FUNDS: anesthesia, pre op, post op, post op complications, nursing interventions - thick secretions

1. A patient receiving general anesthesia is in the emergence phase. Which nursing action is the PRIORITY?

C. Maintain a patent airway

2. A nurse prepares a child for tonsillectomy under general anesthesia. Which finding requires immediate intervention before anesthesia induction?

B. Loose tooth

3. A patient under moderate sedation suddenly becomes difficult to arouse but continues to maintain spontaneous respirations. Which is the nurse’s PRIORITY action?

A. Administer reversal agent per protocol

4. Which statement indicates correct understanding of moderate sedation?

C. “I will be able to respond to verbal commands.”

5. Which assessment finding is MOST concerning after a spinal anesthetic?

A. Hypotension

6. Which patient is MOST appropriate for epidural anesthesia?

B. Patient undergoing labor

7. The nurse applies topical anesthesia for suturing a laceration. Which statement reflects correct understanding?

C. “You may feel pressure, but not sharp pain.”

8. Which pre-operative instruction requires correction?

C. “Stop clear liquids 8 hours before surgery.”

9. The nurse teaches deep breathing and coughing to a patient scheduled for abdominal surgery. Which finding means teaching is effective?

B. Patient demonstrates splinting of incision with a pillow

10. Which patient statement indicates need for further education before abdominal surgery?

D. “I will stop my metformin the morning of surgery.”

11. Which nursing action is MOST important for reducing the risk of postoperative pneumonia?

A. Encouraging early ambulation

12. Which medication order should the nurse question for a patient scheduled for surgery tomorrow?

C. Aspirin 81 mg

13. A PACU nurse notes the patient’s PCO₂ is rising, heart rate is 130, and muscle rigidity is present. What is the PRIORITY intervention?

A. Administer dantrolene

14. A patient is transferred from PACU to the post-op unit. Which assessment MUST be completed before the PACU nurse leaves?

B. Full set of vital signs

15. After surgery with general anesthesia, which finding requires immediate intervention?

A. Respiratory rate 10/min

16. A patient has not voided 7 hours post-op. The bladder is distended. What is the PRIORITY nursing action?

B. Assist patient to stand or sit to void

17. A patient on the post-op unit reports nausea and abdominal distention. No bowel sounds are heard. The nurse suspects:

B. Paralytic ileus

18. A patient 1 day post-op is tachypneic, febrile, and has crackles. What complication is MOST likely?

B. Atelectasis

19. A patient suddenly reports a popping sensation at the incision and the nurse notes exposed organs. What is the FIRST nursing action?

B. Cover with moist sterile gauze

20. A patient is 3 days post-op and develops erythema, purulent drainage, and fever. The nurse suspects:

C. Wound infection

21. A patient becomes restless, pale, BP 82/50, pulse 128, RR 28, and urine output drops. Which condition is MOST likely?

B. Hemorrhage

22. A patient with pneumonia has thick secretions and dyspnea. What is the nurse’s FIRST action?

C. Place in high-Fowler’s position

23. A patient with unilateral right-lung pneumonia is experiencing dyspnea. Which position BEST improves oxygenation?

C. Left side-lying

24. A patient using CPAP complains of thick secretions. Which intervention is MOST appropriate?

B. Encourage oral care and hydration

25. Which finding indicates that respiratory interventions are EFFECTIVE?

C. Sputum becomes thinner and easier to expectorate

26. A patient with thick secretions shows improvement when the nurse sees: (SATA)

A. Decreased work of breathing
B. RR from 30 to 18
C. Moist, productive cough
D. Cyanosis around lips
E. SpO₂ improving from 89% to 95%

ABCE

The nurse is caring for a patient who received spinal anesthesia. Which assessment finding requires IMMEDIATE intervention?

B. Blood pressure 82/46 mmHg

The nurse is completing pre-op teaching for a patient having abdominal surgery tomorrow. Which statement indicates a need for further education?

