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Postoperative care
Postoperative chapter review
| Question | Answer |
|---|---|
| What is the purpose of a postanesthesia care unit (PACU)? | it is the ongoing evaluation and stabilization of patients to anticipate, prevent, and treat complications after surgery |
| After the surgery is completed, Who takes the patient to the PACU? | the circulating nurse and the anesthesia provider |
| Define- PACU nurse | they are skilled in the care of patients with multiple medical and surgical problems immediately after a surgical procedure |
| What education must the PACU nurse have? | areas requires in-depth knowledge of anatomy and physiology, anesthetic agents, pharmacology, pain management, extubation, and surgical procedures. |
| What is the most important assessment in postop? | respiratory |
| Who and what determines the patients readiness for discharge? | The health care team determines the patient's readiness for discharge from the PACU by the presence of a recovery score rating of at least 10 on the recovery scale |
| During the postoperative period, what are all patients at risk for? | for pneumonia, shock, cardiac arrest, respiratory arrest, deep vein thrombosis, and GI bleeding. |
| When the patient is admitted to the PACU, what do you IMMEDIATEY assess for? | a patent airway and adequate gas exchange. Although some patients may be awake and able to speak, talking is not a good indicator of adequate gas exchange. |
| What are some RESPIRATORY SYSTEM COMPLICATIONS? | Atelectasis Pneumonia Pulmonary embolism PE) Laryngeal edema Ventilator dependence Pulmonary edema |
| What are some CARDIOVASCULAR COMPLICATIONS? | Hypertension Hypotension Hypovolemic shock Dysrhythmias Deep vein thrombosis (DVT) Heart failure Sepsis Disseminated intravascular coagulation (DIC) Anemia Anaphylaxis |
| What are some SKIN COMPLICATIONS of Surgery? | Pressure ulcers Wound infection Wound dehiscence Wound evisceration Skin rashes Contact allergies |
| What are some GASTROINTESTINAL COMPLICATIONS Surgery? | Paralytic ileus Gastrointestinal ulcers and bleeding |
| What are some NEUROMUSCULAR COMPLICATIONS of Surgery? | Hypothermia Hyperthermia Nerve damage and paralysis Joint contractures |
| What are some RENAL URINARY COMPLICATIONS of Surgery? | Urinary tract infection Acute urinary retention Electrolyte imbalances Renal failure |
| What does the use of accessory muscle, sternal retraction, and diaphragmatic breathing? | this could indicate an excessive anesthetic effect, airway obstruction, or paralysis, which could result in hypoxia. |
| Define-stridor | a high-pitched crowing sound |
| Why do snoring and stridor occur with airway obstruction? | from tracheal or laryngeal spasm or edema, mucus in the airway, or blockage of the airway from edema or tongue relaxation |
| What happens when neuromuscular blocking agents are retained? | the patient has muscle weakness, which could affect gas exchange |
| What are the indicators of muscle weakness? | the inability to maintain a head lift, weak hand grasps, and an abdominal breathing pattern |
| What does a respiratory rate of less than 10 breaths per min indicate? | anesthetic- or opioidanalgesic–induced depression. Rapid, shallow respirations may signal shock, cardiac problems, increased metabolic rate, or pain. |
| When does the nurse check the lungs post-op? | at least every 4 hours during the first 24 hours after surgery and then every 8 hours, or more often, as indicated |
| When are Vital signs and heart sounds are assessed? | on admission to the PACU and then at least every 15 minutes until the patient's condition is stable |
| What values for bloodpressure need to be reported to the surgeon | report blood pressure changes that are 25% higher or lower than values obtained before surgery (15- to 20-point difference, systolic or diastolic) to the anesthesia provider or the surgeon. |
| What is a pulse deficit and what could it mean? | it is a difference between the apical and peripheral pulses and could indicate a dysrhythmia. |
| What assessement is important after epidural or spinal anesthesia? | Motor and sensory assessments |
| How long does the patient who had epidural or spinal anesthesia remain in the PACU? | until sensory function (feeling) and voluntary motor movement of the legs have returned |
| What IV solutions are used for IV fluid replacement in the PACU? | Isotonic solutions such as lactated Ringer's (LR), 0.9% saline, and 5% dextrose with lactated Ringer's (D5/LR) |
