if Co2 increased you have H. Pylori)
EGD
```
65
Pharmacotherapy for PUD
antacids, H2 receptor agonist, PPI, cytoprotective agents, antibiotics
66
Antacids
-Neutralize gastric acid t bring the pH above 3-3.5
-Most not absorbed and excreted through feces
- can cause diarrhea, constipation, effect absorption of other drugs, electrolyte alteration
- take medication 1-2 hours before or after taking antacid
- monitor electrolytes
-
67
Antacid Contraindications
- Amphojel high in sodium, do not use in pt. wih HTN, CHF, renal disease D/T fluid retention
- those containing aluminum must be used cautiously in pt with gastric disease b/c they cn cause constipation and phosphate depetion
- those with magnesium can cause hypermagnesmia
- those containing sodium bicarb can cause metabolic alkalosis
- those with calcium can cause rebound hyperacidity, metabolic alkalosis, and constipation
68
Common antacids
- aluminum carbonate (Basalgel)
- aluminum hydroxide gel ( Alternagel, Amphojel)
- calcium carbonate (turns)
- aluminum/ magnesium compounds (Maalox, Riopan plus)
- sodium bicarbonate
69
Surgery for PUD
- vagotomy (removal of vagus nerve)
| - pyloroplasty ( repair pyloric sphincter)
70
Complications of PUD
```
Pyloric Obstruction
- anorexia, N/V
Hemmorhage
- anemia
Perforation/Peritonitis (lethal!!!)
- rigid, board like abdomen
- rebound tenderness
- no bowel sounds
- hypotension, tachycardia, shallow respirations
```
71
Nursing Management of PUD
- V/S and I/O
- assess repirations and gastric status
- maintain NG tube
- observe for distention
- small, frequent meals
- minimize stress
72
Goals for PUD
- minimize pain
- gastric drainage
- nutrition
- monitor I/O
- observe for hemm/infection
73
IBD Patho
chronic inflammation of GI tract (autoimmune!!). Chrons or Ulcerative Colitis
74
Chrons
usually affects the terminal Ileum and ascending colon, can effect any portion of GI tract
75
Ulcerative Colitis
More common! Affects colon, frequent stool
76
Ulcerative Colitis S&S
```
Diarrhea, mucousy, bloody
LLQ pain
bloody stools
fever (rare)
anemia
weight loss
dehydration
```
77
UC Complications
- chronic anemia
- arthritis
- skin, eye, liver, renal disease
- hemmorage, perforated bowel
- colon cancer
78
Chron's S&S
- always diarrhea
- abdominal pain (RUQ)
- steatorrhea
- fever
- anemia
- weight loss
79
Chron's Complications
- fistula, abcess
- SBO
- colorectal cancer
80
Nursing Management IBD
Diet
- NPO w/ IVF during flare up
- small, frequent meals low residue, lactose free, elemental
- high protein, high vitamin, high carlorie
IV access for antibiotics, transfusion
monitor V/S, I/O, daily weight, stool for occult blood, lab values
Educate: NO alcohol, NO smoking, LOW stress
81
Pharmacotherapy for IBD
5-amino acids, antimicrobials, coricosteroids, immunosuppresents, antidiarrheal
82
5-Amino Acids
- decrease inflammation
| - sulfasalazine ( Azufinide)
83
Antimicrobials
most common
| metronidazole ( flagyl)
84
corticosteroids
metylpredisalone
85
immunosupressents
azathioprine (imuran)
| methotrexate
86
Antidiarrheal
- diphenoxylate HCL (lomotil)
- record number and consistency of stools
- can cause constipation
- bismuth subsalicylate (kaopectate), diphenoxylate-atropine (lomotil), Ioperamide (imodium), amphorated tincuture of opium ( paragoric)
87
Surgery for UC
- total protolectomy
| - total colectomy with ileal pouch
88
Surgery for Chrons
intestinal resection with anastomosis
89
Ileostomy Vs Colostomy
Ileostomy stools more liquid
| colostomy stools more formed
90
Goals of IBD
- less pain
- no diarrhea, fever
- adequet nutrition and fluid
- stress managed
91
Bowel Obstruction
Partial or complete blockage of intestinal lumen
Small (more common) or large bowel
Needs prompt treatment
Intestine contents, gas, fluid, digested substances, accumulate proximal to obstructuion
92
Etiology of bowel obstruction
- increased pressure, distention
- increased pressure obstructs arterial blood flow
- fluid leaks into peritoneal cavity, hypovelmic shock, bowel necrosis, dehydration
93
Risk Factors for Bowel Obstruction
- adehesions (fibrous tissue after sx.)
