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post op Flashcards

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1
Q

anestheisa nursing considerations

A
  • Ensure the patient has signed a consent form
  • Patients who have received sedation may not give legal consent.
  • Ask the patient to urinate before receiving anesthesia
  • Ensure the bed is in a low position and the side rails are up
  • Monitor airway and oxygen saturation
  • Monitor and report lab values
    ABG, CBC, electrolytes, wbc
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2
Q

nursing considerations vital based for anestheisa

A
  • Monitor cardiac status
    Rhythm, heart rate, blood pressure
  • Monitor temperature
  • Monitor drains, tubes, catheters, and IV access throughout anesthesia and surgery
  • Assess level of sedation and anesthesia
    *Level of consciousness
    *Vital signs
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3
Q

adverse effect of hypotension with anesthesia

A
  • If hypotension occurs as an adverse effect of medication or dehydration, lower the head of bed, give IVF bolus and monitor
  • Notify surgeon and anesthesiologist of abnormalities
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4
Q

what is Malignant hyperthermia

A
  • Acute life-threatening medical emergency
  • Inherited muscle disorder induced by the chemicals in anesthesia
  • Hypermetabolic condition
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5
Q

what happens in Malignant hyperthermia

A

alteration in calcium activity in muscle cells (muscle rigidity, hyperthermia, and damage to the CNS)

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6
Q

triggering events for Malignant hyperthermia

A

inhaled anesthetic agents and succinylcholine

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7
Q

what happens to body during malignant hypertherimia

A

Increased carbon dioxide level, decreased oxygen saturation level, and tachycardia occur first

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8
Q

s/s of MH

A

Dysrhythmias, muscle rigidity, hypotension, tachypnea, skin mottling, cyanosis, and muscle-cell protein in urine (myoglobinuria) occur next

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9
Q

late s/s of MH

A

Extremely elevated temperature is a late manifestation
Increases as high as 44 degrees Celsius (111.2 degrees farinheight)

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10
Q

MH nursing actions

A
  • Advocate terminate surgery.
  • Administer IV dantrolene, a muscle relaxant. PRIORITY*
  • Administer 100% oxygen.
  • Obtain specimens for ABGs to monitor metabolic acidosis and serum chemistry to evaluate potassium level.
  • Infuse iced IV 0.9% sodium chloride.
  • Apply a cooling blanket; ice to axillae, groin, neck, and head; and iced lavage.
  • Insert an indwelling urinary catheter to monitor output and the presence of blood.
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11
Q

who is likely to overdose from an anesthetic

A
  • Anesthetics and other medications can cause complications and interactions.
  • Overdose can occur in an older client who has pre-existing conditions or a client who has poor liver or kidney function
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12
Q

complications of general anesthesia

A
  • unrecognized hypoventilation
  • intubation probelms
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13
Q

unrecognized hypoventilation complication causes

A

Cardiac arrest, hypoxia, brain damage, and death can result from failure to oxygenate and exchange gases during surgery

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14
Q

unrecognized hypoventilation complication nursing action

A
  • Monitor end-tidal carbon dioxide levels (35-45).
  • For equipment malfunction, manually ventilate the client.
  • blood gas
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15
Q

intubation probelm complication

A
  • Injury to teeth, lips, and vocal cord during intubation if the mouth is too small, inability to open the mouth wide, and mouth tumors
  • Neck injury from improper neck extension during intubation
  • Sore throat
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16
Q

intubation problem nursing action

A
  • Nurses may assist the anesthesiologist with the intubation.
  • Have tracheostomy supplies available
  • assess airway
  • listen to lung sounds, look out for lung collapse
  • use incentive spirometer
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17
Q

types of local anestheic

A

procaine and lidocaine

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18
Q

local anestheisa concurrent administration

A

a vasoconstrictor, usually epinephrine, prolongs effects and decreases the risk of systemic toxicity.

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19
Q

contraindication for local anesthesia

A
  • Distal injuries (fingers) are a contraindication due to decreased circulation.
  • Prolonged vasoconstriction can lead to tissue necrosis.
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20
Q

local anesthesia main methods of admin

A

topical
local infiltration
regional nerve block

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21
Q

topical

A

Apply directly to the skin or mucous membranes.

