Nursing Care Quiz: Complications and Management

Pre-Op and Post-Op Care

• Obtaining Consent: The provider obtains consent, and the nurse witnesses it. The nurse asks the patient about the procedure and if they have questions.
• Health History: Pre-op teaching includes explaining the surgery, discussing potential post-op issues (like going to PACU), identifying chronic pain levels, and how to use an incentive spirometer. Identifying any allergies/reactions is also crucial.
• Pre-op Assessment: Nurses must ensure the patient is NPO (nothing by mouth) and complete a head-to-toe assessment to get baseline vital signs, identify any baseline health issues and chronic conditions.
• Post-op Assessment: Assessing skin condition and mobility is important after surgery for infection prevention. Assessing chronic conditions and pain levels are also critical. The nurse will assess the patient's pain level and pain management needs. Finally the nurse will check the patient's breathing ability, educating them on incentive spirometer use.

Nursing Assessment After Surgery

• Complications (Waking Up Wild): Assess for complications like waking up disoriented; this could indicate hypoxia, so oxygen levels are essential for patient safety.
• Respiratory Issues: Assessing for patient safety regarding respiration issues during sedation is important.
• Respiratory Related Sedation: Assess for hypoventilation and ineffective oxygenation related to sedation.
• Pneumonia: The cause of pneumonia is decreased consciousness, depressed cough, and depressed epiglottis reflexes which results in surgical tube insertion enabling infection.
• Clinical Manifestations: Assess for fever, chills, productive cough, dyspnea, tachypnea, and chest pain. Also monitor for adventitious breath sounds, rhonchi and crackles which can indicate fluid buildup in the lungs.
• Prevention: Use incentive spirometry and deep breathing exercises.
• Treatment: Antibiotics

Increase Fluid Intake and Treating Hypotension

• Increase Fluid Intake: Increase fluid intake to treat hypotension that may occur due to the decreased blood volume from dehydration or lack of fluid intake.
• Hypotension: The nurse should assess and treat hypotension, potentially with fluids. Preventing DVT/ PE through ambulation and blood thinners is often part of this care.
• VTE, Pulmonary Embolism: Patients at risk of blood clots, should have interventions like ambulation and blood thinners. This is done to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).
• Ileus: This can be caused by slow GI motility and include symptoms like hypoactive bowel sounds, gas pain and abdominal distension.

Infection Prevention

• Infection Risks: Surgical procedures increase risks of infection; monitor the surgical site for infection.
• Assessing Dressing/ Wound Site: Assessing/ checking skin, noting drainage, dressing condition, smell; and presence of color dehiscence and/or separation of wound edges.
• Monitor Surgical Site: Monitor the surgical incision to prevent infections.

Fractures

• Clinical Manifestations: Symptoms could include edema, pain, tenderness, deformity, ecchymosis, loss of function and crepitation.
• Nursing Management: Implement mobility assistance, monitor peripheral vascular status, assess for pulses, maintain proper alignment and monitor for signs of bleeding and drainage.

Compartment Syndrome

• Two Causes of Compartment Syndrome: Increased compartment contents related to bleeding, inflammation, edema, IV filtration; or decreased compartment size from casts, dressings, splints, or premature closing of fascia.
• 6 p's: The 6 P's to watch for are: Pain, Pressure, Paresthesia, Pallor, Paralysis, Pulselessness
• Symptoms: Excessive swelling and pressure in a contained area, such as a limb in a cast.
• Interventions: Splitting a cast, avoiding ice to avoid further vasoconstriction, and surgical intervention may be necessary for relief.

Decubitus Ulcers

• Characteristics: Injury to skin and underlying tissue (often bony prominences) caused by pressure, shearing or friction, or moisture.
• Stages: Characterized by tissue depth of involvement: Stage 1, intact skin; Stage 2, partial-thickness; Stage 3, full-thickness; and Stage 4, full-thickness with exposed bone, tendon, etc.
• Risk Factors: Immobility, poor nutrition & dehydration, impaired mental status, incontinence and moisture.
• Nursing Management: Prevention is key, promoting pressure redistribution, mobility, and skin care, as well as monitoring for risk factors.

Venous Thrombosis (VT)/ DVT

• Etiology/ Virchow's Triad: Venous stasis (blood flow slowed); endothelial/ vascular damage; blood hypercoagulability.
• Clinical Manifestations: Unilateral leg pain, warmth, swelling, redness, tenderness and possible discoloration of the affected extremity, possibly pain, and possibly tenderness upon palpation of the affected area.
• Assessment: Assess for symptoms like pain, swelling, warmth, erythema & possible signs of deep vein thrombosis.

Nursing Interventions – Management

• Anticoagulants: Heparin, enoxaparin, rivaroxaban, warfarin to prevent further clot formation.
• Monitor Vital Signs: Monitoring vital signs to assess for changes related to DVT.
• Monitor PT(prothrombin time), PTT (partial thromboplastin time) and D dimer to assess clotting activity. Monitor CBC/ hgb, hct, platelets for bleeding risk.
• Elevate: Elevating the affected leg; promote ambulation when appropriate and allow fluids or reposition patients at risk for complications.

Asthma

• Symptoms: Cough is the most common first symptom; other symptoms include wheezing, shortness of breath/dyspnea, chest tightness, diminished breath sounds, hyperresonance on chest X-rays, accessory muscle use, and increased respiratory rate.
• Causes: Airway obstruction, bronchospasm, airway inflammation and swelling, increased mucus production; triggers are allergens, irritants, stress, exercise, infections.
• Acute Asthma Attack: Symptoms worsen quickly and can lead to respiratory acidosis.
• Assessment: Assess peak flow, respiratory rate, breath sounds, pulse oximetry & O2 saturation.
• Management: Inhaled corticosteroids, bronchodilators, and patient education on triggers, medications and avoidance of triggers.

