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PACU Care Complications Flashcards

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1
Q

At what temperature when patient is considered hypothermic (PACU care complications)?

A

Temp < 36 C

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2
Q

PACU Care Complications

What are complications associated with hypothermia?

A

Shivering
Impaired wound healing/ surgical infection site
Myocardial ischemia
Coagulopathy

Hypothalamus plays a central role in temperature sensing and regulation

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3
Q

What is the treatment for hypothermia?

A

Warming measures checked Q15 minutes

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4
Q

PACU Care Complications

What are the risk factors for PONV?

A

Female +1
Nonsmoker +1
PONV Hx +1
Postoperative opioids +1

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5
Q

PACU Care Complications

What procedures increase risk of PONV?

A

laparoscopic
strabismus correction
ear procedures

Odom-Forren J. Drain’s Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders: 2013: 404.

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6
Q

What is the difference between Reglan and Zofran (PACU care complications)?

A

!Reglan - MOA is increasing gastric emptying
!Reglan contraindicated patient’s with Parkinsons because it blocks dopamine receptors
!Zofran - given after chemotherapy or surgery
Zofran - 5-HT3 receptor antagonists, MOA blocking the action of serotonin, a natural substance that may cause nausea and vomiting

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7
Q

PACU Care Complications

What are the side effects of scopolamine (PACU care complications)?

A

!Disorientation
!Hallucinations
Sedation
Dry mouth
Visual disturbance
Dysphoria
Confusion

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8
Q

PACU Care Complications

What is the mechanism of action of scopolamine patch?

A

Prevents transmission of signals between vestibule in innear ear and vomiting center of brain

Odom-Forren J. Drain’s Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders; 2013:408t.)

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9
Q

Who are at risk for unintended intra-operative awareness complication (PACU care complications)?

A

History of drug or alcohol abuse
Extreme anxiety
Previous episode of awareness
For pt w/ ASA status > 3 consider lighter anesthesia

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10
Q

What is emergence delirium (PACU care complications)?

A

Dissociative state of consciousness demonstrated by responsive/ non-responsive agitation that may last 10-45 minutes
Anxiety and Agitation

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11
Q

What is the treatment for emergence delirium (PACU care complications)?

A

Keep safe
!Always rule out hypoxemia

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12
Q

PACU Care Complications

What are the causes of upper airway obstruction?

A

tongue relaxation most common cause, d/t not fully recovered from opioid or sedative medications or whoresidual neuromuscular blocking agents.

Other causes - airway edema, airway injury, hemorrhage, obstructive sleep apnea, or preexisting neurologic or muscular weakness

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13
Q

PACU Care Complications

What are treatments of upper airway obstruction?

A

verbal or tactile stimulation
airway repositioning with chin lift or jaw thrust
placement of oral or nasopharyngeal airway adjunct
application of positive pressure with a bag-valve-mask device

If above are ineffective: oral or nasal placement endotracheal tube, or emergency cricothyroidotomy or tracheostomy

Position patient side-lying with head down to facilitate drainage

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14
Q

What are the signs of airway obstruction (PACU care complications)?

A

Snoring or stridor
Use of accessory muscles
Paradoxical respirations
Dyspnea
Somnolence
Hypoventilation
Hypoxia
Sleep apnea

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15
Q

What is laryngospasm (PACU care complications)?

A

Flow of air is blocked into and out of the lung by spasm of the larynx
It may be partial (possibly with stridor souds) or complete (absence of sound).
Risk factors include excess secretions, vomitus, blood, coughing, artificial airway placement

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16
Q

What are the signs and symptoms of laryngospasm (PACU care complications)?

A

Dyspnea
Hypoxia
Hypoventilation
Absence of breath sounds
Hypercarbia
High pitch crowing sounds

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17
Q

What are possible interventions for laryngospasm (PACU care complications)?

A

Hyperextend neck
Reduce stimuli
Administer humidified O2
Positive pressure ventilation w/ BVM
Administer succinylcholine
Administer steroids/ Lidocaine IV

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18
Q

How does succinylcholine help in laryngospasm (PACU care complications)?

A

Relax laryngeal muscles

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19
Q

How does steroids/ lidocaine IV help in laryngospasm (PACU care complications)?

A

Decrease airway irritation - racenic epinephrine

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20
Q

PACU Care Complications

What is noncardiogenic pulmonary edema?

Study These Flashcards
A

Noncardiogenic pulmonary edema = negative pressure pulmonary edema

d/t upper airway obstruction, laryngospasm, naloxone bolus, incomplete reversal of neuromuscular blockade, or a significant period of hypoxia

21
Q

PACU Care Complications

What are the signs and symptoms of noncardiogenic pulmonary edema?

Study These Flashcards
A

hypoxemia
cough
failure to maintain oxygen saturation levels
tachypnea
frothy sputum

Treatment includes O2 administration, patent airway, CPAP, mechanical ventilation with PEEP if unable to maintaint patent airway

22
Q

PACU Care Complications

What type of diseases predispose patients to pulmonary embolism?

Study These Flashcards
A

obese or immobility
pelvic or long bone procedures
history of congestive heart failure
congenital heart disease
malignant disease.

Signs and symptoms include
tachypnea
pleuritic chest pain
hemoptysis
breathlessness
sense of impending doom

23
Q

What is bronchospasm (PACU care complications)?

