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Perioperative Nursing Unit VI : Part II

Perioperative Nursing Unit VI : Part II. Postoperative Care Lee Resurreccion. Blood Draw. Main Goal of Postop Nursing. Restore homeostasis and prevent complications. The major challenges of postoperative nursing are:. Sedation Past medical history

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Perioperative Nursing Unit VI : Part II

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  1. Perioperative NursingUnit VI : Part II Postoperative Care Lee Resurreccion

  2. Blood Draw

  3. Main Goal of Postop Nursing • Restore homeostasis and prevent complications

  4. The major challenges of postoperative nursing are: • Sedation • Past medical history Note: The complications presented today are based on the assumption that the patient has no serious medical history.

  5. Immediate Postoperative Care • PACU environment • Two Areas of PACU • Phase I • Phase II • Fast Tracking

  6. Bathroom Break

  7. Potential PACU Client Complications: Respiratory • Airway Obstruction • Hypoxemia • Hypoventilation

  8. Airway Obstruction • Laryngospasm • Tongue obstruction • Laryngeal edema • Respiratory secretions

  9. Hypoxemia:(PaO2 less than 60mm Hg on ABGs) • Atelectasis • Pulmonary Embolism • Aspiration • Bronchospasm

  10. Hypoventilation:decreased respiratory rate • Depressed CNS • Restrictive devices • Pain

  11. Nursing Management to Prevent Respiratory Complications • Assessments • Auscultation • Inspection • Monitoring devices • Interventions • Positioning • TCDB / IS • O2

  12. PACU Respiratory NANDA Nursing Diagnoses • Ineffective Airway Clearance • Ineffective Breathing Pattern • Impaired Gas Exchange • Risk for Aspiration

  13. Potential PACU Client Complications: Cardiovascular • Transient hypertension • Hypotension • Shock • Arrhythmia

  14. Nursing Management to Prevent Cardiovascular Complications • Assessments: • VS • Cardiac rhythm • Skin • I/O • Interventions: • O2 therapy • Treat causes of arrhythmias

  15. PACU Cardiac NANDA Nursing Diagnoses • Decreased cardiac output • Deficient fluid volume • Excess fluid volume • Ineffective tissue perfusion

  16. Potential PACU Client Complications: Neurologic • Emergence delirium • Delayed awakening

  17. Nursing Management to Prevent Neurologic Complications • Assessments: • LOC • PERRLA • Sensory/motor status • Interventions: • Assure adequate O2 • Maintain safety

  18. PACU Neurological NANDA Nursing Diagnoses • Disturbed thought processes • Impaired verbal communication • Disturbed sensory perception • Risk for injury

  19. Potential PACU Client Complications: Hypothermia • Causes • Implications • Interventions

  20. Potential PACU Client Complications: Nausea/Vomiting • Causes: • Pain Medication • Anxiety • Pain • anesthesia • Assessments: Level of Nausea • I/O • Pain (level of pain) • Interventions • Antiemetics (Zofran) • NPO • Positioning

  21. Potential PACU Client Complications: Pain • Assessments • S/S • Location • Duration • Quality • Level • Interventions: • Observe for indicators of pain • Medicate • Non-pharmaceutical options

  22. Discharge Criteria from the PACU to the Surgical Unit • VSS • Light-moderate drainage from surgical incision • Satisfactory LOC • Satisfactory level of pain • Urine output is adequate • Patent airway and 02 saturation > 90%

  23. Etiology of postop respiratory complications: • Etiology of postop respiratory complications: • General Anesthesia • Depressive effects of narcotics • ET tubes • Postop pain • Decreased patient mobility

  24. Respiratory Complication: Atelectasis • Assessments indicating atelectasis: • Increased pulse • Decreased breath sounds • Decreased 02 saturation • Confirmed with CXR

  25. Respiratory Complication: Pneumonia • Assessments indicating pneumonia: • Elevated temperature • Tachycardia • Tachypnea • Productive cough • Dyspnea • Crackles

  26. Respiratory Complication: Pulmonary Embolism (PE) • Assessments indicating PE: • Dyspnea • Acute tachypnea • Hemoptysis • Decreased 02 saturation • Apprehension/anxiety

  27. Nursing Management to Prevent Postop Respiratory Complications: • Ambulation ASAP • Assess respiratory depth, rate, and character of respirations • Encourage and assist with turning, coughing, and deep breathing Q 1-2 hours while awake

  28. Nursing Management (continued) • Monitor respiratory secretions for amount, color, and odor • Position with HOB elevated • Maintain adequate hydration • Notify physician if pulse oximetry is below 90%

  29. Etiology of Postop Cardiovascular Complications: • Body fluid loss • IV fluids • Immobility

  30. Cardiovascular Complication: Thrombophlebitis/DVT • Assessments indicating thrombophlebitis/DVT: • Erythema, edema, tenderness of the extremity • Positive Homan’s sign • Apprehension/Anxiety

  31. Cardiovascular Complication:Hemorrhage/hypovolemia • Assessments indicating hemorrhage/hypovolemia: • Postural hypotension • Syncope • Tachycardia • Tachypnea • Oliguria • Decreased LOC

  32. Cardiovascular Complication: Fluid/Electrolyte Imbalance • Assessments indicating fluid/electrolyte imbalance: • Hypo/hypertension • Confusion • N/V • I/0 imbalances

  33. Nursing Management to Prevent Cardiovascular Complications • Encourage & assist with leg movement and ambulate ASAP • Assess skin color, temperature, and moistness • Monitor I/O (0.5ml/kg/hr) • Administer O2 for marked hypotension

  34. Nursing Management (continued) • Monitor surgical dressing for drainage • Mechanical thromboprophylaxis (TED stockings/SCDs) • Monitor labs • Encourage PO fluids when BS active • Administer antiemetics when N/V present

  35. Postop Complication: Urinary Function • Causes • Medications / anesthesia / positioning • Assessments • Distention / I&O • Interventions • Assist to comfortable voiding position • Palpate bladder • Assess I/O

  36. Postop Complication: GI Function • Causes • Immobility / anesthesia / medications / bowel manipulation • Assessments • BS / flatus / girth • Interventions • Assist with ambulation/movement • Advance diet only as tolerated • Gum chewing? * *Barclay, L. & Vega, C. (2006). Gum chewing may speed recovery from postoperative ileus. Archives of Surgery, (141), pp. 174 – 176.

  37. Postop Complication:Pain and Comfort • Causes • incision/positioning/manipulation • Assessments • Level/location/duration/aggravating factors • Interventions • Pharmaceutical and non-pharmaceutical

  38. Postop Complication:Hyperthermia • Causes • Retained respiratory secretions/Infection (wound/urinary) • Assessment • VS / lung sounds / incision / urine color, turbidity and odor • Interventions • IS • wound culture • UA/push fluids

  39. Postop Complication:Psychologic Function • Causes • Anxiety/body image disturbance/role strain • Assessments • Anxiety level/verbal and nonverbal cues • Interventions • Encourage verbalization/notify social worker/encourage visitors (family/clergy/friends)

  40. Increased Risks for the Older Adult • Decreased respiratory function • Compromised cardiac function • Drug toxicity • Mental status changes • Delayed healing/increased risk for infection • Limited mobility

  41. ? Question ? • What is the #1 nursing intervention to prevent respiratory and cardiovascular complications as well as many other potential postop complications? • Answer:

  42. Discharge Planning/Teaching • Wound care • Prescriptions • Activity • Diet • Follow up care • S/S of complications

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