Ch 16 Postoperative
What does the presence of bowel sounds usually indicate? What should you keep in mind?
The presence of active bowel sounds usually indicates return of peristalsis; however, the absence of bowel sounds does not confirm a lack of peristalsis. The best indicator of intestinal activity is the passage of flatus or stool
What;s the difference between Morphine and Hydromorphine?
The usual dosage of Hydromorphine is much smaller than morphine (about 1/5 to 1/10)
How do you monitor the wounds progression
by outlining it with a pencil and including the date and time
pulse deficit and what it could indicate
This is when there is a difference bt the apical pulse and the peripheral pulses it could indicate dysrhythmia
How long is cardiac monitoring done?
Until discharge of PACU
How long do pt stay in PACU if they got spinal or epidural anesthesia?
Until sensory and motor functions are back
When should you report BP changes?
When it is 25% higher or lower than values obtained before surgery. ( 15pt difference systolic and 20pt difference diastolic)
Serous Drainage
Yellow
Postoperative Period
The postoperative period starts with completion of surgery and transfer of the patient to a specialized area for monitoring such as the postanesthesia care unit (PACU) and may continue after discharge from the hospital until all activity restrictions have been lifted.
Some incisions are covered with a transparent plastic surgical or spray in the operating room. How long can this type of dressing stay intact?
3-6 days
How often should the lung sounds be assessed?
Check the lungs at least every 4 hours during the first 24 hours after surgery and then every 8 hours, or more often, as indicated
How often should you monitor cultures?
24.48,72hrs
WHat is the typical IV solution for the pt being admitted to the nursing unit?
5% Dextrose 0.45% Normal Saline
The client who had neck surgery to remove the entire thyroid gland is transferred to the medical- surgical unit after 4 hrs in the PACU. The client reports difficulty swallowing. What is the nurse's priority action? A. Assess the client's respiratory status B. Inspect the throat with a penlight C. Adjust the position of the drain in the incision D. Reassure the client that this is a normal and common problem after anesthesia
A
The nurse is about to give the prescribed pain medication to a client 30 minutes before a scheduled dressing change. The client states that the drug makes him feel sick and he would rather "tough it out." What is the nurse's best first response? A "Tell me more about the sick feeling." B "That's fine. You have the right to refuse any drug." C "Your surgeon would not have prescribed the drug if it wasn't needed." D "Remember that the pain of the dressing change would be worse than feeling sick."
A
What should you highly stress the importance of ?
Activity
Before the pt leaves what do you need to make sure of ?
Always ensure that the patient and family receive written discharge instructions to follow at home. Assess the patient's and family's understanding of the instructions by having them explain the instructions in their own words.
what should you assess in the PACU?
Assessment data include: LOC, Temp,Pulse, O2Sat, BP
When changing the client's abdominal dressing on the second postoperative day, the nurse observes crusting on about half of the suture line and oozing small amount of serosangenious drainage. What should the nurse do? A. Loosen the sutures or staples in the area where crust have formed B. Clean the suture line with sterile saline and apply new dressing c. Gently remove the crust and culture the material beneath d. Apply pressure over the incision and notify the surgeon
B
Sanguineous Drainage
Bloody
What could an increased pulse mean or the presence of bradycardia?
Bradycardia could indicate hypothermia or be an effect of the medication Increased pulse could indicate: shock, pain, hemmrorhage
A postoperative client's arterial blood gas (ABG) values are pH 7.36, HCO-3 21, PaCO2 35, PaO2 98. WHat is the nurse's priority? A. Compare these values with the client's preoperative ABG values B. Assess the airway and notify the physician C. Document the values as the only action D. Increase the oxygen flow rate
C
Which assessment parameter is most important for the nurse to employ for the client admitted to the postanesthesia care unit (PACU) for recovery after surgery under epidural anesthesia? A Determining the client's level of consciousness B Checking for pain on dorsi and plantar flexion of the foot C Assessing the response to pinprick stimulation from feet to mid-chest level D Comparing blood pressure taken in the right arm with blood pressure taken in the left arm
C
What drugs are commonly given through PCAs and an epideral catheter?
