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3802
Post operative pt 1
43
Biology
Undergraduate 1
03/11/2009

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Cards

Term
Postoperative Nursing Care
Definition
Care that begins immediately after the completion of the surgical procedure.
Term
Post-Anesthesia Care Unit (PACU)
Definition

The area where a patient will be transferred to following regional or general anesthesia for monitoring until they are stabilized for discharge to a general care ward or intensive care unit or discharged home.

Term

IMMEDIATE POSTOPERATIVE REPORT:


Definition
  • )  PACU Nurse receives a report from the Surgical Team, prior to the patient arriving to the PACU.
  •      2)  Intraoperative (O.R.) Report
Term
Intraoperative (O.R.) Report includes the following information
Definition

  • a)       Demographic data
  • b)      Patient’s Diagnosis
  • c)       Allergies
  • d)      Surgical Procedure
  • e)       Anesthesia Procedures
    • a)       Medications
    •  
    • b)      Intravenous Fluids
    •  
    • c)       Vital Signs
Term
Additional items of the Intraoperative (O.R.) Report include
Definition
  • a)       Blood Loss
  • b)      Fluid Replacement
  • c)       Blood Transfusions
  • d)      Urinary Output
  • Laboratory Tests
  • e)       Other items to report
  • 1.  Dressings
  • 2.  Equipment used
  • 3.  Equipment needed
Term
Blood Transfusions
Definition

.  Red blood cell transfusions are given to raise the hematocrit level in patients with anemia or to replace losses after acute bleeding episodes.

Term
Autologous Blood
Definition

means using your own blood.

     a. Person donates blood before a planned surgical procedure.

     b. Blood can be donated up to 5-weeks before the planned surgical procedure.

     c. Blood can be frozen and stored up to 3-years.

     d. Blood donated for non-emergency (elective-type surgeries).

Term
When the patient is admitted to the PACU, the PACU Nurse and Surgical Team continues
Definition

to confer about the patient’s status.

Term
It is the Surgeon’s responsibility
Definition

to describe the patient’s status, the results of the surgery, and any complications that occurred during surgery.

Term

PATIENT TRACER METHODOLOGY:

)  In PACU

Definition

a)       Assess patient’s physiological status

b)      Ongoing assessment to establish trends

c)       Monitor surgical site

d)      Monitor recovery from anesthesia

e)       Comparison with PRE-OP Baseline, i.e. Vital Signs

Term
Vital Signs Monitoring:
Definition

a)       Every 15-minutes x 4

b)      Every 30-minutes x 4

c)       Every 45-minutes x 4

d)      Every 60-minutes x 4

Term

COMMON POSTOPERATIVE PROBLEMS

Compromised Airway

Greatest concerns

Definition
  • Airway Obstruction
  • Hypoxemia
  • Atelectasis
  • Aspiration
  • Bronchospasm
  • Pulmonary Edema
  • Hypoventilation
Term
Airway Obstruction
Definition

1.        Most common cause of blockage of the airway is the patient’s tongue. The base of the tongue falls backward against the soft palate and occludes the pharynx.

 

Term
Hypoxemia
Definition
PaO2 of less than 60 mmHg, is characterized by a variety on non-specific clinical signs and symptoms ranging from agitation to somnolence
Term
Atelectasis
Definition
– Alveolar collapse may be result of bronchial obstruction caused by retained secretions or decreased respiratory excursion
Term
Aspiration
Definition
Aspiration of gastric contents into the lungs is a potentially serious airway emergency.  Extremely important for the patient to be NPO (nothing by mouth) prior to surgery
Term
Bronchospasm
Definition

1.        – Is a result of an increase in bronchial smooth muscle tone with results in closure of small airway.  Patients will have wheezing, dyspnea, use of the accessory muscles, hypoxemia and tachypnea.

Term
Pulmonary Edema
Definition

1.        Is caused by an accumulation of fluid  in the alveoli and may be the result of fluid overload.  Pulmonary edema is characterized by hypoxemia, crackles on auscultation, decreased pulmonary compliance, and presence of infiltrates on chest x-ray.

Term
Hypoventilation
Definition

1.        Caused by decreased respiratory rate or effort, hypoxemia, and an increasing PaCO2 (high levels of carbon dioxide) in the lungs.  Hypoventilation may occur as a result of depression of the central respiratory drive secondary to anesthesia or pain medication.

Term

Inadequate Oxygenation Affects Many Systems

Central Nervous System

Definition
  • *Restlessness
  • *Agitation
  • *Confusion
  • *Muscle Twitching
  • *Seizures
  • *Coma
Term

  b)  Inadequate Oxygenation Affects Many Systems:

Cardiovascular System

Definition
Hypertension; Hypotension; Tachycardia; Bradycardia; Arrhythmias               
Term
Integument System
Definition
Delayed capillary refills; skin flushed and moist; cyanosis
Term
.  Pulmonary System
Definition

– Absent to increased respiratory effort in accessory muscles; abnormal breath sounds; abnormal arterial blood gases

Term

Inadequate Oxygenation Affects Many Systems

.  Renal System

Definition
Decreased urinary output
Term

1)       Neurological Compromise:

a)  Assess for:

Definition
  • .  Level of Consciousness
  • .  Emergence Delirium
  • Delayed Awakening
  • Pupillary Responses
  • .  Gag Reflexes
  •      6.  Hand Grips    
  •     7.  Movement of Extremities
  •      8.  Complete Neurological Assessment
Term
Level of Consciousness
Definition
Patient’s level of consciousness, orientation, & ability to follow command should be assessed.  Until the patient is fully awake & able to communicate effectively, it is the responsibility of the PACU Nurse to serve as the patient’s advocate.
Term
Emergence Delirium
Definition

Can include such behaviors as, restlessness, agitation, disorientation, thrashing, & shouting.