Study These Flashcards
A

Constriction of bronchial smooth muscles

24
Q

What are the signs and symptoms of bronchospasm (PACU care complications)?

Study These Flashcards
A

Dyspnea
Wheezing
Use of accessory muscles
Tachypnea
Decrease O2 saturation

25
What are the risk factors of bronchospasm (PACU care complications)?
Asthma COPD Chronic bronchitis Aspiration
26
What is the intervention for bronchospasm (PACU care complications)
Reduce airway irritability
27
What is hypoxemia (PACU care complications)?
D/t respiratory depressant effect of anesthetic agent resulting to shallow breathing. This is more prevalent in patient s/p upper abdominal surgery.
28
What are the signs/ symptoms of hypoxemia (PACU care complications)?
Decrease SPO2
29
What is the intervention for hypoxemia (PACU care complications )?
Administer O2 Deep breathing
30
What are the causes of dilutional hyponatremia in TURP syndrome (PACU care complications)?
Absorption of irrigating solutions !Leads to water intoxication
31
What are the s/s of dilutional hyponatremia (PACU care complications)?
Confusion Nausea Bradycardia Seizure Coma
32
What are the characteristics of compartment syndrome (PACU care complications)?
5 P's Pallor Paresthesia Paralysis Pulselessness Pressure
33
# PACU Care Complications What are the s/s of compartment syndrome?
intense pain unrelieved by conventional methods (hallmark) paresthesia sharp pain on passive stretching of middle finger/toe of affected extremity progressive symptoms include decreased strength, decreased sensation (numbness and tingling), and decreased capillary refilling; peripheral pulses are not generally compromised. **Immediate intervention includes elevation of the extremity, application of ice, and release of restrictive dressings**. | The most significant sign is pain out of proportion with injury or surge
34
# PACU Care Complications What is the most consistent indicator of potential MH in the OR?
Unexpected doubling or tripling of end tidal CO2 when ventilation is kept constant | Possible uncontrolled hypermetabolism ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders; 2013:401.
35
# PACU Care Complicatons Possible urine color in MH?
Dark and cola colored d/t myoglobin breakdown | Central core and muscle diseases predispose patient to MH ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders; 2013:401.
36
# PACU Care Complications Renal goal for treating patient's with MH?
Hydration and diuretics ensure minimum urine output of 2mL/kg/h ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders; 2013:401.
37
# PACU Care Complications What is the late sign for MH?
Fever ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders; 2013:746.
38
# PACU Care Complications What BP medication can not be given to MH?
!No calcium channel blockers for MH It can increase hyperkalemia and lead to death | Diltiazem is a calcium channel blocker agent ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders; 2013:749.
39
# PACU Care Complications Treat MH with dantrolene
2.5mg/kg prn - initial dose treat for the next 48 - 72 hours ICU monitoring for MH complications 25% of MH with relaps ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders; 2013:401.
40
# PACU Care Complications What class of medication is dantrolene, that is given in MH?
muscle relaxant | Inhibits further release of calcium from the skeletal muscle ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders; 2013:747.
41
# PACU Care Complications What is the difference between symptoms of MH and Thyrotoxic Crisis?
Thyroid storm or thyrotoxic crisis can occur after surgical manipulation of a hyperactive thyroid. S/S may initially include fever and tachycardia, and later agitation, disorientation, hypertension, tachycardia, and heart failure proceeding to shock, hyperthermia. Malignant hyperthermia more typically appears intraoperatively with a rise in end-tidal CO 2 , **rigidity**, elevated creatinine kinase, or lactic acidosis, whereas thyroid storm more typically appears postoperatively and with hypokalemia. | Tx bb, iodine, vasopressors, fluidt, O2, salicylates, steroids, cooling
42
# PACU Care Complicatons How long to monitor MH susceptible patient in Phase 1, if no MH noted 1 hour postoperatively, and after following MH safe anesthetic technique?
1-1.5 hour in Phase 2 ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders; 2013:401.
43
# PACU Care Complications MH Trivia!
MH incidence between 1:5,000 - 1:100,000 1st anesthesia exposure may trigger MH **on average**, 3 anesthetics are required to trigger MH reactions develop frequently in males vs. females (2:1) ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders; 2013:401.
44
What is citrate toxicity in blood transfusion (PACU care complications)?
Per NIH, citrate toxicity occurs when citrate in transfused blood begins to bind calcium in the patient's body. However, clinically significant hypocalcemia does not usually occur unless the rate of transfusion exceeds one unit every five minutes or so.
45
What is the treatment for Disseminated Intravascular Coagulation (PACU care complications)?
Fresh frozen Plasma when bleeding is present or anticipated
46
What medication to treat Von Willebrand Disease (coagulation/ bleeding d/o)?
DDVAP - prevents breakdown of clotting factors
47
What are signs and symptoms of epidural hematoma as complication of epidural anesthesia?
Lower back pain Motor changes Bowel/ bladder dysfunction (urine incontinence / NOT retention)
48
What is the treatment for von Willebrand disease?
Cryoprecipitate - produced by thawing FFP and collecting the precipitate
49
# PACU Care Complications What patient conditions increase risk for aspiration?
morbid obesity renal or hepatic failure ascites brain injury or increase ICP decreased LOC delayed gastric emptying difficulty swallowing cerebral palsy trauma pain drug overdose difficult aiway gastrointestinal obstruction anorexia esophageal disorders diabetes ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders; 2013:196.)

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