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AH- Ch. 20
PostOperative
| Question | Answer |
|---|---|
| What do you assess in the PACU? | ABC, VS, Lymph nodes, Check incision site, Neurological function, GI/GU, hypothermia |
| Lymph nodes usually identify? | infection |
| How do you assess neurological functions? | PERRLA, check if A&O x3, pain, coping, sensation |
| Bowel sounds should be present before? | the pt can eat |
| If the pt is not away how should they be positioned? | on their side, to prevent aspiration |
| ABC to prevent complications are? | take deep breaths, incentive sperometer, turn every 2 hrs |
| Dehydration will cause? | hypotension |
| How to assess for dehydration? | I&O, at least 30 ml/hr output, and skin turgor |
| What are the 3 types of drains and the drainage associated with them? | Jackson pratt(serosanguinous), Hemovac (Sanguinous), and PenRose(serous) |
| What is phase one of postanesthesia care? | intensive monitoring and care |
| What is phase two of postanesthesia care? | PACU or in pt unit, loss monitoring |
| What is phase three of postanesthesia care? | home/extended care facility |
| What is the intial assessment of pt in the PACU? | ABC, neurologic, Genitourinary, surgical site, and pain |
| What do you do what the tongue is blocking the airway? | stimulation, jaw thrust, chin lift, and artifical airway |
| What if there are retained secretions in the airway? | suctioning, TCDB, IV, chest PT |
| What is the pt has a laryngospasm causing airway obstruction? | put on oxygen, give muscle relaxant, Lidocaine, corticosteroids |
| What is the pt has laryngeal edema causing airway obstructions? | put on oxygen, give histamines, corticosteroids, and sedatives |
| What do you do if the pt has atelectasis? | give humidified O2, deep breathing, incentive spirometry, ambulation |
| What do you do if the pt has pulmonary edema? | give O2, diuretics, and fluid restriction |
| What do you do if the patient is aspirating? | O2, Cardiac support, antibiotics |
| What do you do if the pt is having a bronchospasm? | give O2, bronchodilator |
| What causes hypoxemia? | atelectasis, pulmonary edema, aspriation, bronchospasm |
| What causes hypoventilation? | depression of central resp. drive, poor resp. muscle tone, mechanical restriction, and pain |
| What do you do when there is depression of central respiratory drive? | stimulation, reversal of meds, and mechanical ventilation |
| What do you do when there is mechanical restriction? | elevate head of bed, reposition, loosen dressings |
| What are nursing interventions for the airway? | positioning of pt, change positions q 1-2 hrs, early ambulation, adequate analgesia, adequate hydration |
| How do you reverse hypotension? | restore ciculatory volume |
| What do you assess with cardiovascular dysfunction? | VS, cardia dysrhythmias, oxygen therapy, epinephrine |
| What causes hypertension? | sympathetic NS stimulation |
| How do you treat hypertension? | analgesics |
| What causes dysrhythmias? | hypokalemia, hypoxemia, hypercapnia, acid base imbalances |
| What are interventions for dysrhythmias? | eliminate cause, life support |
| What causes emergence delirium? | hypoxia, anesthesia, bladder distention, pain, electrolyte imbalance |
| What are implementations for emergence delirium? | evaluated for hypoxiz, pt safety, continous reorientation |
| Stimulation of stress response increases what? | muscle tension, local vasoconstriction, and sympathetic stimulation |
| What is ischemia? | complications of pain |
| What meds are used post op for pain? | opioids |
| What is PCA? | self admin of med |
| What does PCA do? | has pt participation, eliminated delayed administration, and maintains therapeutic level |
| What are the requirements for PCA? | understand need to self dose, and physical ability to self dose |
| What is hypothermia? | temp of <96.8, shivering |
| In the first 48 hours the temp is what? | 100.4, stress response |
| In the first 48 hours if the temp is higher then 100.4 then there is? | respiratory congestion or atelectasis |
| After 48 hrs if the temp is >99.9 what might be the reason? | infection |
| What causes N&V? | fluids in stomach, ingestion before peristalsis resumes, inadequate ventilation with anesthesia, type of surgery |
| What are interventions for N&V? | lateral position, meds, and do not eat until BS present |
| What are causes of abdominal distention? | handling of intestines, limited intake, swallowing air |
| What are interventions for abdominal distention? | early ambulation, frequent assess of BS, dulcolax suppository |
| What is paralytic Ileus? | significant decrease in bowel function post op from bowel manipulation |
| What are s/s of paralytic Ileus? | ab pain, distention and absent BS |
| What are interventions for paralytic Ileus? | NG tube, bowel rest, IV therapy |