Term
Delayed Awakening
Definition
Common cause of delayed awakening is prolonged drug action, particularly narcotics, sedatives, & inhalational anesthetics.
Term
Pupillary Responses
Definition
Size, reactivity, & equality should be determined
Term
.  Complete Neurological Assessment
Definition
if surgery involved the Neurological System
Term
 Hypothermia
Definition

1.  Operating Rooms are very cool

    

     2.  Anesthesia depresses level of body function – lowering metabolism

    

     3.  Fall in body temperature

    

     4.  Patient complains of feeling cold & uncomfortable

Term
)  Hyperthermia
Definition

     1.  Malignant Hyperthermia – Life-threatening complication of anesthesia

    

     2.  Causes – Tachypnea; Tachycardia; Premature Ventricular Contractions (PVCs); Unstable B/P; Cyanosis; Skin Mottling & Muscular Rigidity

    

     3.  Elevated Temperature Occurs Late – 24 to 72 hrs post-op
Term
Pain:
Definition

a)  Pain perceived before full consciousness is regained

           

b)  Pain causes patient to become restless

           

c)  Pain may responsible for changes in Vital Signs

           

 d)  Assessment for discomfort & evaluation of pain-relief therapy

Term

5)  Nausea & Vomiting:

Definition

a)  Anesthetics slows GI mobility & may cause nausea

 

b)  Auscultate for Bowel Sounds in all four quadrants

    

     1.  Bowel Sounds may be very faint or absent in the immediate recovery phase

    

      2.  Prior to offering any nourishment MUST AUSCULTATE FOR BOWEL SOUNDS

   

      3.  Inspect the abdomen for distention

    

  c)  May be an accumulation of gas

    

      1.  For a patient who has had abdominal surgery, distention will occur if internal bleeding has occur

 

        2.  Distention may also occur when a patient develops Paralytic Ileus

Term

 

6)  CARDIOVASCULAR COMPROMISE:

a)       Fluid & Electrolyte Imbalance

Definition

a.       Fluid retention during the first 2 to 5 post-operative days can be the result of the stress response to surgery.

 

b.      Fluid overload may occur during the post-operative period of fluid retention when IV fluids are administered too rapidly.

 

c.       Fluid deficit may be related to slow or inadequate fluid replacement.

 

d.      Hypokalemia (low potassium) can be the consequence of urinary and GI tract losses, especially if potassium is not replaced in IV fluids.

Term
Deep Vein Thrombosis (DVT
Definition

a.       DVT may occur in leg veins as a result of inactivity, body position, and pressure, all which lead to venous stasis and decreased perfusion.

 

b.      Patients with a history of DVT have a greater tendency for pulmonary embolism. 

 

Pulmonary embolism should be suspected in any patient complaining of tachypnea, dyspnea, and tachycardia, especially when the patient is already receiving Oxygen Therapy
Term
)  Syncope (fainting)
Definition

a.       May indicate decreased cardiac output, fluid deficits, or defects in cerebral perfusion.

 

b.      Frequently occurs as a result of postural hypotension when the patient ambulates.

Term
Hemorrhage
Definition

Loss of a large amount of blood externally or internally in short period of time. 

Term
)  Signs & symptoms include
Definition

.  Decreased B/P

 

                        2.  Increased Heart Rate with decreased quality

 

                        3.  Restlessness

 

                        4.  Apprehension

 

                        5.  Skin:  Cool, Moist, Pale

 

                        6.  Respirations, rapid

 

                        7.  Alterations in Level of Consciousness


Term
Thromboembolism
Definition
Thrombus means a formation of clot attached to interior wall of a vein or artery, which can occlude the vessel lumen.  Embolus means a piece of thrombus that has dislodged and circulates in bloodstream until it lodges in another vessel, commonly lungs, heart, brain, or mesentery.
Term

Thromboembolism

Causes

Definition

1.  Immobility**

 

                     2.  Vascular manipulation

 

                     3.  Dehydration

Term

Thromboembolism

)  Signs & Symptoms

Definition

1.  Redness

 

                       2.  Swelling

 

           3.  Warmth

                 

                                  4.  Pain

 

                       5.  Chest Pain

 

                       6.  Tachypnea

 

                       7.  Dyspnea

   

                       8.  Restlessness

Term

 

E.  DISCHARGE FROM PACU
Definition
Evaluation of discharge from the PACU not only includes vital signs, but also the patient’s body temperature control, good ventilatory function, orientation to surroundings, absence of complication, minimal pain and nausea, controlled wounded drainage, adequate urinary output and fluid and electrolyte balance.
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