D. “I should stop taking my ibuprofen 24 hours before surgery.”

General anesthesia

is a controlled, medically induced loss of consciousness used during major surgeries.
It affects the entire body—brain, muscles, reflexes, breathing, and sensation.

General anesthesia involves giving medications that cause CNS depression (slow down brain activity), leading to:

• Complete unconsciousness

• No awareness of the procedure

• No pain (analgesia)

• Relaxed skeletal muscles

• Loss of protective reflexes (like gag reflex)

The anesthesia medications paralyze muscles—including the diaphragm—so the patient cannot breathe on their own. which means they require

intubation & mechanical ventilation

General anesthesia is delivered through:

• IV medications (e.g., propofol, ketamine)

• Inhalation gases (e.g., isoflurane, nitrous oxide)

Induction

• Happens right before the surgery begins

• Patient receives IV anesthetics → quickly becomes unconscious

• Airway is secured (intubation)

Maintenance

• Occurs during the surgery

• Anesthetic gas + IV meds keep the patient “asleep”

• Muscles remain relaxed

• Reflexes remain suppressed

Emergence

• Occurs as the patient wakes up

• Gases are stopped; patient begins breathing on their own

• Extubation occurs

• Patient transferred to PACU

General anesthesia affects every body system:

• Respiratory: stops spontaneous breathing → need ventilator

• Cardiovascular: may decrease BP, heart rate

• Neurologic: unconsciousness, no reflexes

• Musculoskeletal: muscle relaxation/paralysis

• GI/GU: slows motility → risk of N/V and urinary retention

Why tape eyes in surgery

During general anesthesia:

• Eyes don’t close fully

• Tear production decreases

• Blink reflex is lost

Taping the eyes:

✔ prevents corneal abrasions
✔ prevents drying
✔ protects against accidental injury during surgery

Protecting the patient includes:

• Maintaining airway with endotracheal tube

• Careful positioning to prevent nerve damage/pressure injuries

• Eye protection (taped shut)

• Preventing hypothermia

• Frequent monitoring of vitals, O₂ sat, CO₂, cardiac rhythm

Children & young adults emergence from anesthesia

agitated & disorientated & physically thrash (POSSIBILITY)

aka emergence delirium

moderate sedation/analgesia

aka conscious or procedural sedation is used short term on minimally invasive procedures

pts can respond to verbal commands

LMA (laryngeal mask airway) - makes sure air is passing into the trachea & not in vocal chords

monitor cardiac rate & rhythm, O2 sat, LOC, pain, BP

• Local:

• Injection of an anesthetic to a specific area of the body

• Topical:

• Applied to intact skin and can be sprayed, spread, or applied

Regional anesthesia

• Anesthetic agent injected near nerve or nerve pathway in or around operative site

• Remains awake & aware of the procedure, loses sensation in specific area of body

• Reflexes may be lost

• Nerve blocks –

• injected local anesthetic around a nerve trunk like jaw, face or extremities

• Spinal anesthesia –

• Injected in subarachnoid space through lumbar puncture, used for lower abdomen, perineum, and legs. Can cause headache, hypotension and urinary retention

• Epidural anesthesia –

• injected into intervertebral space in lumbar area and used for chest, abdomen, pelvis, and legs and in childbirth

Holistic preoperative screening:

complete medical, physical, social, psychological, and personal assessment

Patient and family education:

provide pre and post-op instructions

Individual patient and family centered care:

promote empowerment and emotional support/comfort

• Teaching about physical activities

• Deep breathing & coughing 1-2 times/hr for first 24 hrs postop. Prevents pneumonia & atelectasis; CONTRAINDICATED for pts after eye, intracranial or spinal surgery

• Incentive spirometry 10x/hr while awake. Prevents atelectasis

• Leg & foot exercises - each exercise 5x/q2h. Prevents venous stasis of blood & increases venous blood return

• Mobility instructions - early ambulation is key

• Splinting of wounds when C/DB (coughing or deep breathing) & moving to prevent incisional pain