| What are hiccups? | intermittent spasm of diaphragm |
| What are meds for hiccups? | Phenothiazine |
| Urinary retention is caused from? | surgical intervention, immoblity, medications, and bedpan |
| What are interventions for urinary retention? | monitor I/O, 30 ml/hr |
| Pt are expected to void within? | 6-8 hrs post op |
| Who removes a dressing first? | surgeon |
| What is wound dehiscence? | disruption of surgical wound |
| What are causes of wound dehiscence? | infection, distention, cough, age, poor nutrtion |
| What is wound evisceration? | protrusion of wound contents (something gave way, pain, vomiting) |
| What are nursing interventions for eviseration? | low fowlers, lie quietly, covor protruding coils, notify surgeon |
| What are the criteria to discharge from PACU? | Awake, stable VS, uncompromised pulmonary function, no excess bleeding |
| What should you educate the client about before going home? | outcome, postop changes, written instructions, what to observe for, limit activity |
| What is the primary nursing care in post op? | protect pt, and preventing complications while the body repairs itself |
| The pt's immediate recovery period is supervised by a? | post anesthesia care nurse |
| The initial admission of the pt to the PACU is a joint effort between? | the anesthesia care provider and PACU nurse |
| How a pt moves through the phases of care in the PACU depends on? | their condition |
| What is rapid postanesthesia care unit progression? | accelerated process through the phases of postanesthesia care |
| What is fast tracking? | accelerated care, where they jump to phase 2 |
| Assessment should begin with? | ABC |
| What is the greatest value of pulse ox? | provide early warning of hypoxemia and significant reduction of arterial blood gases. |
| ECG monitoring is initiated to determine? | cardiac rate and rhythm |
| The initial neurologic assessment focuses on? | level of consciousness, orientation, sensory and motor status, size, quality, and reactivity of the pupils |
| The assessment of the urinary system focuses on? | intake and output as well as fluid balance |
| What is the goal of PACU care? | identify actual and potential pt prob that may occur as a reslut of anesthetic administration and surgical intervention |
| What are the most common causes of airway compromise? | obstruction, hypoxemia, and hypoventilation |
| Airway obstruction is most common caused by the? | pt tongue |
| What are less common causes of airway obstruction? | laryngospasm, retained secretions and laryngeal edema |
| What is hypoxemia? | partial pressure of arterial oxygen of less than 60 mm hg |
| What is stelectasis? | alveolar collapse |
| Atelectasis may be the result of? | bronchial excursion |
| Atelectasis may affect a ? | portion or an entire lobe of the lung |
| What is pulmonary edema caused by? | accumulation of fluid in the alveoli and may be the result of fluid overload; left ventricular failure or prolonged airway obstruction, sepsis, or aspiration |
| Pulmonary edema is characterized by? | hypoxemia, crackles, and decrease pulmonary compliance |
| Bronchospasm is the result of an? | increase in bronchial smooth muscle tone with resultant closure of small airways |
| Bronchospasm is used more frequently in pts with? | asthma and COPD |
| What is hypoventilation? | decrease resp rate or effort, hypoxemia and an increasing partial pressure of arterial carbon dioxide |
| Atelectasis can progress to? | pnemonia |
| With resp assessment the nurse must eveluate? | airway patency, chest symmetry and depth, rate and character |
| Impaired ventilation may initially be detected by the? | observation of slowed breathing or diminished chest and abdominal movement |
| What is the recovery position? | lateral |
| Deep breathing is encouraged to? | facilitate gas exchange and to promote the return to consciousness |
| Effective coughing is essentail in? | moblizing secretions |
| What are the most common heart prob after surgery? | hypotension, hypertension and dysrhythmias |
| Hypotension is evidenced by signs of hypoperfusion to the? | vital organs |
| What is the most common cause of hypotension? | unreplaced fluid and blood loss |
| Primary cardiac dysfunction may occur in the case of? | myocardial infarction, cardiac tamponade and pulmonary emboli |
| Secondary myocardial dysfunctions occurs as a reslut of? | the negative chronotropic and negative intotrapic effects of drugs |
| What is the common cause of hypertension? | the result of sympathetic NS stimulation that may be the result of pain, anxiety, bladder distention or respiratory compromise |
| Dysrhythmias are often the result of? | indentifiable cause other than myocardial injury |
| What is the leading cause of ddsrhythmias? | hypokalemia, hypoxemia, hypercarbia, alterations in acid base status, ciculatory instability |