- volvulus (twisted bowel)
- hernia
- tumor
- fecal impaction
- paralytic ileus D/T sx., infection, opioids
94
S&S of bowel obstruction
- distention
- pain, cramping
- diarrhea/constipation
- obstipation (severe constipation, no gas)
- S/O dehydration (tachycardia, fever)
- peritoneal signs (if perforated)
- bowel dounds borborygmi above obstruction, absent below
95
Diagnostic Tests for Bowel Obstruction
```
CBC (low H&H, increased WBC)
BMP (electrolytes)
urinalysis (UTI D/T pressure?)
abdominal X-RAY, CT (string of perles)
EGD, colonoscopy
barium enema
```
96
Nursing Management for BO
NPO
IV access
GI decompression (NG tube)
monitor V/S I/O, bowel function, labs
97
Surgery for Bowel Obstruction
bowel resection - 30-45 day recovery
bowel resection w/ colostomy - temporary a few months
- lysis of adhesion - scar tissue from abdominal SX.
98
Goals of Bowel Obstruction
decrease pain, maintain nutrtion, prev. respiratory complications, relieve obstruction
99
Cytoprotective Agents
- sucralafate
- treatment of PUD
- forms an ulcer adherent paste that protects ulcer from further damage
- constipation side effect
- instruct pt, to take med 30 min to 1 hour before meals or 2 hours after meals and at bedtime
- do not give antacids within 30 mins of sucralfate admin
- misoprotsol (cytotec)
- prostaglandin analogue
- contraindicated in pregnancy
- PUD
100
Gastric Stimulants
- improves gastric emptying
- relief of GERD sypmtoms
- prevention of nausea by chemo or sx.
- facilitation of small bowel intubation
- metoclopramite (Reglan)
101
anticholinergics
decrease gastric secretions
side effect is drowsiness, dry mouth, urniary retention
- encourage increaed fluid intake
- avoid driving until effects are known
- belladonna alkaloids (atropine, scopolamine), propatheline (pro-bathine)
102
What is perioperative care?
Care provided before, during, and after sx.
103
What is preoperative care?
- 2-3 weeks before sx.
- preadmission testing PAT (not always done by nurse)
- bring list of medications including supplements
104
Nurses Role Intraoperative
promote safety and privacy
prevent wound infection
promote healing
105
nurses role post operative
```
prompt pain control
assessment of surgical site
assessment of drainage tubes
monitor rate and patency of IV
assess patients level of senstaion, circulation, and safety
```
106
Classifications of Surgical Intervention
Emergent: must be done now
Urgent: must be done soon w/i 24-48 hours
Elective: preplanned
107
Preoperative: Pre Admission Testing
Initiates teaching appropriate to patient
- who will drive patient home?
- does patient understand surgery?
- medication/food restriction
108
Informed Consent - Preoperative
Required! Nurse must be sure it's ON FILE, prior to pre-medication, nurse is the patient's advocate
Nurse can serve as witness
- pt must understand before signing, be able to make decisions
109
Preoperative Nursing Assessment
A. Nursing History
B. Physical Assessment (objective data)
C. Assess patient's needs
110
Nursing History
- nutrition, diet, normal elimination pattern, normal sleep pattern, sexulatity, reproductive, etc.