Common drugs given through a PCA include hydromorphine and morphine Common drugs through an epidural catheter include: opiods fentanyl (Sublimaze), preservative free morphine (Duramorphine), bupivacaine(Marcaine)
The PACU nurse is receiving handoff report from the circulating nurse and the CRNA for a pt who had a 2 hr open reduction of a fractured elbow. For which information should the nurse ask the reporting team for more detail? A. The client is Jewish B. The estimated blood loss is 150mL C. The client reported an allergy to codeine D. The total intraoperative urine output is 25mL
D
The assessment findings for the nasogastric tube drainage of a client recently transferred from the PACU include the presence of 140 mL of greenish yellow drainage. What is the nurse's best action? A Instruct the client to drink water until the drainage is clear. B Reposition the tube to increase the drainage. C Call and report this finding to the surgeon. D Document the finding as the only action.
D
What might decreased urine output mean?
Decreased urine output could possibly be an indication of hypovolemia or renal complications
What are 2 complications of healing and give examples
Dehiscence- a partial or complete separation of the outer wound layers Evisceration- is the total separation of all wound layers and protrusion of the internal organs
What should you not do unless prescribed by the surgeon after GI surgery?
Do not irrigate or move the NG tube
All patients are at risk for what during the postoperative period
During the postoperative period, all patients remain at risk for pneumonia, shock, cardiac arrest, respiratory arrest, clotting and venous thromboembolism (VTE), and GI bleeding. These serious complications can be prevented or the consequences reduced with collaborative care. Nursing observations and interventions are part of critical rescue management for patient safety and quality care.
Who is more at risk of F&E Imbalance after surgery?
Fluid and electrolyte imbalances occur more often in older or debilitated patients and in those with health problems such as diabetes mellitus, Crohn's disease, or heart failure
Antidote for Benzos and opioids
Flumazenil (Romazicon) Narcan
What is the normal color of NG drainage? What are other colors that could show up and what do they usually indicate?
Greenish Yellow Red- active bleeding brown- old bleeding
When concerning O2 Sat, when should you contact the surgeon or anesthesiologist? When should you contact the rapid response team?
If the oxygen saturation drops below 95% (or below the patient's presurgery baseline), notify the surgeon or anesthesia provider. If it drops by 10 percentage points and you are certain it is an accurate measure, call the Rapid Response Team
What is PONV and how can you help reduce this distressing symptom?
Postoperative n/v to help reduce PONV, have the pt lay in a sidelying position before raising the HOB up slowly
Teaching plan for the pt and family after surgery includes what?
Prevention of infection Care and assessment of the surgical wound Management of drains or catheters Nutrition therapy Pain management Drug Therapy Progressive increase in activity
What type of diet should someone be on after surgery to help promote wound healing
Protein, Calories, Vit C
What is one of the most critical assessments to perform after surgery?
Respiratory assessment is the most critical assessment to perform after surgery for any patient who has undergone general anesthesia or moderate sedation or has received sedatives or opioid drugs.
What position should the pt be put in immediately once the enter the PACU?
Semi-fowler's if not place in side lying or turn the head to the side to prevent aspiration
What is the best indicator that peristalsis has returned?
The best indicator of intestinal activity is the passage of flatus or stool
What should you do before you remove any sutures or staples? When are they usually removed
clean the incision 5 to 10 days varies up to 30 depending on the type of surgery and the pt's health
How often should the dressings me assessed for blood or drainage?
every hour on the PACU when on the unit when VS are taken (at least q 8 hrs)
What are some manifestations of paralytic ileus?
few or absent bowel sounds, distended abd, abd discomfort, vomiting, no passage of flatus or stool
How often should you assess the LOC?
q 4-8 hrs
How often are vital signs measured once discharged from the PACU
q15 min four times then q 30 min four times, then q hr four times then every 4 hrs for 24-48 hrs
How is acid-base balance affected?
respiratory status both before and during
Who have a higher chance of delayed wound healing?
smokers, elderly, obese, diabetic, decreased immunity
WHy should pillow support only be done if ordered?
this position could restrict circulation and increase the risk for VTE
