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Postoperative Care, Exams of Nursing 2025/
Graded A+|Guaranteed Pass
Postoperative Care - ANSWER -The Postoperative period begins immediately after surgery and continues to the patient is discharged from medical care. From OR --> PACU --> either transfer to ward/unit or Discharge home from ambulatory surgery suite Nurses must monitor the patient for postoperative problems during these transitions; It's critical in the safe recovery of the patient Post-Anesthesia Care Unit - ANSWER -Surgical Team surgeon anesthesia provider circulating nurse Report to PACU Nurse PACU Notes - ANSWER -The patient's immediate recovery period is supervised by a Post-Anesthesia Care Nurse, an educated specialist working in a Post-Anesthesia Care Unit (PACU). The PACU Nurse receives a report from the Surgical Team, prior to the patient arriving to the PACU. The PACU is located adjacent to the Operating Room Suite in order to minimize transportation of the patient immediately after surgery.
There may be two patient areas designated to patient recovery: Patients who have undergone general anesthesia are admitted to the Phase 1 Area. Patients who have had local or regional anesthetic or conscious sedation and who will be disc harged home from the PACU recover from surgery in the Phase 2 Area. These patients are considered Ambulatory Surgery Patients. Report to PACU Nurse - ANSWER -Demographic data Diagnosis Allergies Surgical procedure Anesthesia procedures Medications, IV fluids Vital signs On admission to the PACU, the Anesthesia Care Provider gives a verbal report to the admitting PACU Nurse. Information include the following: a) Patient's Name, Age, Name of Anesthesia Care Provider, Surgeon, Surgical Procedure. b) Brief Patient's History - indication for surgery, medical history, medications, allergies. c) Intraoperative Management Anesthetic agents administered, other medications received preoperatively or intraoperatively, Blood Loss, Fluid Replacement Totals, included Blood Transfusions, Urine Output.
Hemoglobin (Hgb) Men: 14 -18 grams/100 mL Women: 12 - 16 grams/100 mL Hematocrit (Hct) Men: 42% - 52% Women: 37% - 47% Platelet Count 150,000 - 400,000 mm ³ Prothrombin Time (PT) 11 - 12.5 seconds Activated Partial Prothrombin Time (APPT) 30 - 40 seconds Sodium (Na): 136 - 145 mEq/L Potassium (KCL): 3.5 - 5.0 mEq/L Chloride (Cl): 98 -106 mEq/L Bicarbonate (HCO3): 21 - 28 mEq/L
Serum Creatinine Men: 0.6 - 1.2 mg/100 mL Women: 0.5 - 1.1 mg/100 mL Blood Urea Nitrogen (BUN): 10 - 20 mg/100 mL Report to PACU Nurse cont' - ANSWER -Blood Transfusions: Red Cell Transfusions - given to raise the hematocrit level in patients with anemia or to replace losses after acute bleeding episodes. Autologous Blood - means using your own blood. Person donates blood before a planned surgical procedure. Blood can be donated up to 5 weeks before the planned surgical procedure. Blood can be frozen and stored up to 3 years. Blood donated for non-emergency (elective-type) surgeries. Other items to report: Dressings Equipment used
Every 45-minutes X 4 = 3 hrs Every 60 minutes X 4 = 4 hrs Common Postoperative Problems - ANSWER -Compromised Airway!!!!! Neurological Compromise Hypothermia Pain Nausea and Vomiting Cardiovascular compromise Compromised Airway - ANSWER -Greatest concerns: Airway Obstruction Hypoxemia Atelectasis Aspiration Bronchospasm Pulmonary Edema Hypoventilation Airway Obstruction - ANSWER -The most common cause of blockage of the airway is by the patient's tongue. The base of the tongue falls backward against the soft palate and occludes the pharynx. This is most pronounced when the patient is in the supine position and in the patient who is extremely sleepy after surgery.