111
Physical Assessment
Head to Toe - Focus on the system that needs surgery
112
Pyschological Needs
- medical decisions
- emotional support - who will take care of patient? how are they feeling?
- cultural considerations - do they want priest? blood transfusion?
113
PreOp Nutrition/Hydration
NPO 8-12 hours
| Check institiution Policy
114
Medication Reconciliation
Stop Taking: anticoagulants, NSAIDS, diuretics, eye drops/inhalers, herbal supplements
115
Preoperative Medications
- Benzodiapines
- midazolam (versed)
- diazepam ( valium)
- relax pateitn, amnesic effect
- Barbiturates
- phenobarbital
- sedation
- anticholinergics
- atropine So4
- opiod analgesic
- fentanyl
- Histamine 2 receptor antagonist
- antiemetics
- metoclopramide hydrochloride (Reglan)
- odansetron hydrochloride ( Zofran)
- promethazine (phenergan)
- scopolamine (transdermal patch)
- phenothazine derivitives
- antibiotics
116
Preop Teachings
- deep breathing
- incentive spirometer
- turning and positioning
- VTE prophalylaxis
117
Patients With High Risk
- old
- diabetes/ chronic disease
- obesity
118
Intraoperative Care
When the patient is placed on the OR table and ends when the patient is transferred to the PACU
119
Role of RN
- Remains sterile
| - safe and optimal outcome is goal
120
Role of Circulating Nurse
- Not sterile, inform family, maintain privacy
121
What are SCIP procedures?
Actions that are required to be completed within the standard perioperative time frame
122
Universal Protocol
Call time out to ensure
1. Correct patient
2. Correct procedure
3. Correct surgical site
123
Nursing Management Intraoperative
- maintain asepsis
- assist with transfer
- provide for privacy/modesty
- provide patient safety
- position patient
124
Types of Anesthesia
I General : completely unconscious
II Local: just the area is numb
III. regiona: ex. epidrual
IV: MAC: twilight zone
125
General Anesthesia: Pre Induction
- pre-op assessment
- check and confirm consent form
- call "time-out"
- time when pt. could have problems, maximum attention on patient.
- attach patient to monitoring machines
126
General Anesthesia: Induction
- initiation of medication
- airway secured
- monitor the devices
127
General Anesthesia: Maitenence
maintain patient safety, positioning of patient
128
General Anesthesia: Emergence
- assist in placement of dressing
- safety of patient
- prepare for pacu
129
General Anesthesia: IV induction agents
- most common
- Barbiturate Hypnotics
- Nonbarbiturate Hypnotics
130
Barbiturate Hypnotics
- thiopental ( pentothol)
- methohexital (brevitol)
- rapid induction w/i 20-60 seconds
- sedation and hypnosis
- NOT analgesia
- may have post op nausea
131
Nonbarbiturate Hypnotics
```
etomidate (amidate)
- little change in cardiovascular status
- useful in unstable patients
- minor resp depression
propofol (diprivan)
- rapid onset
- new
- can maintain anesthesia
- rapid elimination
- less N/V
```
BOTH:
- observe for abormal skeletal movement, N/V, hypotension, hypoglycemia, bradycardia
132
General Anesthesia: Inhalation Agents
through tube or mask
trauma to teeth, lips, vocal cords, or trachea may occur
laryngospasm or bronchospasm
volatile liquid: liquid at room temp. , mixed with O2
gasses: gas at room temp
- depress neurotransmitter in CNS
133
Nitrous Oxide
- Gas
- adjunct to IV drugs
- commmon induction agent
- avoid in pt with bone marrow depression
- give with O2 to prevent hypoexmia
- smells like perment marker
134
Volatile Liquids
Exhibit respiratory depression, hypotension, and myocardial depression, muscle relaxation!