• Turning & positioning - q2h when awake → prevents skin break down

• Prepare the patient physically

• Hygiene & skin prep - shower only, or shower with chlorhexidine sponges 1-3x; instruct NOT to shave hair at site

• Elimination - enemas, laxatives/cathartics as prescribed for bowel surgeries, or lower abdominal organs (GU), an indwelling urinary catheter may be ordered

• Nutrition & fluids - regular meals should be finished 8 hours before surgery; light meals such as tea and toast may be consumed up to 6 hours before surgery: clear liquids (ex: water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee) allowed up to 2 hours before surgery

• Medications

  • Routine meds usually withheld: 

    • NSAIDs (ex: ibuprofen) → withheld 1 week before surgery

    • Anticoagulants, antiplatelets (ex: aspirin) → withheld 3-5 days before surgery

    • Metformin → withheld 2 days before surgery

    • Routine meds (given-instructed to take): BP meds, synthroid, insulin (may decrease dose)

• Rest & sleep

Post-op care focuses on

preventing complications, managing pain, monitoring recovery, and ensuring patient safety after surgery or anesthesia.

Hand-Off: OR → PACU

A structured report is given so PACU nurses know:

• procedure done

• anesthesia used

• complications

• estimated blood loss

• drains/tubes

• medications given
  ➡ Ensures continuity of care.

When switching from PACU nurse to acute care nurse what must the acute care nurse do

take a set of vitals before other nurse leaves

How often should assessments be done

w/ emphasis on preventing complications from anesthesia and surgery (every 10-15 mins for approx. 1 hr)

assessments to complete post op

• Respiratory status: airway and respiration 

• CV status: circulation 

• CNS status: neurological functions

• Fluid status: fluid and electrolyte balance 

• Wound status: skin integrity and condition of the wound 

• Temperature control 

  • Malignant hyperthermia: unexpected tachycardia, tachypnea, high PCO2 levels, muscle rigidity 

    • Elevated temp is late sign

• Genitourinary function: urine output minimum 30 mL/ hr

• Gastrointestinal function 

  • Paralytics ileus 

• Comfort: pain management is vital 

Maintaining Respiratory Function

Patency, rate, rhythm, symmetry, breath sounds, color of mucous membranes 

“I COUGH”

Never position the pt. w/ arms across the chest

Preventing circulatory complications

HR, rhythm BP, capillary refill, nail eds, peripheral pulses 

Assists first ambulation. Avoid pillows under the knees. Do not cross legs

Temperature regulation

Malignant hyperthermia treated with dantrolene sodium

Achieving rest and comfort

Enhance the efficacy of pain control, minimize side effects of each modality  Do no assume the pt’s pain is incisional

Maintaining Neurological Function

LOC, gag and pupil reflexes

Promoting normal bowel elimination and adequate nutrition

Anesthesia slows motility.

Progress diet gradually as ordered

Promoting urinary elimination

Urinary function returns in 6-8 hrs. Amount of at least 200 mL

Promoting wound healing

Check skin for rashes, petechia, abrasions, or burns; wound for drainage

Maintaining/enhancing self-concept

Observe patients for behaviors reflecting alterations in self-concept

post op respiratory complications: respiratory

• Atelectasis: increased RR, dyspnea, fever, crackles & productive cough, occurs 1-2 days post op

• Pneumonia: fever, productive cough, chest pain, purulent mucus, dyspnea, occurs 3-5 days post

• hypoxemia/hypoxia: restlessness, confusion, dyspnea, diaphoresis, cyanosis 

• Pulmonary embolus: dyspnea, chest pain, cyanosis, tachycardia, drop in BP 

post op respiratory complications: circulatory

• Hemorrhage: hypotension, weak, rapid pulse, clammy skin, rapid breathing, restlessnes,s reduced urine output 

