SURG - Post-op Care
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Questions and Answers

How often does a patient need hemodynamic monitoring in the PACU?

  • Every 4 hours with EKG
  • Continuously with EKG (correct)
  • Every 4 hours with urine in and outs
  • Every 4 hours with neurovascular checks
  • 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?

    <p>Flatus/bowel function</p> Signup and view all the answers

    Why is it crucial to monitor creatinine and urine output in the post-operative patient?

    <p>Acute kidney injury (screening/prevention)</p> Signup and view all the answers

    What is a sign of acute kidney injury in the post op patient?

    <p>Rise in serum Cr &gt;1.5x baseline level</p> Signup and view all the answers

    Dextrose containing fluids are SAFE in brain injuries.

    <p>False</p> Signup and view all the answers

    Maintenance fluids for adults. ___ mL per hour PLUS 1 mL per kg per hour

    <p>60</p> Signup and view all the answers

    Post-op complications timing

    <p>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</p> Signup and view all the answers

    A post-op patient has s/s tachycardia, hypotension, pale and diaphoresis. What is likely cause?

    <p>Hemorrhage</p> Signup and view all the answers

    You should encourage ambulation to prevent DVT/PE for patients at risk in the post-op setting.

    <p>True</p> Signup and view all the answers

    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.

    <p>Stress Ulcers</p> Signup and view all the answers

    What is NOT a classification of a surgical site infection?

    <p>Medial incisional</p> Signup and view all the answers

    A patient must be tolerating diet without symptoms with return of bowel function before discharge.

    <p>True</p> Signup and view all the answers

    A patient must be ambulating with pain controlled off IV narcotics to be discharged.

    <p>True</p> Signup and view all the answers

    The post-operative patient pain management approach: Scheduled pain medication and as needed pain medications

    <p>True</p> Signup and view all the answers

    Calculation of Maintenance IV Fluids..

    <p>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</p> Signup and view all the answers

    Where should you see the placement of the NG tube when getting placement confirmation with a XRAY?

    <p>below the esophagus &gt;10 cm distal to GE junction</p> Signup and view all the answers

    profuse serosanguinous drainage (salmon colored) that is a surgical emergency is called

    <p>dehiscence</p> Signup and view all the answers

    Deep Vein Thrombosis chemical prophylaxis?

    <p>Enoxaparin (Lovenox)</p> Signup and view all the answers

    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.

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    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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