Post operative change, risk and nursing management

  1. Pre-op Assessment
    • Medical history
    • medication use
    • physical limitation/ disabilities
    • surgical/anesthetic history
    • psycho-social/emotional status
    • baseline observations
    • Consent and pt understanding
  2. what indicators are used to measure pt. readiness to be discharged from PACU
    • level of consciousness
    • pain
    • oxygen level
    • movement
    • breathing
  3. Surgical Stress Response
    • Endorcrine response
    • Immune response
    • metabolic response
  4. endocrine response
    • Increased ACTH (Adrenocorticotropic hormone)
    • Increased ADH (antiduretic hormone)
    • Activation of renin-angiotensin system
  5. Immune response
    Increased cortisol
  6. Metabolic response
    • Increased adrenaline
    • Increased BGL
    • Increased oxygen requirements
  7. Fluid changes
    Increased vascular permeability allows larger protein molecules to pass out of the vascular space- vascular volume decrease
  8. Hypovolemia
    rapid blood loss caused by surgical blood loss, fluid shift, insensible losses

    General anaesthetics and opioid analgesics increase vascular space & decreased fluid volume
  9. 2-3 days postoperative
    • *As capillary permeability returns to  normal, fluid returns to the vascular space.
    • *diuresis  increases greatly (150ml/h)
    • *Pts with cardiac or renal disease can be a risk of overload and pulmonary edema
    • *nursing assessement include BP, pulse, Full blood count, urine output, lung sounds.
  10. Renal complication
    • urinary retention
    • acute renal failure
  11. respiratory complicaions
    • *Atelectasis (collapse of the lung due to air blockage)
    • *pneumonia
    • *respiratory depression
    • *airway obstruction
    • *pulmonary oedema
  12. pain in post-op patient
    • *injured tissue release prostaglandins that stimulate pain pathway to cerebral cortex where pain is perceived
    • *detrimental effects of pain
    • -enhances surgical stress response
    • -cause tachycardia/hypertension
    • -O2 demand increases
    • -respiratory function compromised
    • -reduced ability to mobilised
  13. assessment for post op fever
    0-24 hours normal response to surgical trauma

    24-72 hours pulmonary disorders

    <72 hours infection (wound, UTI)
  14. wound complication
    • *Haematoma- oozing red blood
    • *Infection
    • *Dehiscence (rupture of wound causing it to split)
    • *Hernia around incision site
  15. GI tract complication
    post op lleus

    acute gastric dilation

    post-op nausea and vomiting

  16. Cognition complications
    • *hypoxia
    • *perioperative stroke
    • *medications effects
    • *electrolyte abnormalities
    • *delirium (acute confusion)
  17. cardiovascular complications
    • Haemorrhage
    • shock
    • arrthythmias-low K 
    • MI
    • Hypotension
  18. What implication might increased alcohol consumption during peri and post operative period?
    • Stress
    • wound hypoxia

    Alcohol impairs wound healing and increases the incidence of infection. It influences the proliferation phase of healing by impairing early inflammation response, inhibits wound closure.
  19. What information is important to gather during pre-operative period?
    • assess for current or past medical history of gastritis and GI bleeding
    • baseline vital signs
    • family history of co-morbidities- diabetes
  20. what is the possible explanation for the decrease SpO2 levels?
    Anesthetic and the use of opioid for pain can cause CNS depressant therefore impacts on respiratory rate. It may also indicate internal bleeding which needs to be further assessed and monitor regularly
  21. Nursing consideration for Nasal prong oxygen therapy

    Image Upload 1
    • ability of a person to breath
    • sufficient amount of oxygen flow rate through the device
    • check for pressure sores
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Post operative change, risk and nursing management