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Nurs 186 > Post Operative Phase > Flashcards

Post Operative Phase Flashcards

(46 cards)

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1
Q

Aldrette scale

A

Point scale patient passes to leave PACU

Patient may be in PACU for 45 minutes to several hours

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2
Q

Report from OR to PACU RN

A 
What was done
Anesthetics used 
Allergies
Medical HX 
Blood loss
Meds used
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3
Q

Discharge to home after outpatient surgery

A

Need to be much more alert and stable

Have a higher aldrette score

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4
Q

Who’s a candidate for outpatient surgery

A

Cataracts
Carpal tunnel
Minor ortho procedures
Short procedures

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5
Q

When can they leave from outpatient surgery

A 
Can tolerate fluids 
Can void postop 
Ambulate within limits
Stable vitals
Controlled pain

No driving for 24 hours and don’t make big life decisions

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6
Q

Advantages of outpatient surgery

A

Less expensive
Less risk for infection
Recovery at home

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7
Q

Disadvantages of out patient surgery

A

The burden of care is shifted to non professionals

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8
Q

Report from PACU to nursing unit

A

Past medical HX
General or spinal
How patient is doing and did in recovery
What be needed in room for pt.

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9
Q

Stridor or snoring

Priority if heard

A

Stridor shows there may be an upper respiratory obstruction

Snoring may mean tongue is blocking air way
Check lung sounds Q4

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10
Q

Obstructive sleep apnea

A

Physical characteristics lead to apnea
If patient is considered high risk they get cont. pulse ox and capnography(apnea protocol)

Keep O2 above 95

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11
Q

Atelectasis

A

Pneumonia:collapse of alveoli
Mucous collecting
Occurs 24 hours after surgery if patient is not doing breathing exercises(IS/coughing)

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12
Q

Ways to help prevent pneumonia

A

Incentive spirometer
Cough and deep breathing
Turning and positioning
Ambulating

If patient develops an elevated temperature increase respiratory exercises that is the first sign of Atelectasis

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13
Q

Cardiovascular

A

BP tends to be variable
Check apical pulse and rhythm
Temperature:get back within norm(patients are usually cold coming from OR)

Cold= high BP warm=low BP

Peripheral pulses are important

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14
Q

VS upon arrival

A

15X4(1st hour)
30X2(2nd hour)
1X4(3rd-6th hour)

Report variances of BP of 15 to surgeon and check heart rhythm

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15
Q

Nursing thoughts (temp)

A

Temp>37.5 increase respiration exercises
Temp>38.5 look for physician orders
Temp below 36 warm them up

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16
Q

Nursing thoughts BP and HR

A

Be alert for pulse below 60 or above 100 or irregular(see what their norm is)(hypothermia can make you Brady,shock or pain can make you tachy)

Systolic

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17
Q

Neurological

A

Potential for injury related to sedation and or neuromuscular blockade

LOC:if they had general anesthesia should be speaking and awake soon

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18
Q

Level of anesthesia blockade

A

Assess how the blockade is wearing off, where is it still in place and where has it dissolved

If blocked at hip work your way down until level of blockade is still present. Watch for improvement

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19
Q

Potential complications of anesthesia blockade

Study These Flashcards
A

Spinal headache
Urinary retention
Hypotension

Orders may say lay flat or have head up

May be on restricted activity

20
Q

Fluids and electrolytes

Study These Flashcards
A 
I&O on all surgical pt's
Minimal 30cc/hr
Check output before end of shift 
Due to void 6-8 hours of no catheter 6-8 after removal 
Check mucous membranes and skin turgor

General anesthesia excreted aldosteron= increased sodium decreased potassium

21
Q

Normal hemoglobin

22
Q

Normal hematocrit

23
Q

BUN

24
Q

Creatinine

25
GFR
90-120
26
PONV Post operative nausea and vomiting
Increased after anesthesia(especially in obese,abd surgery, HX of motion sickness)
27
Post op NG tube
NPO:NG to suction Advance diet as tolerated After surgery may not have vowel sounds for 24 hours(turn off NG suction to hear for sounds)
28
Bowel activity reminisces with surgery
Monitor for constipation and ileus Ileus:part of intestine isn't working Chewing gum and drinking coffee may help with peristalsis
29
Ambulatory can help postop
Improves peristalsis Prevention of Atelectasis Young adults lose 1% of muscle mass everyday bed rest, older adults 5%
30
Primary incision
Skin should looked healed in 2 weeks,under skin 6 weeks-2 years Drainage still occurring by postop day 5 is abnormal
31
Hemovac drain
Can be hooked up to suction on the wall
32
Dressings
In immediate post op setting check dressing every time you check vitals Remove sutures and staples by day 8
33
Changing dressings
If you see drainage or shadow on dressing circle and initial it to monitor draining If dressing is moist to putter environment change it(risk for infection) A draining wound needs to be covered Most dressing changes happen after 24 hours or on post op day 2 Healing by secondary intention need to remain covered
34
Tape blister
Be sure to document Sensitivity to tape Cover the blister up
35
Impaired wound healing
An infection of to occurs usually happens 5-8 days after surgery Redness,swelling, increased drainage WBC and temperature
36
Dehiscence
Partial or complete opening of wound layers ``` High risk in: Obese Diabetes Malnutrition Therapeutic steroids Procedures that last> 2 hours ``` Cover with wet gauze Binder help with prevention of stress related dehiscence
37
Evisceration
Cover with normal saline and sterile gauze Get feet up in bent position Get vitals
38
Hemorrhage
Internal:concealed External:evident Check closely at dressing, including around extreme motors and dependent areas If drain is in place and an increase is occurring, that's. Good indicator that there is still bleeding
39
Hematoma
Collection of blood(bruise) Most hematomas absorbed by the body
40
Medicinal leech therapy
Used to help restore venous circulation where the is an area of venous congestion
41
Compartment syndrome Happens in post op patients or trauma
Internal swelling or bleeding into a portion of the body beyond its ability behinds its ability to expand Can cause permanent damage in very short amount of time S/S: pain not relieved with normal pain meds given
42
Deep vein thrombosis
SCD's Anti-embolism socks Anticoagulation therapy Ambulation
43
Pulmonary embolism
Blood clot broken loose and goes into pulmonary circulation S/S: dyspnea, angina,bloody sputum,cardiac arrest, Treatments: heads up, O2,heparin drip,heparin therapy followed by Coumadin therapy
44
Pain management post op
Opioids(try to graduate patient from IV meds to PO meds) PCA pump Epidural(monitor very closely) Reposition Heat and cold as ordered Massage Opioids means NO DRIVING
45
Self management education
Prevention of infection and S/S Care and assessment of wound Manage of drains Nutrition therapy(increase calories,protein,vitamin C,iron,zinc) Progressively increase activities and do not break weight restrictions
46
What happens in PACU
Assess level of anesthesia Stabilize condition Tend to postop complications

Nurs 186 (12 decks)

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