| Fluid and electrolyte imbalances are contributing factors to? | cardiovascular prob |
| Fluid retention during the first 2-5 days post op can be the reult of? | stress response |
| Fluid retention results from the secretions of what from the pituitary? | ADH and ACTH |
| ADH release leads to? | increased water reabsorption and decrease urinary output |
| ACTH stimulated the adrenal cortex to? | secrete cortison and aldosterone |
| What can be a consequence of urinary and GI tract lossess? | hypokalemia K |
| Cardiovascular status is also affected by the state of? | tissue perfusion or blood flow |
| Deep vein thrombosis may form in legs veins as a result of? | inactivity, body position and pressure |
| DVT can lead to? | pulmonary embolism |
| Pulmonary embolism should be suspected in any pt complaining of? | tachypnea, dyspnea, and tachycardia |
| What is superficial thrombophlebitis? | irritation from IV or solution |
| What is synocope? | fainting |
| What is the most important aspect of the cardiobascular assessment? | monitor VS |
| Treatment of hypotension should always begin with? | oxygen therapy |
| Treatment of hypertension will center on? | addressing the cause of SNS stimulation and eliminating the percipitating cause |
| What are hazards with the administration of K? | Cardiac dysrhythmias and pain at site |
| What promotes venous return to lower extremities? | leg excercises |
| What is the most effective means of preventing DVT and pulmonary emboli? | subQ herparin |
| What is emergence delirium? | waking up wild |
| What is suspected first in emergence kelirium? | hypoxia |
| What are 2 types of Post op cognitive impairment seen in surgical pt's? | delirium and post op cognitive dysfunction |
| Alcohol withdrawal delirium is a reaction chracterized by? | restlessness, insomnia and nightmares |
| When should the nurse suspect delirium? | if the pt was mentally altert before surgery and becomes impaired after |
| What is the most common cause of post op agitation in the PACU? | hypoxemia |
| Till when should the nurse act as the pt advocate and maintain pt safety? | until the pt is awake and able to communicate |
| Maintenance of normal physiologic function includes? | F&E balance, adequate nutrtion, pain management, proper bowel and bladder function and early mobilization |
| What is the best indicator of pain? | pt's self report |
| What are the most effective interventions for pain? | analgesics |
| What are 2 alternatives for pain control? | PCA and epidural analgesia |
| What are advantages of PCA? | ambulation, improved wound healing and earlier hospital discharge |
| Epidural analgesia is the? | infusion of opioid analgesics through a catheter placed into the epidural space surrounding the spinal cord |
| What is hypothermia? | core temp of less than 96.8 |
| Heat loss may occur in the perioperative setting because of? | infusion of cool IV fluids and ventilation with dry gases |
| What are complications of hypothermia? | compromised immune functions, postop pain, bleeding, myocardial ischemia, impaired wound healing |
| Wound infection and fever go together how? | high fever in afternoon and night and near normal levels in the morning |
| Passive warming raises the? | basal body metabolism |
| Active warming requires? | the application of external warming devices |
| After surgery motality of the intestines may be reduced for? | 3-5 days |
| What contributes to N&V? | genger, hx motion sick, opioids, duration and type of surgery |
| Post op N&V is treated with wat meds? | antiemetic or prokinetic drugs |
| The pt resumes oral intake when? | gag relex returns |
| What is the reason of low urine output after surgery? | increased aldosterone and ADH secretion from stress |
| What should you do to encourage urination? | privacy, running water, warm water on perinium |
| What are the three major sources of wound contamination? | exogenous flora present, oral flora and intestinal flora |
| Wound dehiscence may be preceded by? | a sudden discharge of brown, pink, or clear discharge |
| What are the advantages of ambulatory surgery? | greater convinience, lower rates of hopital acquired infections and reduced cost |
| Common reasons pt seek help after discharge are? | pain, advice on meds, wound oozing |
| What is a common post op complication in the elderly? | pneumonia |
| Vascular function in the older adult is altered because of? | atherosclerosis and decreaed eleasticity in the blood vessels |
| Why is pain control in older adults more complicatied? | possible preexisting cognitive impairment, impaired communication and physiologic changes |
| Post op delirium is common in? | elderly |
Created by:
alicia.rennaker
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