20 Questions
How often does a patient need hemodynamic monitoring in the PACU?
Continuously with EKG
Weight loss >____% total body weight is an indication for post-surgical nutrition. Greater than 20% weight loss increases post op infection rate 3X.
10
Medical device prescribed post-surgery to help improve lung function.
Incentive Spirometry
What must be present for a patient to start a PO diet post surgery?
Flatus/bowel function
Why is it crucial to monitor creatinine and urine output in the post-operative patient?
Acute kidney injury (screening/prevention)
What is a sign of acute kidney injury in the post op patient?
Rise in serum Cr >1.5x baseline level
Dextrose containing fluids are SAFE in brain injuries.
False
Maintenance fluids for adults. ___ mL per hour PLUS 1 mL per kg per hour
60
Post-op complications timing
Hemorrhage = Most common cause of shock in the 1st 24 hours post op atelectasis = most common cause of fever in the first 48 hours UTI; pneumonia; DVT = most common cause of fever after 48 hours wound infections = most common cause of fever after 5 days
A post-op patient has s/s tachycardia, hypotension, pale and diaphoresis. What is likely cause?
Hemorrhage
You should encourage ambulation to prevent DVT/PE for patients at risk in the post-op setting.
True
Critically ill patients or patients undergoing major surgery (or those NPO/ needing NG tube) should get prophylaxis treatment for ____ _____ using PPI. This might increase risk for C. Diff. So discontinue as soon as possible.
Stress Ulcers
What is NOT a classification of a surgical site infection?
Medial incisional
A patient must be tolerating diet without symptoms with return of bowel function before discharge.
True
A patient must be ambulating with pain controlled off IV narcotics to be discharged.
True
The post-operative patient pain management approach: Scheduled pain medication and as needed pain medications
True
Calculation of Maintenance IV Fluids..
If you notice that your patient's sodium level has started to fall = give 0.9% NS If you notice that your patient's sodium level has started to rise = give 1⁄4 NS Brain injury = AVOID dextrose a = a
Where should you see the placement of the NG tube when getting placement confirmation with a XRAY?
below the esophagus >10 cm distal to GE junction
profuse serosanguinous drainage (salmon colored) that is a surgical emergency is called
dehiscence
Deep Vein Thrombosis chemical prophylaxis?
Enoxaparin (Lovenox)
Study Notes
Post-Anesthesia Care Unit (PACU)
- Hemodynamic monitoring in the PACU is necessary for patients who require close observation of their cardiovascular status.
Nutrition and Weight Loss
- Weight loss > 10% total body weight is an indication for post-surgical nutrition.
- Greater than 20% weight loss increases post-op infection rate by 3 times.
Respiratory Care
- A medical device prescribed post-surgery to help improve lung function is an incentive spirometer.
Post-Operative Diet
- For a patient to start a PO diet post-surgery, the following must be present: adequate hydration, stable vitals, and passage of flatus or stool.
Renal Function
- It is crucial to monitor creatinine and urine output in the post-operative patient to prevent acute kidney injury.
- A sign of acute kidney injury in the post-op patient is a decrease in urine output.
Fluid Management
- Maintenance fluids for adults are 70 mL per hour PLUS 1 mL per kg per hour.
- Dextrose containing fluids are SAFE in brain injuries.
Post-Operative Complications
- Post-op complications can occur at any time, with the highest risk within the first 48 hours.
- A patient with symptoms of tachycardia, hypotension, pale skin, and diaphoresis is likely experiencing bleeding.
Deep Vein Thrombosis (DVT) Prophylaxis
- Encourage ambulation to prevent DVT/PE for patients at risk in the post-op setting.
- Critically ill patients or patients undergoing major surgery should receive prophylaxis treatment for stress ulcers using PPI, which may increase the risk of C. Diff.
Surgical Site Infections (SSIs)
- A patient must be tolerating diet without symptoms and have a return of bowel function before discharge.
- A patient must be ambulating with pain controlled off IV narcotics to be discharged.
- The post-operative patient pain management approach includes scheduled pain medication and as-needed pain medications.
Gastrointestinal Care
- The correct placement of the NG tube is confirmed by a X-ray, which shows the tube in the stomach or small intestine.
- Profuse serosanguinous drainage (salmon-colored) is a surgical emergency and is called a hemorrhage.
- Chemical prophylaxis for Deep Vein Thrombosis (DVT) is with heparin or enoxaparin.
Test your knowledge on the frequency of hemodynamic monitoring needed for patients in the Post-Anesthesia Care Unit (PACU). Explore the recommended practices and guidelines for monitoring patients' hemodynamic status after surgery.
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