Hypoxemia - ANSWER -A PaO2 of less than 60 mm Hg, is characterized by a variety of nonspecific clinical signs and symptoms, ranging from agitation to somnolence. Hypoxemia: most common cause is Atelectasis Atelectasis - ANSWER -Alveolar Collapse may be the result of bronchial obstruction caused by retained secretions or decreased respiratory excursion. Hypotension and low cardiac output states can also contribute to Atelectasis. Aspiration - ANSWER -Aspiration of gastric contents into the lungs is a potentially serious airway emergency. Symptoms of aspiration include Bronchospasm, hypoxemia, atelectasis, to name a few. Extremely important that the patient be NPO (nothing by mouth) prior to their surgical procedure. Bronchospasm - ANSWER -Is a result of an increase in bronchial smooth muscle tone with resultant closure of small airways. Airway edema develops, causing secretions to build-up in the airway. Patients will have wheezing, dyspnea, use of the accessory muscles, hypoexmia, and tachypnea. Pulmonary Edema - ANSWER -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 the presence of infiltrates on Chest X-Ray. Hypo-ventilation - ANSWER -Caused by a 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
Common Postoperative Problems: Neurological - ANSWER - Assess: Level of Consciousness - The patient's level of consciousness, orientation and ability to follow commands should be assessed. Until the patient is awake and able to communicate effectively, it will be the responsibility of the PACU Nurse to act as the patient advocate and the maintain patient safety at all times. Emergence Delirium - Or Violent Emergence is a concern to the practitioner. Emergence delirium can include behaviors such as restlessness, agitation, disorientation, thrashing, and shouting. The condition is caused by anesthetics agents, hypoxia, bladder distention, pain, electrolyte abnormalities, or the patient's state of anxiety postoperatively. Emergence delirium is time limited and will resolve before the patient in discharged from the PACU. Delayed Awakening - The most common cause of delayed awakening is prolonged drug action, particularly narcotics, sedatives, and inhalational anesthetics. Delays in awakening usually spontaneously resolve with time. If necessary, some of these sedatives or narcotics may be pharmacologically reversed with antagonists. Pupillary Reflexes - The size, reactivity and equality of pupils should be determined. Gag Reflexes, Hand Grips, Movement of Extremities - the patient's sensory and motor status should be assessed. Coagulation studies review - ANSWER -NORMAL FINDINGS: PT: 11.0 - 12.5 seconds
PTT: 60 - 70 seconds APTT: 30 - 40 seconds Note: Activators have been added to the PTT test reagents to shorten normal clotting time and provide a narrow normal range. This shortened time is call the activated PTT (APTT). Common Postoperative Problems: Hypothermia/hyperthermia - ANSWER -Hypothermia: Operating Rooms are very cool Anesthesia depresses level of body function - lowering metabolism Fall in body temperature Patient's complains of feeling cold & uncomfortable A core temperature of less than 96.8 degrees F occurs when heat loss exceeds heat production. Hypothermia may be a result of loss of heat from a warm body to a cold Operating Room or loss of heat from exposed body organs to the air. Although all patients are at risk for Hypothermia, the very old, pediatric patients, debilitated, or intoxicated patients have an increased risk. Hyperthermia: Malignant Hyperthermia - life-threatening complication of anesthesia Causes - Tachypnea, Tachycardia, Premature Ventricular Contractions (PVCs), Unstable B/P, Cyanosis, Skin Mottling & Muscular Rigidity
The patient should be questioned about the degree and characteristics of pain. Identifying the location of pain is important. The most effective interventions for pain include both pharmacological and non-pharmacological methods. Intravenous Narcotics provide the most rapid relief. Common Postoperative Problems: Nausea and Vomiting - ANSWER -Anesthetics slows GI mobility & may cause nausea Auscultate for Bowel Sounds in all four quadrants Bowel sounds may be very faint or absent in the immediate recovery phase Prior to offering any nourishment MUST AUSCULTATE FOR BOWEL SOUNDS Inspect the abdomen for distention May be an accumulation of gas For a patient who has had abdominal surgery, distention will develop if internal bleeding has occur Distention may also occur when a patient develops Paralytic ileus Nausea and vomiting are significant problems in the immediate post-operative period.
