Midterm Flashcards
(22 cards)
Name 7 post-surgical risks/potential complications.
pneumonia shock cardiac arrest respiratory arrest venous thromboembolism (VTE) bleeding pain (this list is definitely not exhaustive!)
Describe your post-operative respiratory assessments and interventions.
patent airway, adequate gas exchange note artificial airway when applicable rate, depth, pattern of respirations breath sounds accessory muscle use (work of breathing) respiratory depression (as evidenced by decreased rate and/or depth of respirations; may be r/t opioid overdose) hypoxemia (as evidence by decreased PAO2) IS: prevent or reverse atelectasis early ambulation
Interventions for hypoxemia in the post-surgical setting.
airway maintenance monitor SPO2 semi-Fowler's position (30-45 degrees) O2 therapy breathing exercises early ambulation
Describe your post-surgical cardiovascular assessments and interventions.
vital: freq?
heart sounds (note any new dysrhythmias, murmurs, etc.)
cardiac monitoring (telemetry, ecg)
peripheral vascular assessment (pulses, CRT, temp, color, sensation)
monitor for VTE/DVT
early ambulation
use of drugs or devices to prevent cardiovascular complications (need more details here)
What would you want to include in your post-surgical neurological assessment?
LOC, orientation
motor and sensory assessment after epidural or spinal anesthesia
How will you monitor fluid, electrolyte and acid-base balance in the post-operative pt?
I & O, consider all sources (IV fluids, vomitus, urine, wound drainage, NG tube drainage)
hydration status
monitor acid base balance (ABGs, s/sx of acid-base imbalance)
monitor for electrolyte imbalances (labs and s/sx)
What is your priority urinary system assessment in the postop pt?
check for urine retention
report urine output <30 mL/hr
What is a common post-operative GI complaint?
n/v (30% of pts report n/v following general anesthesia)
What GI assessment is important postoperatively?
assess for bowel sounds
peristalsis can be delayed up to 24 hrs
What are the purposes of a postoperative NG tube?
decompress and drain stomach promote GI rest allow GI tract to heal provide enteral feeding route monitor any gastric bleeding prevent intestinal obstruction
How often should you assess postoperative NG tube drainage?
every 8 hours
Describe normal post-op wound drainage.
sanguinous to serosanguinous to serous within the first five days
What nursing interventions would you initiate in post-op pt to address risk of wound infx and delayed healing?
assessment of surgical site
dressing changes (first dressing usually applied by surgeon)
wound drains (help prevent deep infx and abscess)
drug therapy
irrigation to treat wound infx
debridement
surgical management required for wound opening
What is pericarditis?
Inflammation of the pericardial sac
- Could be acute or chronic
- May (or may not) be constrictive
- Pericardial effusion may (or may not) be present
What are some of the possible causes of pericarditis?
Infectious (bacterial, viral, fungal)
Trauma
Post-MI
Cardiac surgery (postpericardiotomy syndrome)
Inflammatory disorders (RA, SLE, rheumatic fever)
Radiation
Idiopathic
S/S of pericarditis
chest pain--usually pleuritic (severe, sharp pain; worse with deep breath) pericardial friction rub (heard over apex) ST-T wave changes fever palpitations tachycardia JVD peripheral edema cyanosis decreased peripheral pulses
What diagnostic testing would you suspect if the provider expected pericarditis?
lab work echocardiogram CXR ECG pericardial fluid analysis CT/MRI may be done
How would you (and the medical team) respond to a pt with pericarditis?
pain control (NSAIDs, anti-inflammatory--colchicine, corticosteroid) treat the cause cardiac monitoring monitor lab work monitor v/s CV assessment treat pericardial effusion, if present O2 therapy may be needed pt/family education may need to discontinue anticoagulation therapy
ARDS is acute respiratory failure with these features:
(1) Hypoxemia that persists even when 100% oxygen is given (refractory hypoxemia, a cardinal feature)
(2) Decreased pulmonary compliance
(3) Dyspnea
(4) Noncardiac-associated bilateral pulmonary edema
(5) Dense pulmonary infilatrates on x-ray (ground glass appearance
What are some common causes of ARDS?
sepsis pneumonia inhalation of gastric contents injury post-operative complication
Iggy says, “Often ARDS occurs after an acute lung injury (ALI) in people who have no [preexisting] pulmonary disease.”
Describe the 3 phases of ARDS.
(1) Exudative: early changes; dypnea, tachycardia; fluid-filled alveoli; FOCUS IS EARLY DETECTION
(2) Fibroproliferative: increased lung damage lead to fibrosis and pulmonary hypertension; poor gas exchange, pt may develop multiple organ system failure (MODS); FOCUS IS SUPPORTIVE CARE
(3) Resolution: Usually occurs after 14 days, resolution of injury; if the injury doesn’t resolve, the pt may die or develop chronic disease. Fibrosis may or may not occur.
S/S of ARDS?
dyspnea pallor intercostal retractions inability to clear cough cyanosis sweating inability to lie flat tripod positioning fatigue
