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Surgery and pain


importance of TCDB fully inflate the lungs and prevent fluid accumulation
dehiscence opening of an incision
evisceration organs protruding through an incision
why is the incentive spirometer so important, what does it do? it aids in taking deep breaths to fully inflate the lungs and it prevents atelactesis/pneumonia
why may a post-op patient have decreased urine output? dehydration, blood loss, hypovolemic shock (decreased tissue perfusion)
S/S of shock decreased BP, high Pulse, diaphoresis
nursing interventions for shock vital signs, trendelenberg, increase IV fluids
how does the Jackson- Pratt/Hemovac drain systems work? self suction (compress it)
how does the Penrose drain system work? passive gravity
what is venous stasis? blood isn't moving/pooling in lower extremities
what to we do to prevent venous stasis? early ambulation, ROM exercises, TEDS/PCDS- help push blood back to the heart
what can venous stasis lead to? Deep Vein Thrombosis aka DVT
when is the best time for patient teaching? pre-operatively
S/S hypoxia confusion, change LOC, restless, drowsy, cyanosis(nail beds and lips)
what is the purpose of a pre-op checklist? to ensure all nursing interventions are completed and to pake sure patient is safely ready for the OR
respiratory complications that can happen post-op? Atelectesis and Pneumonia
why should post-op patients have help in moving themselves? so they dont harm the incision line and we dont want them to lose strength
why do post-op patients have decreased peristalsis? handling of intestines, anesthesia, immobility, narcotics
when do wound infections occur? 1 week or more post-op
what is a pulmonary embolus? clot dislodged and sent into circulation ended up in lung
S/S of pulmonary embolus chest pain, dyspnea, restlessness, tachycardia
what is surgical consent? permission to perform a procedure- states the procedure to be done and risks/benefits
who has to get it signed? the dr
who witnesses it? nurse
why must IV sites be assessed every hour? no infiltration/ phlebitis
s/s of IV infiltration swelling, cold, white/blanche
s/s of Phlebitis red, warmth, edema
why must a patient be NPO for atleast 8 hours pre-op? prevent aspiration pneumonia
what is Versed? concious sedation given pre-op to decrease the amount of anesthesia needed
what is Atropine? anticholinergic given pre-op to decrease respiratory secretion (drying agent)
Why is Xanex given pre-op? to decrease anxiety
what is given pre-op to decrease stomach acid? H2 blockers
what happens to post-op GI system? decreased peristalsis (paralytic ileus)
elective surgery patient can choose to have it or not have it
required/non-elective surgery necessary at some point but patient can choose when
urgent surgery needed to prevent further damage
emergency surgery done immediately to save a life or preserve body function
why are surgical patients at high risk for pneumonia or atelectasis? decreases movement, medication effects, not TCDB d/t pain
what is a PCA? patient controlled anesthesia
nursing interventions for a PCA teach patient they are the only one that can push the button, RR q2h
what is referred pain? pain at a site other than at the original site
what is phantom pain? pain where a body part is gone
why would a post-op patient have urinary retention? anesthesia, taking out the foley
when must a pt void post-op? 6-8 hrs post-op
what can you do to help a pt void? dip hands in warm water, run water, pour warm water over peri area, ambulate, crede maneuver(gently palpate bladder to expel urine)
what will be done if interventions are not successful in getting pt to void? bladder scan and possible straight cath
common complaints if a pt has urinary retention? pressure and fullness on lower abdomen
what must you always remember with an IV? maintain blood volume and urine output
post-op care goals fluid and electrolyte balance, comfort, respiratory function, nutrition/elimination, and maintain cardiovascular function
nursing interventions to maintain cardiovascular function post-op VS q4h, monitor skin color, hematocrit levels, activity tolerance/early amblation
nursing interventions to maintain nutrition/elimination post-op bowel sounds, encourage fluids, assess fluid tolerance, progressive diet, record BM's, assess output, NG tube?, NPO-Gi function returns
nursing interventions to maintain respiratory function post-op adequate hydration, TCDB, oxygen, incentive spirometry
nursing interventions for comfort post-op analgesics, antiemetics, hygiene, position, rest
nursing interventions for fluid and electrolyte balance post-op IV fluid & rate, adequate hydration, electrolyte labs, GI drainage,renal function, lab values
number one concern immediate post-op recovery respiratory status
specific information needed from O.R. nurse overall tolerance, type of surgery, type of anesthetics, results, complications, and I&O
immediate post-op recovery assessment should include vital signs, respiratory status, color, fluid intake, special equipment, and dressing
Immediate post op recovery nursing goals maintain respiratory status, monitor fluid status, and maintain psychological equilibrium
what does maintaining psychological equilibrium in immediate post-op recovery include? speak calmly, orient, quiet atmosphere, body alignment, explain, remember hearing is the last to go
what does maintaining respiratory function in immediate post-op recovery include? airway until gag reflex is ok, position, sucon prn, TCDB, oxygen therapy, mechanical support, check breath sounds, prevent aspiration
what does monitoring fluid status in immediate post-op recovery include? blood loss, IV rate, outputs, bladder distention, electrolytes, hydration, character of drainage, NG tube, N&V
what are 10 post-op complications pulmonary embolism (from DVT), hypovolemic shock, infection, dehiscence, evisceration, gastric dilation, paralytic ileus, atelectasis, pneumonia, and urinary retention
S/S pulmonary embolism chest pain, dyspnea, increased RR, tachycardia, increased anxiety, diaphoresis, decreased orientation, decreased BP, blood gas changes
S/S hypovolemic shock decreased urine, decreased BP, weak pulse, cool/clammy, restless, increased bleeding, increased thirst, decreased CVP
S/S of infection redness, purulent drainage, fever, tachycardia, leukocytosis
S/S gastric dilation N&V, Abdominal distention
S/S parlytic ileus decreased bowel sounds, no stool/flatus, N&V, abdominal distention, and abdominal tenderness
S/S of atelectasis dyspnea, tachypnea, decreased breath sounds, asymetrical chest movement, tachycardia, and increased restlessness
S/S of pneumonia rapid/shallow respirations, fever, wet breath sounds, asymmetrical chest movement, productive cough, hypoxia, tachycardia, luekocytosis
S/S urinary retention unable to void 6-8h post-op, palpable bladder, frequent small voids, pain in suprapubic area
Pre-op checklist on day of surgery NPO,teaching,consent signed,contact lens out, dentures/bridges out, no nail polish, skin prep, vitals within 4h of surgery or 30mins after pre-op, abnormal labs, hx of aspirin,antidepressants, steroids, NSAIDs, side rails, pre-op meds, allergy&ID bands on
what does aspirin and NSAIDs put a pt at risk for? increased bleeding
what does steroids put a pt at risk for? higher risk of infection
nursing interventions for urinary retention 1 hands in warm water, run water, water of peri area 2 bladder scan 3 catheterization
nursing intervention for hypovolemic shock trendelenberg position and boluses of fluid
what is a priority when giving Versed? have resuscitation equipment available and monitor cardiac&respiratory status.
What to watch for with Versed respiratory depression, arrhythmias, hypotension, unresponsiveness, agitation, and confusion
what to watch for with H2 blockers for pneumonia due to colonization and increased Ph in stomach
what can decreased stomach acid from H2 blockers cause may increase growth of candida and bacteria in the stomach
Why give H2 blockers? for painful duodenal and gastric ulcers and burny gastroesophageal reflux
Created by: Purple butterfly