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22
Q

local

A

Inject directly into tissues through which the surgeon will make an incision

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23
Q

regional nerve block

A

Injection into or around specific nerves

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24
Q

spinal

A

Anesthetic injection into the cerebrospinal fluid (CSF) in the subarachnoid space to provide autonomic, sensory, and motor blockade below the level of innervation

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25
epidural
Anesthetic injection into the epidural space in the thoracic or lumbar areas of the spine to block sensory pathways, but leave motor function intact
26
nerve block
Injection of anesthetic around or into an area of nerves to block sensation often for surgery on an extremity or for chronic pain
27
field block
Injection of anesthetic around the operative field for procedures of the chest, plastic surgery, dental, and hernia repairs
28
local Anesthesia: Nursing Considerations
- Observe for a systemic toxic reaction due to CNS stimulation (headache, blurred vision, metallic taste). - Without treatment, it leads to unconsciousness, hypotension, apnea, cardiac arrest, and death. - Establish airway patency, administer oxygen, and monitor oxygen saturation. Then notify the anesthesiologist and surgeon. - Monitor the client following administration of a fast-acting barbiturate. - Monitor and report laboratory values (ABGs, CBC, and electrolytes). - Monitor cardiac status (rhythm, heart rate, blood pressure). - Monitor drains, tubes, catheters, and IV access throughout anesthesia and surgery
29
what should you assess after giving a local anesthesia
- Assess motor function to ensure paralysis does not ensue (sense of touch returns first followed by pain, warmth, cold, and finally the ability to move). - With epidural and spinal anesthesia, monitor for autonomic nervous system blockade (hypotension, bradycardia, nausea, vomiting). - Lower the head of the bed, increase IV fluid infusion rate if no restrictions, and monitor vital signs.
30
csfk leakage w local anesthesia
- CSF leakage (spinal and epidural) manifests with a severe headache when the head of the bed is elevated. - Keep the head of the bed flat to promote the dura tear to seal. - Provide a quiet environment. - Keep the client well hydrated to help replace CSF loss.
31
whos responsible for transfer from post ip to pacu
- responsibility of the anesthesia provider: an anesthesiologist or certified registered nurse anesthetist. - The circulating nurse will give the verbal hand‑off report to the PACU nurse.
32
where is post op care provided
- Postoperative care is usually provided initially in the PACU, where skilled nurses who are certified in advanced cardiac life support can monitor a client’s recovery from anesthesia. - In some instances, a client is transferred from the operating suite directly to the intensive care unit
33
initial post op care involves
- Assessments - Administering medications - Managing pain - Preventing complications - Determining when a patient is ready to be discharged from the PACU - bleeding usually happens within 2hr after pacu
34
priority During the immediate postoperative stage
*****maintaining airway patency and ventilation and monitoring circulatory status are the priorities - Postoperative patients who receive general anesthesia require frequent assessment of their respiratory status. - Postoperative patients who receive epidural or spinal anesthesia require ongoing assessment of motor and sensory function.
35
post op complications
immbolity anemia hypovolemia hypothermia cardiovascular disease respiratory disease immunie disorder DB coagulation defect malnutrtion obesity
36
immobility
Respiratory compromise, thrombophlebitis, pressure ulcer
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anemia
Blood loss, inadequate/decreased oxygenation, impaired healing factors
38
hypovolemia
tissue perfusion
39
hypothermia
Risk of surgical wound infection, altered absorption of medication, coagulopathy, and cardiac dysrhythmia
40
cardiovascular diseases
Fluid overload, deep-vein thrombosis, arrhythmia
41
immune disorder
Risk for infection, delayed healing
42
DB
Gastroparesis, delayed wound healing
43
coagulation defect
Increased risk of bleeding
44
malnutrtion
delayed healing
45
obesity
Respiratory compromise, postoperative nausea and vomiting, wound healing, dehiscence, evisceration
46
post op diagnostic tests
- CBC: WBC (infection/immune status), Hgb and Hct (fluid status, anemia) - Metabolic profile: Serum electrolytes (electrolyte imbalances), BUN, and creatinine (renal function) - ABGs: Oxygenation status Additional laboratory tests: - Serum glucose - prothrombin time - INR based on procedure and associated - health problems
47
