Week 2- Post op

Question 1

3 compensatory mechanisms post op

Answer 1

1) SNS (fight, flight, freeze)= heart, lungs, GI, pancreas, brain, kidney, liver
body releases epinephrine acting on alpha and beta receptors
2) RAAS= first blood will shunt away then go back
Renin-angiotensinogen-angiotensin1, angiotensin 2 (increase BP and afterload)
3) pancreas= increase f=glucagon, slow insulin production to give energy to run away
diabetic will be hyperglycemic normal body response

Question 2

Alpha receptors

Answer 2

increase smooth muscle contraction= increases afterload and increase BP

Question 3

beta1 and beta2 receptors

Answer 3

1- acts on heart, increase contractility, increase HR
2- increase RR, bronchodilate

Question 4

PACU is

Answer 4

requires advanced training
give report to general surgical unit

Question 5

when is pt ward ready

6

Answer 5

1- maintain airway (conscious enough)
2- respiratory stability (include Spo2), NP is kind of where we want them
3- hemodynamically stable (BP, rhythm/HR, Cwms)
4- temperature regulation
5- N/V (aspiration is the biggest risk)
6- Pain (comfortable

Question 6

post op assessment order

Answer 6

Airway
Breathing
Circulation
Disability/Dextrose/Discomfort (LOC)
Environment/Expose
Full-set of VS (including neuro)
Give comfort
Head-to-toe
Inspect the posterior

Question 7

airway assessment

Answer 7

talking,
snoring is a warning because pt might not be able to maintain airway= put in recovery)

Question 8

breathing assessment

Answer 8

(chest wall movement, WOB, accessory muscles, can you hear sounds without stetoscope)

Question 9

circulation assessment

Answer 9

CWMS, diaphoretic, bleeding)

Question 10

disability/dextrose/discomfort assessment

Answer 10

LOC
assess pain quickly

Question 11

env assessment

Answer 11

(is the patient safe and are you safe, Chest tube

Question 13

inspect posterior for

Answer 13

bleeding
wounds

Question 14

reduced diet before or after surgery

4

Answer 14

• Impaired Healing- leading to infection,
• anemia
• dehydration (electrolyte imbalances),
• constipation

Question 15

Use of anesthetic/sedative/analgesic medications

7

Answer 15

can lead to
- Delirium or decrease LOC
- falls
- constipation
- ileus
- N/V
- urinary retention
- respiratory impairment

Question 16

surgical incision complications

Answer 16

Infection, bleeding, dehiscence, evisceration, proper post op support (splinting, sternal precautions)

Question 17

use of IV fluid complications

3

Answer 17

Fluid shifts
fluid overload (renal and cardiac patients more at risk)
electrolyte imbalances,

Question 18

pain can lead to

Answer 18

Prevent full expansion (atelectasis), DVT from immobility, poor sleep, pain crisis (BP, HR increase, Spo2 decrease)

Question 19

neuropsychological complications

Answer 19

delirium
fever
hypothermia
pain
postoperative cognitive dysfunction

Question 20

Gi complications

Answer 20

delayed gastric emptying
distension and flatulence
hiccups
N/V
postoperative ileus

Question 21

urinary complications

Answer 21

infection
retention

Question 22

respiratory complications
post op

a
a
a
b
h
h
p
p
p

Answer 22

• airway obstruction
  aspiration
  atelectasis
  bronchospasms
  hypoventilation
  hypoxemia
  pneumonia
  pulmonary edema
  pulmonary embolus

Question 23

cardiovascular complications

Answer 23

• dysrhythmias
  hemorrhage
  hypertension
  hypotension
  superficial thrombophlebitis
  venous thromboembolism

Question 24

integumentary (incision site) complications

Answer 24

dehiscence
hematoma
infection

Question 25

fluid and electrolyte complications

Answer 25

- acid base disorders electrolyte imbalances fluid deficit fluid overload

Question 26

Pain can slow

Answer 26

recovery pts unable to perform activities to promote recovery

Question 27

complications with unmanaged pain

Answer 27

- not mobilizing - state of stress and discomfort - activate SNS and will impact healing shunt blood away from site

Question 28

NSAID Watch for most common

Answer 28

bleeding Kidneys Ketorolac is most common 3 times up to 15 mg each time Pt at high risk for bleeding and kidney damage probably shouldn’t give

Question 29

Post-operative complications: Nausea/vomiting

Answer 29

Biggest problem is aspiration Increases pressure in the body don't want to do this after surgery

Question 30

Histamine blockers: Dopamine blockers: Serotonin:

Answer 30

- Gravol (dimenhydrinate) - Metoclopramide (maxceran) - ondansetron (Zofran)

Question 31

marijuana ativan

Answer 31

can be used for n/v increase hunger can get nauseous when really stressed

Question 32

surgery with most amount of blood loss

Answer 32

abdominal surgeries

Question 33

treatment for blood loss

Answer 33

apply direct pressure blood products

Question 34

life threatening bleed

Answer 34

apply pressure call for help bigger bleed more pressure

Question 35

5W

Answer 35

higher temperature - wind- atelectasis - water- UTI or urine - Walking- DVT (warm, red swollen) - wound- post op infection - wonder drugs - (adverse reactions)

Question 36

complications of atelectasis

Answer 36

pneumonia

Question 37

high WBC count what to do next

Answer 37

look for other signs of infection, how do they feel, wound characteristics high WBC could be an inflammatory response

Question 38

electrolytes we want to watch | what they do

Answer 38

sodium - think brain first potassium- (works with action potential affect contractility of the heart and muscles)= think heart first magnesium (pulls K and ca in) calcium contractility of the muscles

Question 39

CBC post op

Answer 39

- Hgb (will decrease) - Hct (decrease or stay the same) [ ] of RBC - RBC (decrease) will expect some blood loss - if hgb low and hct high= dehydration

Question 40

What surgeries at most risk of dehiscence

Answer 40

abdominal

Question 41

what to do if you see dehiscence

Answer 41

Call for help Cover with saline-soaked sterile gauze

Question 42

post op neuro complications

Answer 42

delirium

Question 43

causes of delirium

Answer 43

- withdrawl psychosis - toxic psychosis - circulatory and respiratory causes - functionla psychosis metabolic distrubances - pain - viseceral distentions - rule out hypoxemia (treat cause, consider sedation, mainatin patient safety) - anxiety - altered thermoregulation - medications - anaesthetic exposure -

Question 44

types of delirium

Answer 44

hypoactive (sleepy, can be A and Ox3, one of the first things is that guy is a little weird , use family as a resource) hyperactive (super obvious)

Question 45

post op neuro complications

Answer 45

Dizzy, lightheaded, fainting postural changes vagal drugs, blood loss something unrelated to surgery cardiac issues AEIOUTIPS

Question 46

cause of altered mental status

Answer 46

A- alcohol E- epilepsy (seizures) I- Insulin (too much or too little), O- overdose U- underdose T- trauma I- infection P- psychosis S- stroke, shock Causes of altered mental status

Question 47

assessing preload in post op \ HYPERvolemia HYPOvolemia

Answer 47

↑ volume Treatment: Cause Severity ↓ volume Treatment: Cause Severity

Question 48

lab work for DVT

Answer 48

D dimer Coags CBC Doppler US and or CT angio