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N230 exam 1 and 2 > Postop > Flashcards

Postop Flashcards

1
Q

Phases of post anesthesia care

A

Phase 1: immediate postop period
-intense monitoring (might still be on vent)
-ACP gives handoff to PACU nurse

Phase 2:
Preparing pt for transfer to unit, home, or SNF(skilled nursing floor)

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2
Q

Discharge from PACU

Aldrete score

A

9-10 required for discharge

Higher score the better

This determines if your ready to go or not

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3
Q

Respiratory assessment ***

A

Breath sounds, effort, rate

Sputum characteristics

Signs of respiratory distress:
-neuro changes (early sign)
-accessory muscle use
Cyanosis (late sign)

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4
Q

Rispiratory complications ***

A

Obstruction:
1. Blockage due to tongue
2. Laryngeal edema/bronchospasm

Atelectasis: sounds llike quiet crackles (clears with cough)
-if not corrected can cause pneumonia

Hypoventilation:
CNS depression from meds, pain
Reversal agents: Narcan(opioid) , Flumazenil (reversal for benzo (versed)

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5
Q

What does narcan and flumazenil reverse ***

A

Narcan reverses opioids

Flumazenil reverses benzodiazepine (versed)

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6
Q

Nursing interventions
Respiratory ***

A

Airway obstruction: stimulation , jaw thrust/chin lift
Postition
Deep breathing
Insentive spirometer
Coughing
Ambulate/sit in chair
Adequate hydration
Treat pain
Suction for secretions

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7
Q

Cardiovascular assessment ***

A

VS: HR, BP

Peripheral pulses

Skin color

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8
Q

Cardiovascular complications ***

A

Hypotension (usually postop)

Hypertension: look for pain, bladder distention

VTE: can lead to PE

PE s/s:
Tachypnea
Tachycardia
Chest pain
Dyspnea

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9
Q

Nursing interventions
Cardiovascular ***

A

IVF as ordered

Rewarming

Monitor I/O, VS

Early ambulation
*start raising HOB 1-2 min, sit with legs dangling monitor pulse/bp

VTE prophylaxis: intermittent compression device, anticoagulants)

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10
Q

Neurological assessment ***

A

LOC

Pupils

Sensory/motor status

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11
Q

Neurologic and psychologic complications **

A

Emergency delirium (in PACU)

Delayed emergency (in PACU) r/t anesthesia

Postoperative cognitive dysfunction: can last weeks to months

Delirium

Anxiety/depression

ETOH withdrawal

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12
Q

Delirium

A

pain

sleep deprived

fluid imbalance

hypoxemia

drugs

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13
Q

Emergency delirium***

A

Happens in PACU
agitation, disorientation, thrashing, shouting

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14
Q

Nursing interventions
Neuro/psych

A

Orient pt frequently

Early ambulation

Provide psychological support

Assess for underlying causes to symptoms (oxygen status, fluid/ electrolyte imbalance)

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15
Q

Postop pain

A

Pain causes increased risk of atelectasis

Can delay recovery

Assess frequently

Teach pt to know when pain is too bad

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16
Q

Nursing interventions
PAIN

A

PRN: NSAID and opioid

PCA (patient controlled anesthesia)

Assess/document response: improve/ SEs

Assess gas pain (opioids can cause)

17
Q

If having chest or leg pain evaluate for

A

VTE

PE

18
Q

PCA
Patient controlled anesthesia ***

A

Pt has button and can administer a dose of pain med themselve

Usually morphine, hydromorphone

May have continuous dose with bolus or just bolus

19
Q

Safety with PCA ***

A

Requires nurse double check

Nurse programs the pump, must be checked carefully

20
Q

Gastrointestinal assessment ***

A

Bowel sounds: NPO until bowel sounds present
*must listen to bowels for 5min to say their absent

Nausea

Bowel movements/ passing gas

Tolerating PO

21
Q

Gastrointesinal complications ***

A

Postop N/V

constipation

Postop ileus : temporary impaired bowel motility
*normal after abdominal surgeries

22
Q

Nursing interventions
Gastrointestinal ***

A

Encourage PO fluids as tolerated

Suction available/ recovery position for vomiting

Position on right side (helps with gas pain)

23
Q

Complications R/T Temp changes

A

Hypothermia

Hyperthermia

24
Q

Hypothermia ***

A

Causes:
skin exposure
cold fluids
skin prep
inhaled gases

-can cause shivering (uses up O2)
-altered drug metabolism
-pain
-hypertension
-bleeding

25
Q

Hyperthermia ***

A

malignant hyperthermia : immediately postop

Infection : later = 3-4 days postop

Difference in infection and malignant hyperthermia is the timing

26
Q

Nursing interventions
Temp change

A

Passive warming measures:
Socks, warm blanket

Active warming:
External warming devices

Apply oxygen if shivering present

Temp >103 may need to use body-cooling measures

27
Q

Urinary assesskments ***

A

UOP:
Min=0.5ml/kg/hr

Bladder scan if not voided in 6-8 hours

Remove catheter ASAP (Cauti)
*if nothing in bad first check for leak

28
Q

Urinary complications ***

A

Acute urinary retention:
Anesthesia, drug SEs, lower abdominal/pelvic surgery, pain

UTI

Acute kidney injury:
From meds, dehydration/blood loss

Low UOP:
Expected postop but should increase

29
Q

Nursing interventions
Urinary ***

A

Promote voiding with:
position
Running water
Walking to bathroom
Offer PO fluids

Bladder scan if no UOP in 6-8 hours

30
Q

Integumentary assessment ***

A

Look for: bleeding, reddness, swelling, pain, drainage

Systemic infection (fever, leukocytosis)

Assess any drains

Assess wounds (Q15-30 min immediately postop)

Drainage should change from sanguinous-serosanguinous-serous

31
Q

Drainage should change from what ***

A

sanguinous (bloody)
To
serosanguinous
To
serous (clear)

32
Q

Integumentary complications ***

A

Skin and soft tissue infection (SSI)
*usually not evident for 3-5 days postop

Dehiscence: incision opens up

Evisceration: incision open and something sticking out
*dont push stuff back in

33
Q

Nursing interventions
Integumentary ***

A

Hand hygiene

Adequate nutrition

Dressing changes as ordered
*surgeon usually does first dressing change
*if bleeding you can reinforce if but dont remove it

34
Q

Spinal headache ***

A

Cause: leakage of CSF from hole in dura mater

Classic: frontal/occipital pain 24-72 hours after spinal anesthesia

Lay flat

Tx:
IVF
Blood patch
Caffeine

35
Q

Discharge home ***

A

Must be:
Alert, hemodynamically stable, PONV/pain under control

Accompanied by an adult (no driving)

Need access to:
Pharmacy
Phone # to call emergency (surgeon)
Follow up instructions

36
Q

Discharge home education ***

A

Get teach back from both patient and caregiver

Symptoms to report
Med teaching
Care of incision/drainage
Activity allowed
Give pt discharge paperwork

37
Q

Delegation

A

RN:
Assessment
Report
Skills (dressing change, foley cath insertion)
Med administration
Teaching

UAP:
VS, I/O
ADL’s
CDB (cough and deep breath)

N230 exam 1 and 2 (11 decks)

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