Postop Care
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| postoperative period | begins immediately after surgery and continues until the patient is discharged from medical care
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| How a patient moves through the phases of care in PACU is determined by | the patient's condition
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| If a patient is stable and recovering well, they may progress through the PACU phases rapidly. This is refered to as | (RPP) rapid postanesthesia care unit progression; can occur with either in- or outpatients
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| fast-tracking reduces overall costs, recovery time, and medical morbidity. How is this done? | involves admitting ambulatory surgery patients who have received general, regional, or local anesthesia directly to phase II care
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| PACU Phase I (Initial Assessment) | begins with evaluation of the ABC status; identify signs of inadequate oxygenation and ventilation
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| greatest value of pulse oximetry monitoring | provides an early warning of hypoxemia and changes in arterial blood gases
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| PACU priority care includes monitoring and managing | respiratory and circulatory function, pain, temperature, and the surgical site
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| protocol for deviations in ECG results from preoperative findings include | measuring and comparing BP to baseline (invasive monitoring is initiated only if needed); assess body temp, capillary refill, and skin condition (color, moisture)
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| initial PACU neurologic assessment focuses on | level of consciousness, orientation, sensory and motor status, and size, equality, and reactivity of pupils
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| initial PACU urinary system assessment focuses on | intake (intraoperative fluid totals), output, and fluid balance; note IV lines, irrigation solutions & infusions; wound drains and catheters
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| initial PACU surgical site (wound) assessment focuses on | the condition of any dressings and the type and amount of any drainage
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| the goal of PACU care | identify actual and potential patient problems that may occur as a result of anesthetic admin and surgical intervention, and to intervene appropriately.
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| the primary postop problem (most common cause of postop hypoxia) | atelectasis (bronchial obstruction caused by retained secretions or decrease lung volumes); alveolar collapse
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| patient manifestations of atelectasis | decrease breath sounds; decrease or low O2 saturation
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| atelectasis interventions | humidified O2, deep breathing, incentive spirometry, and early mobilization
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| pulmonary embolism, a major postop complication, is caused by | a thrombus dislodging from the peripheral venous system; lodges in pulmonary arterial system
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| pulmonary embolism patient manifestations | acute tachypnea, dyspnea, tachycardia, hypotension, bronchospasm, and decrease O2 sat
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| pulmonary embolism interventions | O2 therapy, cardiopulmonary support, anticoagulant therapy
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| hypoxemia, specifically a PaO2 <60 mmHg is characterized by | agitation to somnolence, hypo- to hypertension, tachy- to bradycardia; ABG analysis should be used to confirm hypoxia if pulse oximetry is <92%
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| other causes of hypoxemia | bronchospasm, hypoventilation, pulmonary edema, aspiration (gastric contents)
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| positioning of the unconscious patient | lateral "recovery" (side lying); keeps an open airway and reduces the risk of aspiration if vomiting occurs
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| positioning of the conscious patient | supine with head of the bed raised; maximizes expansion of the thorax by decreasing the pressure of the abdominal contents on the diaphragm
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| emergence delirium (waking up wild) | postop neurologic alteration that causes most concern; if occurs, suspect hypoxia first
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| causes of emergence delirium | anesthetic agents, hypoxia, bladder distention, pain, residual neuromuscular blockade, presence of an endotracheal tube
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| changing a patient's position every 1 to 2 hours allows for | full chest expansion and increases perfusion of both lungs
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| deep breathing and coughing aid in | gas exchange to promote the retun to consciousness, help prevent atelectasis, and move respiratory secretions to larger passages for expectoration
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| most common cardiovascular PACU problems | hypo- and hypertension, dysrhythmias
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| postop fluid and electrolyte imbalances contribute to cardiovascular problems. These imbalances develop as a result of | the body's normal response to stress, excessive fluid losses, and improper IV fluid replacement
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| postop congnitive dysfunction (POCD) | a decline in the patient's cognitive function for weeks or months after surgery; almost exclusively seen in the older patient
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| deep visceral pain results from pressure in the internal viscera and may signal | the presence of complications such as intestinal distention, bleeding , or abscess formation
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| causes of postop hypothermia (temp <95 degrees F), up to 12 hrs after surgery | effects of anesthesia, body heat loss during surgical procedure
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| causes of postop mild elevation of temp (up to 100.4) the first 48 hrs or days 1 & 2 | inflammatory response to surgical stress
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| causes of postop moderate elevation of temp (above 100.4 degrees F) the first 48 hrs or days 1 & 2 | lung congestion, atelectasis, dehydration
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| causes of postop elevation of temp (above 100 degrees F) after the first 48 hrs or day 3 and later | infection (ex. wound, UTI, respiratory, etc)
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| stress related hormones such as cortisol have catabolic effects on the body, releasing amino acids. This helps with | wound healing
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| evidence of wound infections usually manifest after the 3rd to 5th day. Local and systemic manifestations include | Local: redness, swelling, increased pain and tenderness at the site; Systemic: fever and leukocytosis
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| expected urine output from a catheter | clear, yellow in color; odor of ammonia; watery consistency; 800-1500 ml first 24hrs (minimal expected output is 0.5 ml/kg/hr)
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| expected gastric contents drainage from nasogastric tube/gastrostomy tube | up to 1500 ml/day; sour odor; watery consistency; pale, yellow green, bloody following gastrointestinal surgery
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| expected drainage of bile from a t-tube | 500 ml; bright yellow to dark green in color; acid odor; thick consistency
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| expected wound drainage from a hemovac | odor same as the wound dressing; consistency varies; amount varies w/ procedure but may decrease over hrs to days; color varies with procedure(sanguineous or serosanguinous, changing to serous)
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| wound dehiscence | separation and disruption of previously joined wound edges; may be preceded by a sudden discharge of brown, pink, or clear drainage
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