Common cause of airway obstruction post-op is:
Pt's tongue: put pillow under nech to manually elevate mandible to clear airway
The most common cause of post-op hypoxemia is:
atelectasis caused by retained secrestions or decreased respiratroy excrusions
What is the best postion in an unconsciuos pt recovering from surgery:
Lateral recovery postion to keep airway open and reduce risk of aspiration incase vomitting occurs, once conscious, pt is returned to supine position
To prevent atelectasis, what should you have your pt do:
Deep breathe 10 per hr, incentive spirometer; have pt cough with pillow on abd; adequate hydration to keep mucos loose and thin
If the pt had spinal anesthesia, what position do you have them lie:
supine
If a pt's cough reflex and swallowing is impaired d/t anesthesia, what is done until reflexed return:
suctioning
What are the common s/s of neuropsychologic post-op:
pain, fever, delirum, hypothermia
What are the common s/s of the respiratory system post-op
Airway obstruction, hypoventilation, aspiration of vomit, atelectasis, PNA, hypoxemia
What are the common S/S of cardiovascular post op:
Dysrhythmias, hemorrhage, hypotension, HTN, phlebitis, VTE
What are the common S/S of the GU post-op:
Retention, infection
What are the common s/s of GI post-op:
N/V, distension/flatulence, paralytic ileus, hiccups, delayed gastric emptying
What are the most s/s of the integumentary post-op:
Incision site: infection, hematoma, dehiscence/evisceration, keloid formation
What are the most common s/s of fluid and electrolyte post-op:
FVO, FVD, electrolyte imbalances, acid-base disorders
If pulse ox is lesss than 95%, what should be used to determine O2 sat:
Arterial blood gas analysis
What are the potential RR compications post-op:
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airway obstruction: tongue
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Hypoventilation: hypoxemia/hypercania d/t anesthesia depression
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Aspiration: vomit into lungs may cause pulmonary edema
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PNA
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Hypoxemia
Notes on nsg intervention for respiratory:
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Assess RR patency/accessory muscle use indicates RR distress
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auscultate BS: anteriorly, laterally, posteriorly
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Sputum characteristics: trachea and throat=colorless/thin, lungs/bronchi=thick and yellow
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Position pts: laterally for unconscious, supine for conscious and every 2 hrs for full chest expansion
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deep breathe and cough
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splinting: pillow/blanket against incision line as they cough for support
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ambulation
What are the potential cardiovascular complications post-op:
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Dysrhythmias: d/t hypoxemia, hypercapnia, electrolyte/fluid imbalance
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Hemorrhage
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Hypotension: disorientation/loss of consciousness, chestpain d/t FVD such as hemorrhage
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HTN: d/t sns stimulation from pain/anxiety/bladder distension/repiratory compromise
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Hpovolemia: d/t dehydration, hemorrhage, vomitting, suction, wound drainage
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VTE: anesthesia contributes to vasodilation, inactivity, body position, and pressure
Hypotension that accompanies by normal pulse with warm/dry/pink skin represents what:
normal residual effects of vasodilation after anesthesia requires just monitoring
Hypotension that accompanies by rapid/weak pulse and cold/clammy/pale skin represents:
impending hypovolemic shock requiring immediate attention
Nsg intervention of cardiovascular notes:
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Administration of IV/bolus to normalize BP d/t FVD
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O2 therapy and assessment of VS
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Accurate I7O record along with Lab serum levels
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Early AMb: to improve muscle tone/improve GI/GU function/stimulates circulation/wound healing
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Pharmacologic prophylaxis: Heparin or Fragmin along with SCDs to prevent VTE
What are the potential neurologic/psychologic complications:
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Emergence delirium: waking up wild/thrashing/shouting
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Delayed emergence: d/t prolonged opioids/sedatives
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Postoperative cognitive dysfunction: in eldlery d/t anesthesia is a declined cognitive fuction "sedated like"
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Delirium: out of control
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anxiety/depression
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alcohol withdrawal delrium
Notes on nsg interventions for neurological/psychologic:
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Assess LOC
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Assess pupils
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Act as pt's advocate until pt is fully awake and capable of communication;safeguard their safety
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Orient the pt using clocks, calendars, photographys
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observe pt's behavior to determine normal from abnormal
What are the potential GI complications:
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N/V: females, hx of motion sickness, anethetics/opioids, duration of surgery
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Distension/flatulence: d/t decreased perstalsis from handeling of bowel/NPO status
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Hiccups: d/t irritation of the phrenic nerve that innerviate the diaphragm
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paralytic ileus
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Delayed gastric emptying: d/t handeling of the bowel during abd surgery contributing to N/V
Notes on nsg interventions of the GI:
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Assess abd distension, BS
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Administer IV fluids and antiemetics
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NPO
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Advance diet as tolerated
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early frequent ambulation to prevent abd distention; put pt on right side to help with easy flatulence
How can you encourage a female to void:
Sitting, running water, privacy, drinking water, pouring warm water over perineum, ambulate to the bathroom, bedside commode
How can you encourage a male pt to void:
Standing, running water, water intake, warm water on perinuem, bedside commode, ambulation to bathroom
This type of drain is inserted to permit drainage of excessive serosanguineous fluid/purulent drainage via a latex tube; promotes healing of underlying tissue; prevents complications:
Penrose drain
What are the two types of Close-wound drainage systems drains excess exudate that might interfere with the formation of granulation of tissue; reduce risks of microorganisms, tubes are sutured in place and connected to a resivori:
JP or a Hemovac; fresh post op drain is bloody, late post-op drain is yellowish color
This type of drain facilitates the drainage of body fluids from an organ, duct, or abscess; inserted under the radiological guidance; is sterile/thin/long type of catheter:
Pigtail
This type of suture requires that each stitch to be tied and knotted separately:
interrupted suture
This type of suture is just one thread that runs in a series of stitched and tied only at the beginning and the end:
continuous suture
This typ of suture is used primarily on obesed and DM pts; very large sutures, used in addition to skin sutures, attached to underlying tissues of fat and muscle as well as skin for better support in obesed pts or cases of long healing time:
Retention sutures
A piece of stainless steel wire used to slose certain surgical wounds in place of sutures is defined as:
staples
This type of tape is used primarily for superficial cuts, fall off on their own, strips of tapes used to securely close the edges of an incision; alternate for sutures, falls off within 10 days:
steri-strips
Absence of bleeding and appearance of clot binding to wound edges, inflammation at wound edges for 1-3 days which reduced when clots diminishes, sign of scar formation, and diminished scar size over a period of mo to yrs is a sign of:
sequential signs of healing
Post op pain is greatest when:
12-36 hrs after surgery and decreases within 2-3 days
What are some tx for pain post-op
PCA, epidural analgesia, PRN meds, anti-inflammatory agents
Notes on suctioning:
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NG tube REQUIRES IV MAINTENANCE
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chest tube
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Monitor F & E
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monitor drainage
Gerontologic considerations for post op
