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NURS 412 > Post-op complications > Flashcards

Post-op complications Flashcards

(73 cards)

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1
Q

Respiratory Complications

A

Anaphylaxis
Atelectasis
Hypoxemia
Aspiration
Pneumonia
Sepsis

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2
Q

What causes buildup of mucous in the lungs = lung infection?

A

general anesthesia decreases normal breathing and removes urge to cough after surgery, hurts to breath

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3
Q

Anaphylaxis

A

affects AIRWAY, swells up, loose capacity to breathe

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4
Q

Atelectasis

A

hypoventilation and excessive retained secretions
happens when the air sacs of alveoli deflate (can cause collapse of the lungs)
most common cause of hypoxemia

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5
Q

What are signs and symptoms of atelectasis?

A

agitation
hypo/hypertension, tachycardia (compensation)
absent or decreased A/E to that lobe of the lung
diminished/absent breath sounds
dullness in percussion
reduced chest expansion, tachypnea
fever

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6
Q

pt has just gotten out of surgery and is in acute rep distress. What might cause this?

A

the tongue. Wake pt up or put in oral airway

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7
Q

Hypoxemia

A

reduction in the oxygen tension in arterial blood that leads to a reduction at the tissue level (which is hypoxia)

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8
Q

aspiration

A

foreign material that enters trachea instead of esophagus

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8
Q

what is the normal value of PaO2?

A

80mmhg, less than that is hypoxemia (need blood gas analysis to confirm)

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8
Q

what causes hypoxemia?

A

reduced ability of oxygen to diffuse across alveoli
reduce perfusion of ventilated alveoli
reduced ventilation of perfused alveoli
reduce oxygen tension of inspired air
reduced volume of inspired air

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8
Q

what can aspiration cause?

A

pneumonia

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8
Q

what are interventions for atelectasis?

A

DB and cough q1h when awake
incentive spirometer
reposition HOB
apply o2

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9
Q

What is the mechanism of swallowing?

A

involves 5 cranial nerves and 26 muscles (motor, cognitive and behavioral processes)
an abnormality of any of these can cause ineffective swallowing= aspiration

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9
Q

what prevents aspiration?

A

gag/cough reflex

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9
Q

who does not have gag/cough reflex?

A

Older adults, people with stroke, anesthesia

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10
Q

What do we do for people that do not have gag/cough reflex?

A

intubate, NPO
PPI preop in those who are obese or pregnant

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11
Q

Pneumonia signs and symptoms

A

sudden onset of chills, shaking, high fever
dyspnea, tachypnea, sharp chest pain (increased w inspiration)
productive cough
decreased breath sounds
cyanosis w hypoxemia (PaO2 <80)

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12
Q

Pneumonia intervetions

A

DB and C q1h
incentive spirometry
early ambulation
HOB >30 degrees
oral hygiene
maintain airway
apply o2
contact MRP/RT
labs and diagnostics (sputum cultures, CXR, blood cultures)
abx
fluids

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13
Q

SEPSIS

A

systemic response to overwhelming infection, when a pts immune system fails to control pathogens or their toxins from a site of infection (SIRS criteria)
Systemic illness caused by microbial invasion to sterile parts of the body
leading cause of death and hospitalization

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14
Q

What are the most common populations for SEPSIS?

A

aging pop
chronic disease
artificial joints, heart valves, CVCs
Cancer, autoimmune diseases, immunocompromised
organ transplants
increased use of antibiotics and antimicrobials

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15
Q

What are the most frequents sites of infection for SEPSIS?

A

lungs
urinary tract
abdo
soft tissue skin

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16
Q

Symptoms of SEPSIS

A

early on, organ hypo perfused despite good BP
blood flow/oxygen prioritized to brain and heart, thus shunted away from kidneys, skin, GI tract, lungs = organ disfunction

altered LOC
confusion
psychosis
sao2<90
jaundice
decreased albumin
tachycardia
hypotension
CVP
oliguria
anuria
creatinine
decreased platelets
PT
decreased protein C D-dimer

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17
Q

What does severe SEPSIS have…?

A

NO SYMTPOMS

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18
Q

What is SIRS criteria?

A

2 or more of…
altered LOC
HR>90
emp >38 or <36
Resp >20
WBC count >12 (normal 4-11)

