Med Surg: Postoperative complications Flashcards
(22 cards)
What are possible immediate respiratory problems?
Airway Obstruction:
- Tonue falling back: supine, block pharynx, accesory muscle
- Retained thick secretions: noisy, cracking, suction, cough, hydrate
- Laryngospasm: stridor, sternal retration
- Larngeal edema
Hypoxemia:
- Atelectasis: alveolar collapse, decrease breath sounds & O2 saturation, cough, deep breath, early mobilization
- Pulmonary edema: fluid in alveoli, airway lost, sepsis, decrease O2 saturation
- Aspiration: astric content in lungs: infection
- Bronchospasm: increase muscle tone, narrow airway, wheeze
HYpoventilation:
- depression of central respiratory drive
- poor respiratory muscle tone
- Mechanical restriction
- Pain
What are ongoing respiratory problems?
Atelectasis
Pneumonia
What is the nursing management of respiratory problems?
Assessment: rate, depth, effort, chest symmetry, pulse ox, mucus characteristics
Positioning: lateral side until conscious, elevate HOB
Oxygen: help get rid of anesthetic ases, give more to blood/tissues
Coughing: incentive spira (visual feedback), deep breathe, splint
Positiong changes: every 2 hours, allow chest expansion, sit in chair, ambulate, offfer analesics, hydrate
What are the immediate cardiovascular problems?
Hypotension: decrease perfusion, LOC, chest pain, oliguria, cardiac ischemia, renal/bowel ischemia, unreplaced fluid and blood.
Hypertension: SNS stimulation
Dysrhythmias: anesthetic agents, stress, heart disease, electrolyte imbalance.
What are ongoing cardiovascular problems?
Fluid and electrolyte imbalance: fluid retention, fluid overload, fluid deficiet, hypokalemia and hemorrhage
Tissue or blood floor alterations: stress response, vasodilation, stagnant blood, tachypnea, dyspnea, chest pain, cough blood, agitation
Syncope: faint, decrease CO, fluid volume deficiet, decrease cerebral perfusion
What is the nursing management of cardiovascular problems?
Assessment: VS, telemetry, skin color, temp, moisture
Oxygen: to perfuse organs, check bleeding
Fluid management: fluid bolus, monitor I&O, electrolyte, H&H, listen to breath sounds
Correction of dysrhythmias: meds (K deficit)
Prevention of blood flow: prevent VTE (movement, but slowly), anticoagulant, external devices
Activity: Prevent falls, safety
Immediate neurologic problems?
Emergence delirium: waking up wild, restless, agitated, disorientated, hypoxia, pain, bladder distention, ET tube
Delayed emerence: prolonged drug action
What are ongoing neurologic problems?
Postoperative cognitive dysfunction: decrease pt cognitive, anesthesia duration, fluid and electrolyte balances, drug effects, sleep deprevation
Delirium: varied LOC, coordination issues, disturbed sleep-wake
Anxiety/Depression: grieving, amputation, ostomy, trash
Alcohol withdrawal delirium: restless, insomnia, nightmares and visual hallucinations
Nursing management of neurologic problems?
Assessment: LOC, motor function, ability follow commands, pupils, sleep-wake cycle, baseline
Treat hypoxemia
Sedation
Patient safety: railes, tubes/IV secured, ID band
Maintenance of normal physiolgic functions: I&O, vitals, nutrition, pain management, bladder and bowel funtion, mobilization
Emotional support: listen, encourage family, pastoral care, psych consult, prevention is key for alcohol withdrawal
Immediate and ongoing pain and discomfort?
Skin and tissue trauma: can be anxiety & fear, surgical positioning, tubes, internal viscera only feel pressure
Nursing management for pain and discomfort?
Assessment: pain scale, location, restless, diaphoresis
Analgesics: IV opiods, PCA, epidural opiods, regional blockade, plan according to activity, make pain in control
Nondrug approaches: warmth, reposition, ice packs, massage, distration, deep breathing, ambulation
What are immediate and ongoing alterations in temperature?
Hypothermai: core temper <95, cold irrigation, inhalation anesthesia, older, intoxicated
Fever: would, UTI, superficial vein thrombosis, DVT, C. Diff, antibiotics, septic, chills, diaphoresis, GI/GU surgeries
Nursing Management of Temperature?
Assessment: frequent check and see pattent, would infection and inflammation
Passive rewarming: shivering
Active rewarming: external warmth
Diagnosis and treatement of fever: prevent infection, look for source, treat with antibiotics, use antipyretics or cooling devices
Immediate and ongoing Gastrointestinal Problems?
Nausea and Vomitting: increase discomfort, dissatisfies, motion sickness, postop N&V, certain anesthetic and optiods, type of surgery
Abdominal distention: decrease peristalsis, swallowed air, gastric secretions
Hiccups: spasm of disphargm, intestine obstruction, bleeding, acid/base balance, subside on own
Constipation: stool withint 48 house solid food
Paralytic ileus: abdominal wall distended, no movement intestine wall, vomit, discomfort, no flatulance or stools
What is the nursing management of gastrointestinal problems?
Assessment: feel N&V, assess emesis, bowel sounds, flaus
Antiemetics: preventitively to treat
Oral intake: slowly, only as ordered, prevent spiration, suction available
Gastric decompression: if distended, NG tube, early ambulation, pronounced day 2-3, lie right side topass gas
What are immediate and ongoing urinary problems?
Low urine output: common, not dependent on intake, NPO, stress, surgical loss, normal on day 2-3
Urinary retention: anesthesia, pain interfere with bladder fullness
Oliguria: renal failure, ischemia
Nursing Management of urinary problems?
Assessment: amount and quality, check patency and placement
Catheterization: if no outpout 6-8 hours after surgery, check distention first, provide privacy and proper position
Immediate and ongoing integumentary problems?
Would healing issues: inadequate nutrition, chronic disaese, alcoholism, obesity
Wound infection: exogenous flora in environment and on skin, oral flora, intestinal flora, prolonged stay
Wound dehiscence: cover area with sterile non adherent or saline gause, physician notified
Wound evisceration: surgical emergency, call for help, flat HOB, sterile gause with wound saline, check VS, prepare for surgery
Nursing Management of integumentary problems?
Assessment: skin level (2 weeks), whole integument (2 years), head/face (fast heal)
Wound care: drainage dressing, aseeptic technique, open to air when no drainage, splint
Discharge planning for the surgical patient
Wound care needs
Skilled needs: IV antibiotics, tube feeding, wound care, physcial or occupational therapy
caregiver
Licing situation
Finances
Ability to meet follow-up appointments
Discharge teaching for the surgical patient?
diet: restrictions, vitamins, proteins
activity
wound care: hand hygiene, clean home, change dressing
Medication: finish antibiotics, pain meds
Bathing: shower, no tub, pat dry
Follow up appointments: when, who , dont need appointment
Call the HCP if: wound concerns, pain control issues, other complications, quations or concerns