Numerous factors have been identified as contributing to the development of nausea and vomiting, including anesthetic agents and techniques; females tend to experience nausea more frequently than males; length and type of surgery (eye, ear, abdominal and gynecologic surgery procedures). Common Postoperative Problems: Cardiovascular compromise - ANSWER -Fluid & Electrolyte Imbalance Deep Vein Thrombosis (DVT) Syncope Hemorrhage Thromboembolism Fluid and Electrolyte Imbalance - ANSWER -Fluid retention during the first 2 to 5 post-operative days can be the result of the stress response to surgery. Fluid overload may occur during the post- operative period of fluid retention when IV fluids are administered too rapidly. Fluid deficit may be related to slow or inadequate fluid replacement. Hypokalemia (low potassium) can be the consequence of urinary and GI tract losses, especially if potassium is not replaced in IV fluids. Deep Vein Thrombosis (DVT) - ANSWER -DVT may occur in leg veins as a result of inactivity, body position, and pressure, all which lead to venous stasis and decreased perfusion. Patients with a history of DVT have a greater tendency for pulmonary
Nursing Interventions for Hemorrhage - ANSWER -Definitely need to monitor the operative site for signs of hemorrhage. Observe surgical site and dressings regularly, including dependent sites (q 1 hr for 4 hrs, then q 4 hrs) to detect signs of bleeding. Monitor Vital Signs q 15 mins to q 2-4 hrs as indicated to detect signs of hypovolemia. Report abnormalities such as decreasing blood pressure; rapid pulse and respirations; cool, clammy skin; pallor/pale and bright red blood on dressing. Monitor for changes in the patient's mental status, such as Restlessness and a sense of pending doom, as indicators of inadequate cerebral perfusion. Monitor such lab tests as: Hematocrit, Hemoglobin - decreases in levels may indicate hemorrhage. Monitor platelet levels and coagulation function tests (PT, PTT) - because alterations indicate bleeding Thromboembolism cont' - ANSWER -Causes: Immobility** Vascular manipulation Dehydration Signs/Symptoms: Swelling Redness
Warmth Pain Chest pain Tachypnea Dyspnea Restlessness Thromboembolism nursing interventions - ANSWER -Assess for Signs of Thromboembolism such as: redness, swelling, pain, increased warmth along path of veins; edema or pain in extremity; chest pain, tachypnea; dyspnea; restlessness. Immobility** - immobility can cause Deep Vein Thrombosis (DVT). The main cause of DVT is poor blood flow. When circulation slows, blood can pool and more easily form clots. Deep Vein Thrombosis usually occurs in the legs, but can also develop in your arms, chest or other areas of your body. The blood clot can block the circulation or lodge in a blood vessel in the patient's lungs, brain, heart, or other areas. The blood clot can cause severe damage and even death - within hours. Treatment plan may include: Administering anticoagulants as ordered to decrease clot formation. You will learn about One form of anticoagulation therapy in your Clinical Skills Lab - Lovenox. Nursing Interventions may include: Teach or perform range of motion exercises to lower extremities and encourage early ambulation, if not contraindicated. Avoid pressure under knees from bed or pillows to avoid pressure on veins, constriction of circulation or pooling and stasis of blood.
Five additional areas of functional assessment are required for Ambulatory/Outpatient Surgical Patients: Dressing - Dry & Clean Pain - Pain Free Ambulation - Able to stand-up & walk straight (if applicable) Fasting-Feeding - No Nausea & Vomiting Urine Output - Has Voided Discharge - ANSWER -Patient will not be discharged home on IV pain medication. Before discharging the patient from the PACU, the PACU Nurse provides a verbal report about the patient to the receiving nurse. The Receiving Nurse assists the PACU Nurse and personnel in transferring the patient from the PACU cart onto the Ward/Unit Bed. Care must be taken to protect IV Fluid Lines, Wound Drains, Dressings and Traction Devices. Vital Signs should be taken, and the patient's status should be compared with the report received by the PACU. Documentation of the transfer is completed, followed by a more- in-depth physical assessment of the patient. This is critical -
waiting 30 mins or longer to complete a Physical Assessment on a newly admitted Post-Operative Patient can be detrimental. PostOP Patient on the Inpatient Unit/Ward - ANSWER -Operative and PACU Report Transfer to Bed IV Lines Drains Dressings Tractions Abdominal Pillow Special Equipment Time of Admission VITAL SIGNS*** Physical Assessment Family Presence Review Postoperative Orders Potential Complications of PostOP Inpatient - ANSWER -Alterations in: Respiratory Function Cardiovascular Function Gastrointestinal Function Neurological Function