| What is the typical IV solution for the patient being admitted to the nursing unit? | 5% dextrose with 0.45% normal saline (D5 0.45% NS) |
| What is affected by the patient's respiratory status before and during surgery; metabolic changes during surgery; and losses of acids or bases in drainage? | Acid-base balance |
| What is considered when measuring urine output? | sources of output, such as sweat, vomitus, or diarrhea stools. |
| At what level should the urine results be reported to the physician and what could it mean? | output of less than 30 mL/hr (240 mL per 8-hour nursing shift),may indicate hypovolemia or renal complications |
| What is the most common reactions after sur gery? | Nausea and vomiting |
| Preventive drug therapy medication is used for GI upset? | (Zofran), a serotonin antagonist |
| What effects does Nausea and vomiting have to a post-op patient? | it can stress and irritate abd/GI wounds, increase intracranial pressure in head and neck surgery, elevate intraocular pressure in eye surgery, and increase the risk for aspiration |
| How long does a patients who had abdominal surgery often have decreased or no peristalsis? | for at least 24 hours. This problem may persist for several days for those who have GI surgery |
| What is the best indicator of intestinal activity? | is the passage of flatus or stool. |
| What does the bowel sounds mean? | The presence of active bowel sounds usually indicates return of peristalsis; however, the absence of bowel sounds does not confirm a lack of peristalsis |
| Decreased peristalsis occurs in what kinds of patient? | those who have a paralytic ileus |
| Why is a nasogastric (NG) tube inserted during surgery? | to decompress and drain the stomach, to promote GI rest, lower GI tract to heal, enteral feeding route, monitor any gastric bleeding and to prevent intestinal obstruction |
| What is one of the most common tubes used? | The Salem sump, it is a double-lumen tube with an air vent to keep the tube from grabbing the gastric mucosa. |
| What is the Levin tube? | it is a single-lumen tube with no air vent. To promote drainage, suction (usually low) is applied to the NG tube |
| What is recorded about the tubes and when? | Record the color, consistency, and amount of the drainage every 8 hours |
| How do you prevent aspiration with pt having a tube? | check the tube placement every 4 to 8 hours and before instilling any liquid into the tube |
| What is normal NG drainage fluid? | greenish yellow |
| What is abnormal BG fiuld and indication? | Red drainage fluid indicates active bleeding, and brown liquid or drainage with a “coffee-ground” appearance indicates old bleeding |
| How can fluid and electrolyte imbalances occur in patient post-op? | can result from NG drainage and tube irrigation with water instead of saline |
| When does the clean surgical wound heals at skin level? | in about 2 weeks in the absence of trauma, connective tissue disease, malnutrition, or the use of some drugs, such as steroids. |
| How long does it take for the completion of all tissue layers within the surgical wound to heal? | may take 6 months to 2 years |
| Calculating Nasogastric Tube Drainage- Formula | Drainage in collection device − Amount of irrigant = True (actual) amount of drainage |
| During the first few days of normal wound healing, what happens? | the incised tissue regains blood supply and begins to bind together. Fibrin and a thin layer of epithelial cells seal the incision |
| After 1 to 4 days, what happens with the wound healing process, and how long does this last? | epithelial cells continue growing in the fibrin and strands of collagen begin to fill in the wound gaps. This process continues for 2 to 3 weeks |
| How often do you assess the incision on a regular basisand what do you look for? | at least every 8 hours, for redness, increased warmth, swelling, tenderness or pain, and the type and amount of drainage |
| Define- sanguineous drainage | bloody |
| Define- serosanguineous to serous drainage | serum-like, or yellow |
| When is serosanguineous drainage abnormal? | beyond the fifth day after surgery or increasing in amount instead of decreasing |
| What could be the results of abnormal serosanguineous drainage? | this alerts you to the possibility of dehiscence (discussed below), and the surgeon should be notified. Large amounts of sanguineous drainage may indicate internal bleeding. |
| Define- dehiscence | a partial or complete separation of the outer wound layers, sometimes described as a “splitting open of the wound.” |