+

suspected infection

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19
SEPSIS interventions
thorough assessment and VS (keep Sao2>92%) advise MD, PCC (GET HELP) contact ICU team (lab work and diagnostics - cultures and lactate, abx - after diagnostics and blood work, IV fluids- bolus, monitor - VS, urine output)
20
When do you have to be careful with bolus?
HF and renal patients
21
Septic shock
BP not greater than 90mmhg systolic or MAP 65 despite IV fluids
22
Diagnostics for SEPSIS
blood culture CBC, coagulation profile, D-dimer ABGs lactate level C-reactive protein serum proteins blood sugar serum cr and u liver function
23
Cardiovascular complications
VTE: DVT/PE Pulmonary embolism Peri-operative stroke Fluid overload Dehydration Hypovolemia Post-op bleeding Electrolyte imbalance
24
Who is at risk for VTE?
pts without prophylaxis obesity acute illness >40 y/o cancer (hypercoagulation) use low molecular heparin
25
What do VTEs lead to?
PE!!!!!! if not treated
26
Why does PE need immediate intervention?
blocks O2 in bloodstream, leading to hypoxemia, lead to tissue hypoxia
27
Who is most at risk for PE?
joint replacement surgeries (immobility!!!!)
28
What is used to prevent PE?
Prophylaxis... detect those at risk education early/frequent mobilization hydration post op symptom assessment treatment advocacy (do they have decreased sensation?)
29
What is the tx of PE?
heparin
30
Heparin
increased risk of bleeding check lab values (PT) route: SubQ
31
what is the antidote of heparin?
protamine sulfate
32
Peri-operative stroke risks
vascular surgeries longer surgeries HF, low ejection fraction, MI dehydration hyperglycemia stasis in postop, bed rest withholding antiplatelet/anticoagulant
33
Peri-op stroke
ischemic and embolic happens POD1
34
Periop stroke interventions
Call MD!! (facial droop, slurring, sudden neurologic changes) neurology consultation Pts are eligible for thrombolytics within 3 hour window of onset of symptoms 1. Doctor 2. CT scan (tPA) 3. thrombolytics swallowing screening early mobilization glucose control BP control no indwelling catheter (high risk of bleeding with tPA) diagnostics (CXR, holter monitor, carotid doppler, echocardiogram)
35
Fluid overload prec factors
stress response (increase ADH and water retention) CHP rapid high volume IV intra op
36
Fluid overload detection
decreased urine output (<30ml/hr) Increased BP, HR or SOB abnormal breath sounds (crackles/decreased A/E) Peripheral edema
37
Fluid overload prevention
monitor IV fluids/blood products rate and amount monitor output - note 24 hour balance assess for signs of overload meds as ordered (diuretics, ACE inhibitors, digoxin)
38
Dehydration
Excessive loss of water from tissues
39
Dehydration detection
less than 350cc of urine in 12 hours Hypotension/tachycardia dry lips and mucous membranes lack of skin turgor muscle weakness, dizziness, headache, restlessness
40
Prevention of dehydration
monitoring urine output oral/IV intake blood loss during surgery VS including temp correct dehydration and avoid unnecessary transfusion (similar to anemia)
41
hypovolemia causes
total blood volume loss of 15-24% blood loss from surgical site severe dehydration third spacing (not enough albumin, liver disease, fluid loss from vomiting/diarrhea, N/G tube suction)
42
What are symptoms of hypovolemia?
lethargy hypotension rapid/weak pulse cool/clammy skin rapid shallow resps oliguria/anuria MOST CONCERNED ABOUT BP
43
Hypovolemia interventions
VS, o2, IV fluids MRP, ICU outreach
44
Post op bleeding symptoms
excessive bleeding low hgb hypotension, tachycardia pale, cool
45
Post op bleeding interventions
VS notify surgeon Patent IV (1,2) apply pressure keep pt warm lie pt flat (decreased card. work) warfarin? INR?
46
Electrolyte imbalance common electrolytes
NA, KCl, bicarbonate, Ca, phosphorus, Mg
47
what affects heart function?
hypokalemia
48
What causes electrolyte imbalance?
N/V fluid loss during surgery preop NPO status
49
Electrolyte imbalance prevention
monitor lab values report/record abnormal meds (IV/PO) prevent c-diff tx and prevent N/V
50
GI complications
Paralytic ileus Post op N and V (PONV)
51
Paralytic ileus
decreased motility of intestines beyond 24 hours
52
when does paralytic ileus happen?
24-48 hours postop
53
What causes paralytic ileus ?
Gi tract innervation is dusrupted from intestinal manipulation hypokalemia wound infection (increased stress, decreased wound healing) narcotics
54
symptoms of paralytic ileus
severe abdo distension N/V decreased or absent BS severe constipation or passage of flatus and small liquid stools
55
interventions for paralytic ileus
ambulate! Pain management hold fluids and food NG tube to decompress stomach (prevent intestinal preformation) anti-emetic notify surgeon (abd X ray)
56
Post op N/V (PONV)
administer anti-emetics modify analgesic routine if necessary change to alternate opioid
57
GU complications
Urinary retention Healthcare associated UTI (HAUTI)
58
Urinary retention symptoms
absence of voiding bladder distension discomfort anxiety/restlessness diaphoresis htn urinary frequency/urgency/sensation that bladder isnt fully emptied with voiding
59
Urinary retention interventions
ambulate bladder scan
60
HAUTI risks
most common type of infection catheter (biofilm crawls up catheter) female catheter management techniques older age DM, immunosuppressed malnourished
61
HAUTI complications
delirium decreased mobility infection mobility, mortality
62
asymptomatic bacteriuria
urine culture positive without signs and symptoms of UTI DO NOT TREAT W ABX
63
Symptomatic UTI
urine culture (+) at least one positive with the following: fever, suprapubic tenderness, CVA tenderness) + at least one of the following: urgency/frequency, dysuria
64
Indications for a indwelling catheter
acute urinary retention +/ obstruction that cannot be relieved by use of intermittent catheterization short term monitoring of urinary output in critically ill pt per-op use intra op monitoring of urinary output facilitate healing in advanced pressure ulcers in incontinent pts requires prolonged immobilization with inability yo void improve comfort for end of life care
65
After removal of catheter...
mobilize at least BID commode bathroom to void q2h avoid bed pans optimize bowel function if unable to void for 4 hours - bladder scan
66
Surgical site infection prevention
4 pillars!! 1. homothermia (maintain temp) 2. antibiotic timing (given within 1 hour of surgery) 3. glycemic control (lower) 4. skin prep (preop) - with CHG
67
Interventions for surgical site infection
local: would culture and PO antibiotics systemic: same as for sepsis

NURS 412 (21 decks)

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