Wk 3 Postoperative Care Flashcards Preview

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Flashcards in Wk 3 Postoperative Care Deck (58)
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1
Q

When someone comes out of the order, all orders need to be

A

rewritten by the surgeon

2
Q

What should a PACU hand off report look like?

A

General information
Patient history
intraoperative management and evens

3
Q

What does intraoperative management and events include?

A

Most recent vital signs, lab and test results, how much blood the patient has lost

4
Q

What is included in the initial PACU assessment? (6 things)

A
ABCs
Neurological
Surgical and IV site
GU/GI
Pain
Patient safety needs
5
Q

Why is hypoxia a potential complication for post op patients? (4 things)

A

Shallow breathing, anesthesia, resp depression
Obesity
Airway obstruction
Laryngospasm

6
Q

What are two other potential respiratory complications to be aware of for post op patients?

A

Atelectasis

Pneumonia

7
Q

What are nursing interventions for hypoxia?

A
Reposition if can
Keep head of bed elevated
VS
O2 sat
Oxygen 
Suctioning
Coughing, splint prn
Incentive spirometry
Turn q2
Early ambulation
Pain management
8
Q

What is splinting?

A

Keep pressure of incision site, such as squeezing a pillow when coughing or keeping the incision together with hands

9
Q

What are possible cardiovascular issues for a post op patient?

A

Decreased CO

DVT/PE

10
Q

What should the nurse monitor for decreased CO?

A

BP
HR
Pulses
skin temp/color

11
Q

DVTs are most often seen in patients who are…

A

Elderly
Obese
Immobilized

12
Q

What is a good technique to teach patients to promote venous return?

A

Dorsi/plantar flexion, and circumducting feet

13
Q

What BP should you notify the provider of?

A

Less than 90, greater than 160

14
Q

What should you do for a patient with hypotension with a normal pulse, and warm/pink skin who is post op?

A

Just monitor, this is usually vasodilation from anesthesia

15
Q

What should you do for a patient who is hypotensive with rapid or weak pulse, and cold/clammy skin?

A

They need immediate intervention, notify HCP, could be hypovolemic shock

16
Q

If a patient has an abnormally low BP but is asymptomatic…

A

Compare to baseline, you may not need to notify provider if that is normal for them

17
Q

You should notify the provider of a pulse of…

A

Less than 60 or greater than 120, depending on other signs and symptoms

18
Q

What is pulse pressure?

A

Difference between systolic and diastolic pressure

19
Q

What does it mean if someone has a narrow (small) pulse pressure?

A

Could be an indication of hemodynamic compromise

20
Q

A blood pressure that gradually increases or decreases over several readings should… or a change in heart rhythm should….

A

Catch your eye!

21
Q

How to prevent cardiovascular post op problems (4 things)

A

SCDs
Ambulation
Phlebitis assessment
Monitor and protect wound

22
Q

Why are SCDs more often used than TEDs?

A

Because if the TED hose doesn’t fit correctly it can lead to pressure injuries

23
Q

Restless patients… Always think __

A

Hypoxia

24
Q

What is emergence delirium?

A

Short term neurological change

25
Q

What are s/s of emergence delirium in post op patients?

A

Restlessness
Disorientation
Thrashing
Shouting

26
Q

What can emergence delirium possibly be related to? (3)

A

Anesthetic agents
Pain
Presence of ET tube

27
Q

Postop delirium is most common in the

A

Elderly

28
Q

What is a psychological issue to watch for in post op patients?

A

Post-op depression

29
Q

What should you do to prevent neurological and psychological problems in a post op patient?

A

Assess LOC, orientation, memory, ability to follow commands, movement of extremities

30
Q

Post-op pain is the classic example of

A

continuous ongoing pain

31
Q

What is a treatment for post op pain?

A

ATC dosing, be vigilant for side effects such as respiratory depression

32
Q

Who is at risk for respiratory depression?

A

A patient who hasn’t taken opioids before, someone on IV morphine

33
Q

What are interventions for post op pain? (3)

A

Pharmacologic and non-pharmacologic ,documentation of pain

34
Q

During surgery the body often has a low

A

temperature

35
Q

What is an expected finding concerning temperature for a patient 48 hours post op

A

Mild fever, less than 100.4 (due to inflammatory response to surgery)

36
Q

If a patient’s temperature is greater than 100.4 post op, what should you think of?

A

Lung congestion or dehydration

37
Q

When should you be concerned about a low grade fever after surgery?

A

If it’s been longer than 48 hours

38
Q

What is the best thing you can do for a patient who is experiencing gas/abdominal distention after surgery?

A

Early ambulation

39
Q

What is the most common reason for a patient experiencing paralytic ileus?

A

Surgical manipulation of the bowel

40
Q

What are 4 potential GI problems for a post op patients

A

Gas/distention
Nausea
Constipation
Paralytic ileus

41
Q

How long might large intestine motility take to resume in a post op patient?

A

2-7 days

42
Q

How long might small intestine motility take to resume in a post op patient?

A

within hours

43
Q

What are presentations of a patient with a paralytic ileus? (3)

A

Distended abdomen
High pitch bowel sounds
Pain

44
Q

What do we do for a patient who does develop a paralytic ileus?

A

NG insertion to decompress the abdomen and then let them “ride it out”

45
Q

You should gradually advance a patient’s diet, for example

A

NG to low wall suction

NPO with ileus

46
Q

What is the only side effect of opioids that a patient cannot develop tolerance to?

A

Constipation

47
Q

Prevention of constipation is especially important in patients who underwent

A

abdominal surgery, if they have to bear down and push it can be really painful for them

48
Q

What are potential urinary complications of post op

A

Urinary retention

UTI

49
Q

What should be the goal for urinary output for a post op patient?

A

Greater than 30mls an hour

50
Q

Urine output =

A

Renal perfusion

51
Q

If a patient has decreased cardiac output, or has hypotension

A

Urine output will go down due to low perfusion

52
Q

When should a patient be catheterized after surgery?

A

If they haven’t voided in 6-8 hours

53
Q

What should you assess when looking at a wound or incision? (5)

A
Pain
Erythema
Drainage - amount, color, consistency, odor
Dehiscence
Evisceration
54
Q

What is a Tenckhoff catheter?

A

Peritoneal tube for dialysis

55
Q

What is a wound drain?

A

Penrose

56
Q

What is a Hemovac or a Jackson-Pratt?

A

Closed suction drain

57
Q

What is T-tube used for?

A

Common bile duct

58
Q

What are pigtails or pleurXcatheters?

A

Chest tubes