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Surgery and pain
management
| Term | Definition |
|---|---|
| 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 |
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