Week 2: Week 2: Postoperative Care Flashcards
(43 cards)
What are the postanesthesia phases a patient must make it through before being discharged?
Phase 1: care during the immediate postanesthesia period where the goal is to prepare the patient for safe transfer to phase 2 or inpatient
Phase 2: surgery patient is ambulatory and the goal is to prepare the patient for transfer to extended care environment or home with discharge teaching
Extended observation: ongoing care for patients who will be admitted to the unit and those who require observation or interventions with the goal to prepare the patient for self care
What are the priority care pieces for a patient in the PACU?
monitoring/management of respiratory/cardiac functions, pain, temperature, surgical site, sedation score
What is the goal of the PACU
to identify actual and potential patient complications that may arise as a result of anesthesia and surgical interventions
Initial airway PACU assessment
latency
oral or nasal airway
laryngeal mask airway
endotracheal tube with ventilator settings
Initial breathing PACU assessment
respiratory rate and quality
auscultated breath sounds
technology monitoring if needed
supplemental O2
Initial Circulation PACU assessment
ECG monitoring (rate and rhythm)
BP
hemodynamic pressure readings if applicable
temperature
cap refill
color, temperature moisture of skin
apical and peripheral pulses
Initial Neurological PACU assessment
LOC
orientation
sensory and motor status
pupil size and reaction
What is the first sense to return after losing consciousness?
Hearing
Surgical Site initial PACU assessment
dressings and visible incisions
drains (type patency, and drainage)
IV assessment (location, condition, solutions)
Urinary system initial PACU assessment
intake, output
fluid balance
GI initial PACU assessment
N/V
intake
output
bowel sounds
Patient specific needs PACU assessment
return hearing aids, glasses etc.
patient positioning
fall risk assessment
pain
What are common PACU postoperative conditions?
airway compromise
respiratory insufficiency
cardiac compromise
neurological compromise
hypothermia
pain
nausea/vomiting
What are the most common airway complications in the PACU?
airway compromise (obstruction, hypoxemia, hypoventilation)
the tongue is the most common obstructive agent
What patients are at risk for respiratory complications in the PACU?
general anesthesia
older age
smoking history
lung disease
obesity
airway/thoracic/abdominal surgery
What to assess in the PACU with respiratory complications
airway patency
chest symmetry
depth
rate
characteristic of respirations
accessory muscles
breath sounds
sputum characteristics
What are common clinical alterations regarding the respiratory system?
Atelectstasis
Pneumonia
Nursing interventions in the PACU for respiratory
proper patient positioning in the lateral recovery position (keeps airway open and reduces risk of vomiting aspiration) once conscious HOB raised to maximize thoracic expansion
What are the nursing interventions in the clinical unit for respiratory system?
deep breathing to facilitate gas exchange
Incentive spirometer
coughing to move secretions (reduces risk of aveolar collapse)
Positional changes to allow full chest expansion and increase perfusion of both lungs
Post op assessment ABCD
Airway
Breathing
Circulation
Disability/dextrose (LOC)
Post op Assessment EFGHI
Environment/expose
Full set of VS (including near)
Give comfort
Head to toe
inspect the posterior (PI? Pooling blood?)
What complications can a reduced diet lead to?
malnutrition
impaired wound healing
electrolyte imbalance
cardiac changes
dehydration
neurological changes
What complications can occur from the use of anesthetic or sedative medications?
thromboembolism
respiratory complications
reduced mobility (skin breakdown, PE, loss of muscle mass)
What ways can we treat pain?
assess patient throughout day for pain
give fast acting analgesic before activities
give PRN analgesics Q3-6 hrs
use effective combination of analgesics
