Post operative

mattisensept's version from 2017-06-03 21:23

Section 1

Question Answer
Post- Anesthesia CareAssess phycological status, surgical site, & influence of anesthesia at admission.
Periodic re-eval Physiologic status- what are the priorities?, surgical site, recovery from anesthesia
What to do post op?Establish baseline perimeters, compare current statues with preoperative status and discharge criteria, look for "abnormal" signs
Increased RR Atelectasis - collapsed alveoli, intervention - couch and deep breath
Decreased LOC Normal. The goal is "rousable"
Discharge criteria Awake or @ baseline, VS stable, no excess bleeding or drainage, no RR depression >10, oxygen sat >90%, report given
Positioning for unconscious, unresponsive, unsure lateral/recovery position
Positioning for groggy but responsive Semi-fowlers- head elevated to reduce change of aspiration

Section 2

Question Answer
Ambulatory discharge criteria All PACU discharge criteria met, No IV narcs- last 30 min, minimal N/Vm voided, able to ambulate, responsible adult w/pt., discharge instructions given and understood.
Receiving pt. from sx or other departments Before pt. comes-anticipate needs, have stuff ready and set up
Before the patient comes Equipment is ready- standard (bed, BP cuff, thermometer, you & watch, Special stuff, organize you and colleagues to help
When the patient arrivesTAKE VS, EVALUATE LOC, hook up equipment and monitoring devices, Observing dressings and incisions, get rapport, shouldn't leave until pt. is stable
Anesthesiologist/RN from PACU should report Name of pt., sx procedures, anasthetic agent & reversal agent used, estimated blood/fluid loss & replacement, complications, preop conditions and co morbidities, parameter for immediate post op management,
Expected outcomes #1Airway maintained; protective reflexes intact, normal spontaneous respiration, ABGS within postop normal values, no evidence of aspiration, heart rate & BP return to pre op values 1-2 hr post op- remain stable, body temo WNL
Expected outcomes #2urine output >0.5ml/kg/hr, no evidence of hypo or hyper volemia, Arouses easily & responds appropriately to commands, moves all extremities purposefully & within normal strength, skin integrity in tact
Hypervolemia signs Edema, Increased BP
Hypovolemia signs Chills, fever, check skins ability to snap back, puluse increase
Expected outcomes #3 Nutritional intake re-establisehd (protein for healing), pain less than 4, personal support systems used to reduce anxiety

Section 3

Question Answer
Routine post op careNursing diagnoses and potential complications
Expected nursing diagnoses Pain, Nausea, risk for infection, ineffective airway clearance, anxiety, constipation
Expected potential complicationsHemorrhage, thromboembolism, urinary retention, paralytic ileus
Encourage Coughing and deep breathing, preventing venous stasis
Activity is a good thing Good for lung expansion, returning peristalsis, bladder to get along, reduce clot formation (especially elderly and abdominal sx)
Risk with activities Orthostatic (expected), safety (sitting or lying), assess (LOC, vitals), Fluids
Complications to watch for Hypxemia, hypoventilation, hypotension, hypertension, cardiac dysrhythmias, hypothermia, thromboembolism, N/V,

Section 4

Question Answer
Effects of pain Increased sympathetic activity and stress, interferes with sleep, eating and activity, interferes with couch and deep breathing.
Increased sympathetic activity Increases metabolism, increases oxygen demand
Increased stress Decreases ability to fight infection, decreases healing
Dependencea physiologic need for the rug based on long term use
Addiction psychological need for drug
Acute addiction Little change of developing either dependence of addiction
Chronic More likely to develop dependence

Section 5

Question Answer
PCA manage pain Postoperatively, cancer, trauma, pain uncontrolled by other means
PCA drugs used meperidine (demoral), Morphine sulfate, hydromorphone (dilaudid)
PCA advantages Patient manges pain individually, better pain control, less pain medication used over time, less chance of overdose
PUMP Programmable for dose, time, lock-out
PCA tubing regular IV piggybacked into it
Patient trigger
Narcotic filled syringeSpecially filled by manufacturer
KeyAllows for nurse to program system
Patient teaching- how to use the pump Patient can only trigger, may trigger any time they want, pump will limit amount given over an hour
How to describe pain Use pain scale, sharp, full, aching?
Basal rateContinuous rate in mg/hr
BolusNurse initiated dose for breath through pain
ConcentrationDose ml-mg/l, mcg/ml
DoseDose that patient triggers
FrequencyThe interval that allows for patient trigger
Loading doseDose given to patient to start PCA use
Lockouttotal dose that can be triggered over 1 hour

Section 6

Question Answer
PCA nursing interventions
Effectiveness of medication Pain level- pain scale, type of pain, ability to be active
Side effects- Respiratory depression Frequent respiratory rate and depth
Side effects - N/VCommon, use antiemetics
Side effects- sedation Monitor LOC
Side effects- allergic reaction Itching is common
Documentation VS (especially respirations), Among of drug used (# of times patient requested, number of times pain med was delivered, total amount of drug given)
PCA complications - Respiratory depression Monitor respirations frequently, assess LOC, monitor oxygen sat
PCA complications- N/VDecreases over a couple of days, use of anti-emetic drugs, change the medication
Breakthrough pain Check to make sure system functioning properly, may need more med or conjunction med,
Nursing breakthrough pain Notify provider, may have order for any of the breakthrough options

Section 7

Question Answer
Epidural Analgesia Administration of pain reducing medications into the epidural space. Diffuse into the CSF in the subarachnoid space. Works on dermatomes.
Combination of... Opioids & anesthetics provide better analgesia with fewer side effects
Spinal nerve fibers in the dorsal root ganglion are blocked by anesthetics Blocks generation of pain impulses -bipuvicaine, marcaine-
Opioids act on opioid receptors in the CNS Block pain impulse transmission to the cerebral cortex -morphine, fentanyl-
When do use Epidual Analgesia?Post-Operatively -ortho sx on lower limbs, pelvic sx., GU & GI surgery
Epidural CatheterPlace in epidural space, taped securely, dressing applied
Tubing Very thin, connects catheter to pump,
PumpProgrammable, usually mandated by anesthesia or pain service, may have a trigger for patient control.
Basal rateContinuous rate of infusion
PCA ratedemand dose (dose each trigger will deliver), lockout (frequency of dose delivery, total amount that can be delivered in 1 hour)
Nursing interventions - Monitoring Med effectivenessPain, level of sensory loss (loss of touch, heat, cold, pressure, where on the body does it occur) , safety (ability to move extremities, inspect for areas of pressure)
Opioid side effects Pruritus, N, sedation, respiratory depression, treated by lowering the dose
Local anesthetic SEHypotension, Lower-extremity motor sensory deficits, urine retention, toxicity
Epidural SERespiratory depression, RR<8, O2 Sat <90%, can occur 20 hrs after morphine. If occurs= narcan, ambu, slow and stop
Epidural SE #2Urinary retention, after 6 hrs assess, after sx= 50-60ml
Sympathetic blockageEpidural SE, sympathetic blockade, decreased BP & HR, lie flat with legs elevated, notify anesthesia
Monitoring the system Check dressing (hemorrhage), Check 4 dryness (damp-medication is leaking out),
Documentation VS & neurologic signs, sedation, pain, sensory level, side effects
Dislodge of catheter Change in pain relief, damp or wet dressing
Epidural level too high Rise in level of sensation loss, SOB