```
Isoflurane (Forane)
- can cause airway irritation
- no increase in ventricular irritability
- no nephro or hapto toxicity
- use with caution in cardiac patients
Desflurane (Suprane)
- fastest onset and emergence
- ambulatory settings
- use with caution in cardiac patients
Sevoflurane (Ultane)
- rapid acting
- non irritating to airway
- may be associated with emergence delirium
Halothane (fluothane)
- bronchodilation
- may cause hepatotoxicity
```
135
Local Anesthesia
Interrupts nerve impulses
Blocks motor (movement) and sensory (feeling) impulses
Topical most common, can be local infiltration, nebulized, or opthalmic
136
Regional Anesthesia
Injection of local anesthesia around or near nerve groups
Regional (peripheral nerve block
IV reginal block (Bier's block)- short term
Spinal Block (dural sac)
epidural
137
Side effects of local/reginal anesthesia
Regional:
Spinal Headache - result of CSF leaking. r/t needle gauge. Blood patch treatment
Local:
palpatations, tachycardia, temor, pallor, diaphoresis - similar to hyperglycemia
138
MAC anesthesia
- benzodiazepines
- opioids
- maintain own airway
139
Nurse role during/after procedure
- monitor v/s
- document
- LOC
- maintain airway - #1 priority
- discharge criteria (v/s stable, pt breath on own?)
140
Malignant Hyperthermia
rare, metbolic disease, dominant, inherited
- caused by depressed hypothalmus
- rise in body temp of 6 degrees C/hour
- often fatal
- succinylcholine
- tachycardia, tachypnea, hypercarbia, ventricular ectopy, hyperthermia
- treat w/ cooling blanket, cool IV fluid
141
Anaphylactic Reaction
- if shows sypmtoms of anaphylaxis stop infusing
- hypotension
- tachycardia
- bronchospasm
142
What is a sentinel awareness?
patient aware during sx. Report to JCAHO
143
PACU
Immediately after surgery until patient is discharged to regular nursing floor
144
What does the intake nurse need to know on admission to the PACU
Full report from anesthesia, why did they do the procedure? Medication received? complications? Fluid status - how much blood lost? IV fluids?
145
What is the aldrete score?
When patient can be safely discharged from PACU - need 7/8.
if less ask doctor why and document!
146
Primary Focus in PACU
- maintain airway #1
- prevent aspiration
- maintain tissue perfusion
- prevent injury
147
complications in PACU
- airway obstruction D/T tongue falling back is most common
| - hemmorhage (check V/S, BP, output, HR)
148
Assessment Requirements in PACU
- every 5-15 minutes until stable
- then every 30 minutes for 1-2 hours
*make sure V/S completed by surgen before accepting patient*
149
Respiratory Status - PACU
1 priority
Assess for airway devices (ETT, OPA, Tracheostomy)
- O2 sat
- respiratory rate, quality, chest expansion, breath sounds, oxygen
- Complication is hypoxemia PaO2 < 60
- hypoventilation ( hypoexmia, hypercapnia) - shallow rapid breathing
- prevent airway obstruction
- prevent complications by side lying position, HOB elevated
150
Circulation - pacu
- ekg, BP, temp./skin color, cap refill, peripheral pulse
- Hypotension most common compliation D/T fluid loss
- Cardiac Arrythmia (hypovolemia, hypoxia/hypercapnia)
- Hypertension D/T pain, anxiety, bladder distention
151
Neurovascular - PACU
Check pulse below sx. site. Especially for regional anesthesia
152
Neurological - PACU
Ability to follow commands
PERLA
Emergent delerium (restlessness, agitiation, disoreiented, thrashing, yelling)
Delayed Emergence - too long to wake up
153
Body Fluid/Genitourinary
I/O, I/V fluids, if urine <30 mL/hr notify HCP!
