TOPIC 2 - post op Flashcards
(40 cards)
what is the purpose of the PACU recovery room
ongoing evaluation and stabilization of patients to anticipate, prevent, and manage complications after surgery
what are patients at risk for in the postoperative period
pneumonia, shock, cardiac arrest, respiratory arrest, DVT, and bleeding or clotting
assessment data in the PACU includes
LOC, temp, pulse, RR, O2 sat, BP, evaluation of surgical area
VS and heart sounds are assessed on admission and every 15 minutes until stable
observations and interventions are critical for safety and quality
what kind of handoffs do PACU nurses give and recieve
verbal handoff
after report, PACU nurses…
review the medical record for history, pre-surgical symptom conditions, and emotional status
skills of PACU nurses
care of patients with multiple medical and surgical problems
in depth knowledge of A&P, anesthesia, pharmacology, pain management, surgical procedures, and cardiac life support
are able to make quick decisions while working closely with anesthesiologist and surgeon
respiratory system assessment
patent airway, adequate gas exchange, note any artificial airways, rate/pattern/depth of breathing, breath sounds, accessory muscle use, snoring and stridor, respiratory depression or hypoxemia, complications such as atelectasis/pneumonia/pulmonary embolism
begin by checking airway and breathing effectiveness, monitor O2 sat every hour, keep suction/O2/artificial breathing equipment near PACU
cardiovascular assessment
vital signs, heart sounds, cardiac monitoring, peripheral vascular assessment (because anesthesia and positioning during surgery may impair peripheral circulation and contribute to clotting and venous thromboembolism), monitor complications such as hypovolemic shock and venous thromboembolism
neurologic system assessment
observe for lethargy, restlessness, or irritability and test coherence and orientation
motor and sensory function is assessed for all patients who receive general or regional anesthesia
monitor cerebral functioning, LOC, and level of cognition
fluid, electrolyte, and acid-base balance assessment
I/O, hydration status, IV fluids, vomitus, urine, wound drainage, NG tube drainage, acid-base balance
how and when do patients lose fluid during and after surgery
fasting before and during surgery with the loss of fluid and blood during the procedure affect the patients fluid and electrolyte balance
acid-base balance is affected by the patients respiratory status before and during surgery, metabolic changes during surgery, and losses of acids or based in drainage
renal/urinary system assessment
check for urine retention, consider other sources of output (sweat, vomit, diarrhea), report urine output of 30 mL/hr
when does urine control resume after surgery
may be immediate or may take hours
what is a BAIR hugger used for
to restore heat when patients are hypothermic after surgery
prevention is important
what does shivering increase the risk of?
shivering increases oxygen demand and can induce hypoxemia
highest incidence of hypoxemia after surgery occurs on the second post-op day
gastrointestinal system assessment
post-op nausea and vomiting is common, peristalsis may be delayed up to 24 hours, monitor for bowel sounds, monitor for complications such as paralytic ileus and gastric dilation
meds used to reduce nausea and vomiting after surgery
ondansetron, meclizine, scopolamine patch
purpose of NG tubes during surgery
decompress and drain the stomach, promote GI rest, allow lower GI tract to heal, provide enteral feeding route, monitor gastric bleeding, prevent intestinal obstruction
how often and when should NG tube drainage be assessed
look for amount and color changes every 8 hrs
skin assessment
normal would healing - assess tissue integrity frequently
a clean surgical wound heals in about 2 weeks in the absence of trauma, connective tissue disease, malnutrition, infection, or the use of certain drugs such as steroids
complete healing may take up to 6 months to 2 years
abnormal wound healing and risk factors
risk factors- smokers, older adults, obese patients, diabetic patients, and those with reduced immunity
impaired would healing (dehiscence, evisceration, infection) will show between 5 and 10 days after surgery
interventions for dehiscence or evisceration
have the patient lie supine with knees bent to reduce intra-abdominal pressure and apply sterile, non-adherent, or saline dressing
what do drains help prevent
deep infection and abscess formation
who performs the first dressing change
the surgeon to assess the wound, remove packing, and advance or remove drains