A nurse is reviewing the health records of several clients in the postanesthesia care unit (PACU) to identify risk factors that can lead to postoperative complications. Which of the following clients are at risk for complications? (Select all that apply.) 1. A client who has a WBC of 22,500/uL 2. A client who uses an insulin pump 3. A client who takes warfarin daily 4. A client who has heart failure 5. A client who has a BMI of 26
1-4
48
assessment: airway
- An artificial airway (endotracheal tube, nasal trumpet, or oral airway) is left in place until a client can maintain an open airway without support. - Assess blood oxygen saturation levels continuously (Sat probe) Should be greater than 95% or at preoperative baseline. - Assess respiratory pattern, rate, and depth to determine adequacy of oxygen exchange - Assess for symmetry of breath sounds and chest wall movement. - Absent breath sounds on the left can indicate the endotracheal tube has migrated down the right mainstem bronchus or that there is a pneumothorax. - Auscultate lung sounds. - Administer humidified oxygen. - Suction accumulated secretions if the patient is unable to cough Snoring or stridor: - A high-pitched crowing type sound - Can indicate poor oxygen exchange.
49
suction
Use a Yankauer suction for thick oral secretions or a large French suction catheter for nasopharyngeal or nasotracheal secretions.
50
when to take airway out
- Retained neuromuscular blocking agents can hinder the client’s ability to cough and eliminate secretions. - Extubation(removal) of endotracheal tube is based on client’s response to commands, ability to elevate head, and use of thoracic breathing. -As soon as the patient follows commands, encourage coughing, deep breathing, and use of the incentive spirometer
51
circulation: s/s of internal bleeding
- Abdominal distension - Visible hematoma under/near the surgical site - Tachycardia - Hypotension - Restlessness - Increased pain - External bleeding
52
assessing for hypervolemia and hypovolemia
Skin color Temperature Sensation Capillary refill - Check mucous membranes, lips, and nail beds for cyanosis
53
preventative deep vein thrombosis measures
- Sequential compression devices - Antiembolism stockings - Prescribed anticoagulants or antiplatelet medications. +Lovenox +Heparin
54
reportable vs
- A blood pressure difference of 25% from baseline - A drop of 15 to 20 mm Hg in diastolic or systolic pressures - A trending decrease in diastolic or systolic pressures by 5 mm Hg at each 15-min vital sign assessment.
55
positioning for unconscious pt.
Maintain lateral position (right or left side) if the patient is unresponsive or unconscious (risk of aspiration).
56
revere trendelenburg
for hypotension shock
57
pacu level of conscious
- Weakness - Restlessness/Agitation/Irritability - Somnolence - Change in orientation - Assess movement and sensation in all extremities. - Sensory function and voluntary movement of the extremities following a regional block should occur before transfer to another unit. ***worry after 4hr
58
Review I&O during surgery and in PACU:
Emesis Drains Nasogastric (NG) tube Urine Estimated blood losses IV fluids Blood products - Administer isotonic IV fluids (0.9% sodium chloride
59
A nurse is caring for a female client who manifests indications of hypovolemia while in the PACU. Which of the following findings requires action by the nurse? (Select all that apply.) Urine output less than 25 mL/hr Hematocrit 48% BUN 24 mg/dL Tenting of skin over the sternum Apical pulse rate 62/min
1-4
60
Surgical Wound, Incision site, Dressing
- Observe drainage tubes for patency and proper function. (jp, penrsoe) - Check dressings for excessive drainage and reinforce as needed. Report excess drainage to the surgeon. (can cause compartment syndrome( - Outline drainage spots with a pen, noting date and time. Report increasing drainage to the surgeon.
61
delerium
- Older adult patients can experience acute confusion or delirium related to anesthesia or other medications, dehydration, hypoxia, blood loss, or electrolyte imbalance. - Episodes of postoperative delirium can last 2 days or more in older adult patients.
62
A nurse is caring for a client who arrived in the PACU following a total hip arthroplasty. The client is not responding to verbal stimuli. Which of the following actions should the nurse perform first? Compare and contrast the peripheral pulses. Apply a warm blanket. Assess dressings. Place the client in a lateral position
d
63
discharge from pacu
The anesthesiologist must sign out the client before transfer to another unit or discharge to home. - Aldrete score of 8 to 10 (higher more awake) - Stable vital signs - No evidence of bleeding - Return of reflexes (gag, cough, swallow) - Minimal to absent nausea and vomiting - Wound drainage that is minimal to moderate - Urine output at least 30 mL/hr
Med Surg 2
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