Postoperative Care

Question 1

Postoperative period is

Answer 1

Begins immediately after surgery until they are discharged

Question 2

Phase 1 PACU

Answer 2

1. initial recovery period in PACU

2. Hand-off reporting (ACP) stays until ready to accept

Question 3

Nursing care focus for phase 1

Answer 3

i. Immediate postoperative care
1. Constant vigilance is required
2. ECG and more intense monitoring required
3. ABCs

Question 4

Intraoperative management (6 things)

Answer 4

i. Anesthetic agents
ii. Other drugs received preop or intraop
iii. Last dose of opioids admin/p! management plan
iv. Total fluid replacements, including blood transfusions
v. Total fluid loss (e.g. blood, NG drainage)
vi. Urine Output

Question 5

Intraoperative course (5 things)

Answer 5

i. Unexpected anesthetic events or reactions
ii. Unexpected surgical events
iii. Most recent VS and monitoring trends
iv. Results of lab tests/x-rays

Question 6

Postoperative Assessment (6 things)

Answer 6

1. ABCs
2. Neuro
3. GU/GI
4. Surgical site
5. Pain
6. Lab/diagnostic tests

Question 7

Potential post-op complications (5 things)

Answer 7

1. Airway obstruction
2. Hypoxemia
3. Aspiration
4. Bronchospasm
5. Hypoventilation

Question 8

Hypoxemia (4 things)

Answer 8

1. Atelectasis (risk of leading to pneumonia)
2. Pulmonary edema
3. Smokers are at greatest risk
4. Lung disease

Question 9

Hypoventilation related to

Answer 9

opioid use or blocker

smoking

Question 10

Proper patient positioning

Answer 10

i. Lateral “recovery” position

ii. Once conscious—supine position

Question 11

Sustained maximal inspiration

Answer 11

Pt inhale deeply, hold breath for few seconds, exhale, then inhale & cough

Question 12

Postoperative complications cardiovascular

Answer 12

a. Hypotension
b. Hypertension
c. Dysrhythmias
i. Looking at EKG
d. VTE
e. syncope

Question 13

Directly affects cardiac output

Answer 13

fluid & electrolytes

Question 14

Nursing Interventions to Prevent Neuropsychologic Complications

Answer 14

a. Monitor oxygen levels with pulse oximetry
b. Oxygen therapy
c. Pain management
d. Reversal agents (Phase I)
e. Assess for anxiety and depression
f. Alcohol protocols

Question 15

Postoperative Complication Alterations in Temperature

Answer 15

Hypothermia/shivering
fever
malignant hyperthermia

Question 16

Postoperative Complications Gastrointestinal

Answer 16

a. Postop nausea/vomiting (PONV)
b. Constipation (secondary to anesthesia & immobility, opioids)
c. Postoperative ileus
i. Intolerance of oral intake
d. Delayed gastric emptying
e. Hiccups

Question 17

Phase 1 Discharge Criteria

Answer 17

a. Patients awake (or at baseline)
b. Vital signs at baseline or stable
c. No excess bleeding or drainage
d. No respiratory depression
e. Oxygen saturation greater than 92%
f. Pain management
g. Nausea and vomiting controlled

Question 18

Contamination of the wound

Answer 18

Exogenous flora
oral flora
intestinal flora

Question 19

s/s of infection

Answer 19

1. Fever
2. Pain
3. Increased amount of drainage
4. Redness/edema

Question 20

PACU Progression Post-anesthesia Phase II, occurs in

Answer 20

impatient setting

intensive care area

Question 21

Nursing care focus

Answer 21

i. Preparation for care in the home

ii. Extended observation

Question 22

Discharge criteria phase II ambulatory surgery

Answer 22

i. All PACU discharge criteria (Phase I) met
ii. No IV opioids in past 30 minutes-cannot go home
iii. Voided if appropriate to surgical procedure
iv. Able to ambulate if not contraindicated
v. Responsible adult present to drive patient home
vi. Written discharge instructions given and understood

Question 23

Common reasons to seek help after discharge (ambulatory surgery)

Answer 23

i. Unrelieved pain
ii. Questions about medications
iii. Wound drainage and/or bleeding
iv. Increased drainage from a drainage device
v. Fever greater than 100°F

Question 24

Phase II Discharge criteria

Answer 24

a. Hemodynamic stability
b. Pain and comfort management
c. Condition of surgical site and dressings/drainage tubes
d. Fluid/hydration status (voided if appropriate)
e. Mobility status—can ambulate if not contraindicated
f. Emotional status
g. Patient safety needs
h. Significant other interactions