-
Priority care in Postanesthesia care unit (PACU)?
- Monitoring/Management of respiratory & circulatory function
- pain
- temp
- surgical site
-
Assessment begins with
- eval of airway, breathing, and circulation (ABC)
- *evidence of respiratory compromise requires intervention
-
Pulse oximetry is?
a noninvasive means of assessing the oxygenation of the patient
-
Electrocariographic (ECG) monitoring is?
used to determine cardiac rate and rythm.
-
Initial neurologic assessment focuses on?
- Level of consciousness
- orientation
- sensory
- motor status
- size, equality, and reactivity of pupils
-
Which is the 1st sense to return after surgery?
Hearing which is why the RN explains all activities to the patient from the moment of admission to the PACU
-
The most common causes of airway compromise in the immediate PACU period include?
- Airway obstruction
- Hypoxemia
- Hypoventilation
-
Pts at risk for respiratory complications are?
- pts who
- had general anesthesia
- are holder
- smoke heavily
- have lung disease
- are obese
- have had airway, thoracic or abd. surgery
-
Hypoxemia is?
- an arterial oxygen tension (PaO2) of less than 60 mm Hg
- characterized by various signs ranging from agitation to somnolence, hypertension-hypotension, tachycardia-bradycardia
-
causes of hypoxemia?
- atelectasis
- pulmonary edema
- aspiration
- broncospasm
-
Hypoventilation is characterized by?
- decreased resp rate or effort
- hypoxemia
- ^ arterial carbon dioxide tension (PaCO2) also known as hypercapnia
-
The RN evaluates
- airway patency
- chest symmetry
- depth, rate & character of respers
- symmetry of movement
- auscultate breath sounds anteriorly, laterally & Posteriorly
-
Hypoxemia maybe be noticed by?
- rapid breathing
- gasping
- apprehension
- restlessness
- rapid or thready pulse
-
Position of client postop
- lateral "recovery" position
- unless contraindicated
-
Common cardiovascular problems postop?
- hypotension
- hypertension
- dsyrhythmias
-
Pts at greatest risk for cardio problems include
- alterations in resp function
- Hx of cardiovascular disease
- elderly
- debilitated
- critically ill
-
Hypotension commonly caused by?
- unreplaced fluids & blood loss
- which may lead to hypovolemic shock
-
Treatment of hypotension begins with?
oxygenation, aka oxygen therapy
-
Hypertension is caused by?
- pain
- anxiety
- bladder distention
- resp compromise
-
Treatment of hypertension?
centers on elimination of precipitating cause
-
Dysrhythmias result from?
- hypokalemia
- hypoxemia
- hypercarbia
- alterations in acid-base status
- circulatory instability
- hypothermia
- pain
- surgical stress
- preexisting heart disease
-
Treatment of dysrhythmias?
focus on elminating the cause
-
VS
- are monitored Q15 mins
- more often if unstable and then less often when stable
-
Systolic BP is less than 90 mm Hg or greater than 160 mm Hg
RN should notify the anesthesia provider (ACP) or surgeon
-
Pulse rate less than 60 bpm or greater than 120 bpm
RN should notify the ACP or surgeon
-
Pulse pressure difference between systolic and diastolic pressures narrows
RN should notify ACP or surgeon
-
BP gradually decreases during several consecutive readings
RN should notify ACP or surgeon
-
Change in cardiac rhythm
RN should notify ACP or surgeon
-
Significant variation from preoperative readings
RN should notify ACP or surgeon
-
Emergence delirium "waking up wild" is?
- restlessness
- agitation
- disorientation
- thrashing
- shouting
-
Emergence delirium maybe caused by?
- anesthestic agents
- hypoxia
- bladder distention
- pain
- electrolyte abnormalities
- pt's state of anxiety pre op
-
Delayed emergence caused by
- prolonged drug action particularly of opiods, sedatives &
- inhalational anesthetics
-
Hypothermia core temp of less than 96.8 f (36 c)
Frequent assessment of pt's temp is important to detect patterns of hypothermia &/or fever
-
Potential resp problems in clinical unit
atelectasis & pneumonia especially after abd and thoracic surgery
-
Deep breathing is encouraged to be done how often
10 times every hr while awake
-
Pt's position should be changed how often and why?
every 1-2 hrs to allow for full chest expansion and ^ perfusion of both lungs
-
syncope (fainting) may occur b/c of
- decreased COP, fluid deficits
- defects in cerebral perfusion
-
RN should monitor
- I&Os
- electrolytes
- hematocrit
- rate of fluid replacemet
-
Hypokalemia causing dysrhythmias can be a result of?
- urinary or GI losses
- inadequate potassium replacement
-
Deep Vein Thrombosis (DVT) may form in leg veins as a result of?
- inactivity
- body position
- pressure
-
Leg exercises should be encouraged how ofter?
10-12 times every 1-2 hrs while awake
-
Two types of postoperative cognitive impairment seen in surgical patients?
delirium & postoperative cognitive dysfunction
-
Sources of Confusion & delirium are?
- fluid & electrolyte imbalance
- hypoxemia
- drug effects
- sleep deprivation
- sensory deprivation/ or overload
-
Alcohol withdrawl delirium is characterized by?
- restlessness
- insomnia/nightmares
- irritability
- auditory/ or visual hallucinations
-
The RN should do what to prevent/manage post op delirium?
address factors known to contribute to condition
-
Pain can contribute to dysfunction of?
- immune sys
- blood clotting
- delayed return of GI function
- ^ risk of atelectasis
- impaired resp function
-
what is the most reliable indicator of pain?
The PT.
-
what pain can be expected?
- incisional pain
- (however other pain may be present such as the pain of a full bladder)
-
If the analgesic fails to relieve the pain or makes the PT. excessively lethargic or somnolent(sleepy/drwosy) the RN should?
Notify the DR. and request a change in the med order
-
Two alternative approaches to pain control are?
Patient - controlled analgesia (PCA) & epidural analgesia
-
The surgical stress response can be seen as?
a fever of 100.4 during the 1st 48 hrs after surgery
-
A fever that spikes in the afternoon or evening and is near normal in the morning could mean?
wound infection
-
Septicemia is characterized by
an intermittent high fever accompanied by shaking chills & diaphoresis
-
If vomiting occurs it is important to determine?
the quantity, characteristics, & color
-
Antiemetic or prokinetic drugs are used to treat?
Nausea & vomiting
-
Abdominal distention can be caused by?
- Handling of the intestine during surgery
- decreased peristalsis,and dietary intake before & after surgery
-
Early and frequent ambulation can?
prevent or minimize abd distention
-
A nasogatric tube may be used to?
decompress the stomach to prevent nausea, vomiting, and abd. distention
-
Low urine output after surgery is?
- normal regardless of fluid intake
- (800-1500ml) in the 1st 24 hrs
|
|