Asthma Action Plans

• Establish Baseline Peak Flow: Teach patients to measure peak flow, identify a usual baseline level to assess for trends or changes.
• Education on Action Plan: Teach the patient their asthma action plan to manage asthma at home with a plan identifying peak flow ratings to indicate the status of the patient's respiratory system.

Obesity

• Causes: Genetics, prenatal exposure to environmental factors, lifestyle, reduced physical activity, and diet.
• Types: A classification based on Body Mass Index (BMI) categorized as class 1, 2 or 3.
• Complications: Diabetes, dyslipidemia, high cholesterol, HTN and atherosclerosis.

Hypertension

• Stages: Stage 1 is systolic 130-139/ diastolic 80-89, Stage 2 is systolic ≥ 140/ diastolic ≥ 90.
• Causes: Primary (unknown) or secondary (conditions).
• Risk Factors: Family history, age, high sodium/salt intake, obesity, lack of exercise, diabetes.
• Clinical Manifestations (Symptoms) and Assessment: Assessment for symptoms, vital signs and for signs like headaches, dizziness, vision issues.

Medical Emergency

• Early vs. Late Symptoms: Early symptoms may include thirst, hunger, lack of coordination, tremors and headaches. Late signs include decreased alertness, decreased responsiveness, dizziness, seizures and coma.
• Hypoglycemia Treatment: Rapid-acting carbohydrates (juice, glucose tablets) if able to eat and drink. Injectable glucagon for severe cases or, if available, intravenous glucose.
• Hyperglycemia Treatment: Addressing and managing hyperglycemic symptoms with proper interventions.

Insulin

• Types: Basal (long-acting) and correctional. Basal insulin is used to maintain healthy blood sugar levels when someone is not eating, correctional insulin is given as an immediate response to abnormal or high blood sugars.
• Purpose: Correct or manage blood glucose levels for people with diabetes.
• Interventions: Monitor blood glucose levels to ensure adequate diabetes management and to prevent complications.

Appendicitis

• Clinical Manifestations: Periumbilical pain, anorexic and nausea and/or vomiting, then persistent right lower quadrant (RLQ) pain. Additional symptoms may include rebound tenderness and guarding (resistance to palpation suggesting peritonitis), fever.
• Diagnosis: Physical exam + CT scans.
• Medical Interventions: Appendectomy (surgical removal of appendix).

Gastroesophageal Reflux Disease (GERD)

• Pathophysiology: Weakened or malfunctioning lower esophageal sphincter (LES), causing stomach acid to reflux up into the esophagus.
• Clinical Manifestations: Symptoms might include heartburn, regurgitation, difficulty swallowing (dysphagia).
• Risk Factors: Obesity, Medications, pregnancy, smoking, and other factors.
• Diagnosis: Physical exam, history including medication use, and upper endoscopy.

Peptic Ulcer Disease (PUD)

• Types: Duodenal or gastric.
• Etiology: Infection (via H. pylori) and use of NSAIDS. Infection of the lining of the stomach/duodenum by H. Pylori bacteria.
• Clinical Manifestations: Burning epigastric pain (could spread), relieved with food, dyspepsia.
• Nursing Management: Provide pain control relief; identify potential issues, and develop individualized management strategies.

Upper/Lower Urinary Tract Infections (UTIs)

• Types: Upper UTIs affect the kidneys and are more serious, lower UTIs affect the bladder.
• Symptoms (Upper UTI will have symptoms of the Lower UTI that are worse, such as back pain and fever).
• Pyelonephritis: When the infection involves one or both kidneys.
• Medical Interventions: Antibiotic use and supportive care are interventions most frequently used.

Renal Calculi

• Etiology: Elevated or decreased urine pH, low fluid intake, high levels of certain minerals, and foods high in oxalate and purines.
• Clinical Manifestations: Symptoms may include severe flank pain, nausea, vomiting, kidney pain, hematuria or possibly fever/chills.
• Treatment: May involve lithotripsy, medication, or supportive care.

Hypertension

• Classifications: Stage 1, Stage 2, Masked or White Coat.
• Medical Interventions: Diet and Lifestyle adjustments along with pharmacological interventions.
• Nursing Management: Emphasize lifestyle modifications to control blood pressure levels.

Cancer

• Causes: Exposure to carcinogens, genetics, obesity, environmental factors, smoking, and immune status.
• Symptoms: Unusual or continuous pain, changes in bowel or bladder habits, abnormal bleeding, sores that don't heal, unexplained weight loss, lumps, and hoarseness/ persistent cough.
• Management: Early detection, treatment and management of symptoms.

Post-Procedure/ Post-Op Issues

• Assess for Skin Breakdown: Monitor patient for radiation or treatment side effects.
• Monitor for Complications: Check for complications after specific procedures or treatments.

Patient Education

• Prevent Infections: Patient education should include techniques to avoid and recognize infections and risks, as well as instructions for managing issues during the recovery process.
• Discharge instructions: Patients should be given complete with instruction for management of their post-op or post-procedure needs.

Test your knowledge on nursing care related to complications from fractures, decubitus ulcers, obesity management, and asthma. This quiz covers essential definitions, symptoms, and nursing interventions necessary for effective patient care. Prepare to enhance your clinical skills and improve patient outcomes.