perio 5

Question 1

Patient Assessment post op care

Answer 1

• Airway
• Breathing
• Circulation
• Temperature
• Neurological
• Pain
• Fluid therapy
• Wound care

Question 2

• Airway
• Breathing
• Circulation
• Temperature
• Neurological
• Pain
• Fluid therapy
• Wound care

Answer 2

• Airway → Look, listen, feel (patent, partially obstructed,
  obstructed)
• Breathing → Respiratory rate, depressed, rapid
• Circulation → heart rate, BP, skin perfusion
• Temperature → tympanic (hypothermic, MH)
• Neurological → level of consciousness, touch, movement,
  stimulus (extremity surgery, spinal, neuro)
• Pain → Surgery type (positional, subjective, referred)
• Fluid therapy (hydration, blood loss, serous loss)
• Wound care (haematoma, exudate, dehiscence)

Question 3

isobar framework

Answer 3

introduction
situation
observation
background
agree to plan (action)
responsibility and risk management

Question 4

introduction
situation
observation
background
agree to plan (action)
responsibility and risk management

Answer 4

• introduce and identify patient, self and team
• provide current working diagnosis, specific clinical problems, concerns and critical laboratory results
  -check, update and discuss relevant vital signs
• update and discuss relevant medical support information
  -outline plans for assessment an discharge
• confirm shared understanding ; clarify tasks ( read back critical information to check understanding), timing and responsibility is transferred

Question 4

introduction
situation
observation

Answer 4

• introduce and identify patient, self and team
• provide current working diagnosis, specific clinical problems, concerns and critical laboratory results
  -check, update and discuss relevant vital signs

Question 5

background
agree to plan (action)
responsibility and risk management

Answer 5

• update and discuss relevant medical support information
  -outline plans for assessment an discharge
• confirm shared understanding ; clarify tasks ( read back critical information to check understanding), timing and responsibility is transferred

Question 6

Airway Management is a

Answer 6

Priority = continuous monitoring during period of care
in PACU
- Use clinical judgement to alter oxygen therapy or use of
airway techniques

Question 7

Continuously observing patient for…
airway management

Answer 7

Pulse oximetry between 95-98%
- Equal rise and fall of chest
- Gurgling, snoring, stridor, wheezing
- Increased respiratory effort
- Tracheal tug
- Shallow breathing
- Misting in oxygen mask
- Colou

Question 8

Airway Management
Airway and Breathing Complications

Answer 8

• Hypoxaemia
• Obstruction by the tongue
• Obstruction by secretions/blood
• Laryngospasm
• Bronchospasm
• Hypoventilation
• Inadequate Reversal of Muscle Relaxants
• Post-Intubation Subglottal oedema

Question 9

Post-Op Nausea & Vomiting (PONV)

Answer 9

Must anticipate that ALL postoperative patients will suffer
some degree of PONV
- Can be very debilitating and harmful for patients

Question 10

Vomiting with airway obstruction and/or aspiration

Answer 10

major complication

Question 11

Multiple factors → Post-Op Nausea & Vomiting (PONV)

Answer 11

anaesthetic drugs (especially opioids),
pain, hypotension, surgical stimulation

Question 12

Predisposing factors are Post-Op Nausea & Vomiting (PONV)

Answer 12

• Female
• PONV/motion sickness history
• Non-smoker
• Age <60 with anaesthetic >60 mins