Medical Surgical: Post Op Priorities

Areas of Postoperative Care

PACU, ICU, Floor

Who gives Hand-Off Report from OR

Circulating Nurse and Anesthesia Provider to the RN

PACU Hand-Off: General Information

- Patient Name

- Age

- Surgeon

- Surgical Procedure

- EBL

PACU Hand-Off: Patient History

- Indication for surgery

- Medical History

- Currect Meds

- Allergies

ABCD

airway, breathing, circulation, Dressing, Drips, Drains

Inital and Prompt Assessment of Post-Op Client

- Airway Patency

- Respiratory Status

- Vitals

- Neurological Function

- Pain

- Dressing

- Visualize Incsion Site

- Patency of Iv and Drains

What to immedietly put on a Post op Patient

Cardiac Monitor

Primary Risk for first 48 hours post-op

bleeding

Primary Risk for after 48 hours post-op

Infection

If kidneys are not adeqyetly perfused,

urine output drops

Duration of time in PACU

30 minutes to 3 hours

First Intervention of PACU

Cardiac Monitor

Second Intervention of PACU

Vitals and ABC(D)s

Handoff to inpatient when patient is

stable

What Defines a "Stable" Patient

- vitals within baseline

- can control liquids

- A&O x 4

- Pain is controled and tolerable, not a 0

- Pt is oxygenated

Vital Sign Paramaters on Inpatient Unit

Q 15 x 4,

Q 30 x 2

Q 60 x 4

For Nausea, What Medication should you start with

Ondancetron, least side effects

Nursing Diagnosis of Post-Op PT

- Pain

- Alteration in Skin integrity

- Anxiety

- Knowledge Deficit

Nursing Goal for Post-Op pt

Patient will remain free of complications and demonstrate healing

Respiratory Complications Post-Op

- Obstruction

- Atelectasis

- Pneumonia

- Pulmonary Embolism

atlectasis

collapsed lung

Pneumonia

inflammation of the lungs

Concerning blood loss

EBL of 500mL or more

Fluid Volume Overload causes Hemocrit to

lower

Hemoglobin

Protein that carries oxygen on RBC

Hemocrit

% of RBC in a given volume of blood

If the *Hct is high*, but *Hgb is normal*

The patient is...

Dehydrated

If HCT is low, but Hgb is normal

The Patient is expirincing

Fluid Overload

If HCT and HGB are low the patient is most likely

bleeding

Hemoglobin range

12-18

Hemocrit range

50%

Urinary output post-op should be

30mL/hr

In ICU, urinary output should be

0.5ml/kg/hour

Dehiscence

Bursting open of a wound

dehiscence treatment

Stay with patient

Assess VS

Low Fowler's

Towels (sterile + saline)

Surgery prep

Evisceration

wound separation with protrusion of organs

Evisceration Treatment

Stay with patient

Assess VS

Low Fowler's or supine

Towels (sterile + saline)

Surgery prep

Dehiscence and Eviscerations S/S

- "poping feeling"

- Blood

- Vitals

Dehiscence and Eviscerations are _____ complication for Post-Op

Early

Surgical Site Infection is a ____ complication for Post-Op Pts

Late

Respiratory Interventions

C & DB

Incentive Spirometer

Suction

report a drop of b/p of

15-20 mm/hg from baseline

Pt can return to solid food once

Bowel Sounds Return

Notify If no BM in

48-72 Hours

Urination should occur within

6-8 Hours

Malignant Hyperthermia

Genetic Action triggered by anesthesia

Malignant Hyperthermia Patho

Calcium is disrupted causing metabolism

Malignant Hyperthermia S/S

- Rise in body temp

- Hypotension

- Muscle Rigidity

- Rust-Colored Urine

Malignant Hypethermia Tx

- Stop

- Dantrolene

- Cooling Agent

- Cardiac and K+ support