Post-op Flashcards

Hypovolemia
Terms Definitions
Phase 1 of PACU
-admission report from surgery -background information -any complications, meds, anesthesia
Assessment of pt
-ABC's -airway: patency -breathing: resp. rate & quality, BS, 02, supplemental oxygen -circulation: ECG monitoring, BP, temp., Capillary refill, colorr of skin, peripheral pulses
Neurologic ass
-LOC -orientation -sensory & motor skills -pupil size and reaction
Genitourinary ass
-intake & output
Pain
-at incision -other
Resp. problems (common causes)
-obstruction, hypoxemia, hypoventilation
Pt's more at high risk
-General anesthesia -older -obsese -smoking history, lung disease
Airway Obstruction
-most pronounced in the supine position and pts who are really sleepy after surgery ** tongue falling back: tongue falls against soft palate and occludes the pharynx
Hypoxemia
-a partial pressure of arterial oxygen less than 60mmHg is characterized by a variety of non-specific clinical -S/S --agitation to somnolence --hypertension to hypotension --tachycardia to bradycardia
Atelectasis
-alveolar collapse may be the result of bronchial obstruction caused by retained secretions or decreased resp. excursion OCCURS WHEN: mucus blocks bronchioles or when the amount of alveolar surfectant is reduced -oxygen therapy is used if pt had anesthesia
Cardiovascular problems
hypotension, hypertension, dysrhythmias
Pts at greater risk
-hx of cardio disease -the elderly -the debilitated or critically ill
Hypotension
-s/s: disorientation, loss of consciousness, chest pain, hypoxemia -evident by signs of hypoperfusion to the vital organs: brain, heart & kidneys
Most common cause of Hypotension
-unreplaced fluid & blood loss -> leads to hypovolemic shock
Hypertension
sympathetic nervous system stimulation that may be the result of pain, anxiety, bladder distention, resp. compromise -hypothermia
Dysrhythmias
the result of an: unidentifiable cause other than myocardial injury
Leading causes of dysrhythmias
-hypoxemia, hypercaphia, alt. in electrolytes & acid base status, preexisting heart disease
Fluid Retention
-post op days 2-5 result from the stress response which maintains both blood volume & BP
What 2 hormones cause fluid retention?
-ADH and ACTH
ADH (antidiuretic)
-leads to ⬆ H20 reabsorptioin & ⬇ urinary output which ⬆ blood volume
ACTH (adrenocoriticotropic hormone)
-stimulates the adrenal cortex to secrete cortisol and to a lesser degree, aldosterone -which leads to significant sodium & fluid retention ⬆ blood volume
Fluid Overload
-occur when IV fluids are admin. to rapidly when chronic disease exists or pt is an older adult
Nursing ass. for Fluid Overload
-freq monitoring of VS -monitored every 15 min or more often until stabilized and then at less freq. inervals
Notify surgeon if....
-systolic BP < 90 or >160 -pulse rate <60 beats/min or >120 b/min -BP gradually ⬇ during consecutive reading -change in cardiac rhythym
Neurologic/ psychologic
E
Emergence Delirium (most common)
-waking up wild, restlessness, agitation, disorientation, trashing & shouting
Caused by
-anesthetic agents, hypoxia, bladder distention, pain
if it occurs what to suspect first?
-hypoxia
Delayed emergence cause
-prolong drug action: opiods, sedative
Delirium result of??
-F & E imbalance, drug effects -hypoxemia -sleep deprivation -sensory overload ** or sensory deprivation
Nursing ass. for neuro
-LOC, orientation, memory -ability to follow commands -pupils: size, reactivity & equality of pupils
Suspect delirium if??
-pt. was mentally alert before surgery & becomes congnitevly impaired post-op
Pain & discomfort caused by:
-positioning during surgery, internal devices can cause pain -effort & movement assoc. w/ deep breathing, coughing & ambulating may aggribate it
Nursing Ass
-self-report most important -restlessness, diaphhoresis, changes in VS
Alt in temp
Hypothermia
-core temp below 95
pt. most at risk fro Hypothermia
-older pt -debilitated -intoxicated pt.
Complications from hypo
-compromised immune function -bleeding -untoward cardiac events -impaired wound healing
Fever Caused by....
-wound infection -urinary tract secondary to catheterization
Gastrointestinal Problems
-N/V -delayed gastric emptying & slowed peristalsis
Urinary problems
low urine output (800 - 1500 ml) in the first 48 hrs is expected -caused by ADH & aldosterone secretion
DTV
= due to void -need to void every 8 hrs a volume of 150 ml (three times)
Nursing ass
-color, amount, consistency , oder -most urinate 6-8 hrs after surgery
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