• Hypovolemic shock: S/S same as for hemorrhage 

• Thrombophlebitis: veins in the legs are commonly affected 

  • Swelling, inflammation, tenderness

post op respiratory complications: GI

• Paralytic ileus: common in initial hrs after abdominal surgery 

• Abdominal distention: N/V; constipation 

post op respiratory complications: GU

• Urinary retention: occurs 6-8 hrs post-op

• UTI: remove IDC as early as possible

post op respiratory complications: skin & wound

• Wound infection: redness, tenderness, fever, chill, purulent drainage 

  • Occurs 3-6 days post Wound dehiscence: separation of the wound edges at the suture line

  • Occurs 6-8 days post 

• Wound evisceration: protrusion of the internal organs through an incision, occurs 6-8 days post 

• Skin breakdown

post op respiratory complications: nervous system

• Intractable pain: unresponsive to analgesics and pain-alleviating treatments 

• Malignant hyperthermia: severe hypermetabolic state and rigidity of the skeletal muscles

nursing role in pts with thick secretions

Patients with thick mucus are at risk for airway obstruction, hypoxia, atelectasis, pneumonia, and respiratory failure. Your job is to mobilize secretions, improve ventilation, and prevent complications.

ambulation

Early and frequent ambulation is one of the most effective ways to:

• Improve lung expansion

• Loosen secretions

• Promote coughing and deep breathing

• Enhance circulation

➡ Movement helps shift mucus upward so the patient can cough it out.

positioning

Correct positioning improves ventilation and oxygenation and helps drain secretions.

Why it matters:

Laying flat causes:

• ↓ chest wall expansion

• ↓ lung perfusion

• ↑ risk of mucus pooling

change positions q2h

good lung down

Use this when one lung is healthy, one is diseased.

• Example: pneumonia in one lung

• Place patient on the side of the healthy lung

Why: Gravity increases perfusion to the good lung → better oxygenation.

affected lung down

Use this for pulmonary abscess or hemorrhage.

• Example: bleeding in left lung → place left lung down

Why: Prevents infected or bloody drainage from spilling into the healthy lung.

incentive spirometry (IS)

Incentive spirometer encourages slow, controlled deep breaths.

Benefits:

• Expands alveoli

• Prevents atelectasis

• Helps mobilize secretions

• Gives visual feedback → improves effort

Do: 10 times every hour while awake.

noninvasive ventilation (NIV)

Used for patients with:

• Respiratory distress

• COPD exacerbations

• Sleep apnea

• Thick secretions with hypoventilation

types of noninvasive ventilation (NIV)

• CPAP – continuous positive pressure

• BiPAP – two levels of pressure (inhalation and exhalation)

What it does:

• Keeps alveoli open

• Improves oxygenation

• Decreases work of breathing

complications of noninvasive ventilation (NIV)

• Skin breakdown (nose/mouth from mask)

• Dry mucous membranes

• Thick secretions → may need humidification

• Aspiration of stomach contents

➡ Monitor closely and ensure proper mask fit.

Ask the patient:

• “How breathless do you feel?”

• “Is your shortness of breath improving?”

• “How far can you walk now compared to before?”

• Rate breathlessness 0–10

• “Which interventions helped?”

• Frequency of coughing

• Characteristics of sputum: color, amount, consistency

Perform and observe:

Respiratory rate

Monitor before, during, after activity.
➡ Tachypnea may mean poor tolerance or worsening status.

Sputum assessment

• Amount

• Color

• Thickness
  ➡ Thick secretions may need humidification, fluids, or suctioning.

Lung sounds

Auscultate for improvements:

• Less wheezing

• Less rhonchi

• Fewer crackles
  ➡ Indicates better airway clearance.

First action for hypoxia, dyspnea, or SOB is

positioning.

Good lung vs affected lung

• “Good lung down” improves oxygenation.

• “Affected lung down” prevents contamination of the good lung.

Incentive spirometry helps

reopen alveoli.

• CPAP/BiPAP contraindications include

• aspiration risk.