| Define-Evisceration | the total separation of all wound layers and protrusion of internal organs through the open wound |
| When would evisceration/ dehiscence happen? | between the fifth and tenth days after surgery |
| What conditions or occurances would evisceration/ dehiscence happen? | Wound sep occurs more often in obese patients and those with diabetes, immune deficiency, or malnutrition or who are using steroids, This may follow forceful coughing, vomiting, or straining and when not splinting the surgical site during movement |
| When would the nurse assess all dressings, including casts and elastic (Ace) bandages, for bleeding or other drainage? | on admission to the PACU and then hourly thereafter |
| Why would you assess closed-suction drains? | for maintenance of suction |
| Whatkind of drains are used for closed-suctioning? | Hemovac, VacuDrain, T-tubes and Jackson-Pratt drains |
| What kind of tube is used after a cholecystectomy ? | T-tube drains bile |
| When does the nurse assess all drains for patency? | when the patient is admitted to the PACU and every time vital signs are taken |
| When do you monitor the amount, color, and type of drainage? | while the patient is in the PACU and at least every 8 hours after he or she is transferred to the medical-surgical nursing unit |
| What are the physical signs of anxiety? | restlessness; increased pulse, blood pressure, and respiratory rate; and crying |
| When does a change in laboratory test results (e.g., electrolyte, hematocrit, hemoglobin levels) occur? Why? | often occurs during the first 24 to 48 hours after surgery because of blood and fluid loss and the body's reaction to the surgical process. Fluid loss with minimal blood loss may cause hemoconcentration of laboratory values |
| Where would an infection occur if the CBC results show an increase in the band cells (immature neutrophils)? | infection may be the respiratory system, urinary tract, wound, or IV site |
| How do position the patient In the PAC? | immediately position the patient in a side-lying position or turn his or her head to the side to prevent aspiration |
| When can the removal of the airway or ET tube take place? | After the patient regains the gag and cough reflexes and meets the agency's criteria for extubation(to raise and hold the head up and evidence of thoracic breathing) |
| Is a draining wound covered or uncovered? | is always covered with a dressing |
| What is a source for infection on wounds? | An unchanged wet or damp dressing. Change dressings using aseptic technique until the sutures or staples are removed |
| When are skin sutures or staples are usually removed? | 6 to 8 days after surgery, and the incision is secured with Steri-Strips |
| What is the purpose for drains? | provide an exit route for air, blood, and bile. Drains also help prevent deep infections and abscess formation during healing |
| How is the Penrose drain placed? | into the external aspect of the incision and drains directly onto the dressing and skin around the incision |
| What are Jackson-Pratt and Hemovac drains? | two self-contained drainage systems that drain wounds directly through a tube via gravity and vacuum |
| How are the Jackson-Pratt and Hemovac drains placed? | they are sutured in place with a suture that seals the area when the drain is removed |
| What is a major complications to wounds after surgery? Why does it occur? | Wound infection, it usually results from contamination during surgery, preoperative infection, debilitation, or immunosuppression3 |
| Define-débridement | removal of the infected or dead tissue |
| What does the nurse do if dehiscence occurs? | apply a sterile nonadherent (e.g., Telfa) or saline dressing to the wound and notify the surgeon |
| What does the nurse do if an evisceration occurs? | this is a surgical emergency. One nurse tends to the patient while another nurse immediately notifies the surgeon |
| How can a nurse offer pain management after surgery? | drug therapy and other methods of management, such as positioning, massage, relaxation techniques, and diversion |
| What are common pain management drugs that are given? | morphine (Statex), hydromorphone (Dilaudid), ketorolac (Toradol), meperidine (Demerol), codeine, butorphanol (Stadol), and oxycodone with aspirin (Percodan) or oxycodone with acetaminophen (Tylox, Percocet) |
| MEDICAL SURGICAL- POSTOPERATIVE CHAPTER | MEDICAL SURGICAL- PERIOPERATIVE CHAPTER |
Created by:
kmichalle
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