154
Nursing Interventions For PACU
- Safety
- positioning for airway compliance, turn frequently, stay with patient if restless and find cause
- Pain Relief
- PRN medications before pain, elderly need pain meds even if they don't feel pain because they have delayed response D/T anesthesia,
- N/V
- Comfort measures, anti-emetics
- Thermoregulation
- hypothermia (less than 35 C 95 F), increase infection, bleeding, cardiac problems
- give blankets, bair hugger, meperidine (demerol)
- Psychological Support
- orient while coming out of anesthesia, reassure them
155
Criteria for discharge from PACU
- stable V/S
- acceptable aldrete score
- adequent respiration/circulation
- awake
- complications under control
- SPO2 > 90
- report given
- if pt going home, must have responsible adult
156
Postoperative Phase
When patient is admitted to PACU and ends when patient no longer needs sx. related nursing care
157
Initial Assessment in post op care
Any pre op orders dont apply
| Temperature may increase 1st 48 hours, if temp increase for greater than 2 days may be another problem
158
Plan of Care for Respiratory function post op
No pneumonia, no atelectasis, promote gas exchange, RR 12 - 20 SPO2 >95 room air
159
Plan Of Care for Urinary Function Post Op
SCIP - remove foley within 24-48 hours (MD order)
- must void within 8 hours of sx. or removal of foley
- palpate bladder for retention
- bladder scan
- provide measures to help trigger spontaneous voiding
160
Plan of Care GI function Post Op
- enforce dietary orders (NPO to ADAT)
- note for signs/symptoms of ileus (bloated, N/V, constipation, cramps, watery stool)
- antiemetics PRN
- NGT patency
161
Pharmacologic Management Post Op
- Nonopioid
- 1st choice
- for mild to moderate pain
- NSAID (prevent prostaglandin synthesis)
- tylenol (can cause liver damage)
- Opioid
- moderate to severe pain
- monitor for sedation/resp depression
- Adjuvant Analgesic
- local anesthetics (blacks Na channels prev. induction of nerve impulses)
- antivonvulsants ( stabilize nerve membranes)
- antidepressents ( increase level of neurotrans in spinal cord that blocks nerve transmission)
162
Wound Maintainence Post Op
- superficial wound infection most common
- assess for pain/discharge
- aseptic technique
- HCP changes first post op dressing
- incisional cellulitis/ deep tissue absess
- with bowel SX.
- wound will require vacuum, packing, or frequent dressing changes
- deep abscesses may need re-exploration
- Gangrene
- rare, life threatening
- painful, rapid swelling, bloody discharge
- crepitius
- emergency surgery
163
Discharge Criteria
```
comfort control
activity tolerance
knows when to notify HCP
measures to promote healing
health promoion/agency support
restoring wellness
```
164
Cystitis
inflammation/infection of the bladder - urethra to bladder
165
Pyelonephritis
inflammation/infection of kidney - uretrha to kidney
166
Bacteriuria
Bacteria in the urine
167
Bacteremia
bacteria in the blood
168
urosepsis
infection starts in UT and spreads into blood stream
169
Most common cause of UTI
CAUTI
170
Lab Work UTI
- CBC
- leukocyte esterase
- nitrates (normally in urine) to nitrities (when infected)
- WBCs
- Urine Culture
171
Risk Factors UTI
- female
- sexual activity
- use of birth control
- menopause
- catheter
- supressed immune system
- ut abnormailites
- bloackage in UT
- recent urinary procedure (cystoscopy)
172
Escherichia Coli
caused by wiping back to front
173
Kiebsiella
common with CAUTI
174
Enterococcus
From caregiver or pt. to pt.
175
Proteus
pseudomonas
enterobacter
canidida
CAUTI common
176
Obtaining Urine Specimens
Clean catch
sterile urine bag
urethral cath
suprapubic aspiration
177
Treatment UTI
- antibiotic
- fluids
- phenazopyridine (pyridium)
- can cause orange/red fluids
