surgery- post-op

Question 1

before discharge from the PACU unit, what do pt’s sats need to be?

Answer 1

> 95% or baseline

Question 2

pt has excessive bleeding in the PACU, can they go to stepdown?

Answer 2

no!

Question 3

6 things I need to do when about to receive a post-op patient

Answer 3

• check ward routine
• get supplies IV pole, pump, kidney basin, mouth swabs
• supplies for assessment - VS record, pen, steth
• make the “post-op bed”
• pillows and blankets
• suction and oxygen checked

Question 4

number one priority for post-op assessment!

Answer 4

airway and LOC!

Question 5

how often do we take vs post-op?

Answer 5

use rule of 4 (q15x4, q30x4 and so on)

Question 6

what are we most worried about for post-op vitals?

Answer 6

decreasing bp

Question 7

what should i do as soon as patient is awake?

Answer 7

DB and C and leg exercises! (as long as pain is managed)

Question 8

two interventions to prevent obtruction from tongue

Answer 8

artificial airway (if still sedated), recovery position.

Question 9

when do we worry about a change in BP?

Answer 9

if S<90 or >160 or 25% change from baseline

Question 10

the bigger the surgery, the greater the risk is for _______ (temp)

Answer 10

hypothermia.

Question 11

how long post op do we worry about a high temp?

Answer 11

48 hrs after (its expected until then)

Question 12

5 complications of spinal & epidural

Answer 12

• resp depression
• hypotension
• epidural hematoma
• infection (meningitis!)
• posdural puncture headache

Question 13

how long would a pt be on IV fluids after surgery?

Answer 13

until they are eating and drinking well

Question 14

whats the best way to know if a patients bowel is working?

Answer 14

ask if they’ve been passing gas

Question 15

what intervention might be used for paralytic ileus?

Answer 15

NG to prevent green bilious vomiting

Question 16

what is a life threatening complication of surgery? what are the two types?

Answer 16

shock, anaphylactic and hypovolemic

Question 17

can a day surgery patient go home if they just stopped receiving IV opioids 14 minutes ago?

Answer 17

no, must wait 30

Question 18

can we send a day surgery pt home with active vomiting and nausea?

Answer 18

no, shouuld be minimal

Question 19

what are two huge things I’d want to know when receiving a patient from the OR?

Answer 19

how much blood/fluid was given, how much blood loss, and URINE OUTPUT

Question 20

how do we treat hypoventilation post-op?

Answer 20

wake pt up, db&c, O2, incentive spirometry

Question 21

what do we give first, fluids or vasoconstrictive agents if hypotensive/

Answer 21

fill then tank, then squeeze the pipes

Question 22

regarding CVS, we monitor for:

Answer 22

dysrhythmias and DVT

Question 23

what probelms related to CNS do we monitor for?

Answer 23

slow to waken post op, motor and sensory functions not back to baseline, signs of stroke

Question 24

if pt doesn’t void for _____ hrs after surgery, then we assess

Answer 24

6-8

Question 25

two early signs of anaphylactic shock

Answer 25

anxiety and impending doom, swelling of lips, tongue

Question 26

if pt with anaphylactic shock has cold, clammy, mottled skin, are they likely to survive?

Answer 26

no

Question 27

nursing care for anaphylactic shock r/t drugs to give: fluids to-do list: CVS: Urinary: Plan:

Answer 27

epi, bronchodilator, steroids get 2 large bore ivs in, NS, colloids (albumin), blood transfusion get on tele and frequent VS insert foley prepare to transfer to ICU

Question 28

is treatment for hypovolemic shock much different than anaphylactic?

Answer 28

no, just not giving EPI and cause we are looking for is different