Post-Operative Phase: Module 3

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Questions and Answers

What characterizes third-intention healing?

It involves the closure of wounds with minimal scarring.

It primarily focuses on preventing infection rather than closure techniques.

It is suitable for deep wounds resutured later, leading to wider scars. (correct)

It is used for shallow wounds that can be sutured immediately.

Which drainage device is specifically designed to continuously remove fluid from a wound site?

Jackson-Pratt (correct)

Penrose drain

Colostomy bag

T-tube

Which aspect is NOT included in post-operative care for a patient?

Assessing thermoregulatory status

Controlling nausea and vomiting

Maintaining adequate fluid volume

Administering routine vaccinations (correct)

What is one of the indicators for readiness for discharge from the PACU?

Stable vital signs Signup and view all the answers

Wound evisceration refers to which of the following?

The protrusion of internal organs through a surgical incision. Signup and view all the answers

Which of the following can be classic signs of shock?

Narrowing of pulse pressure Signup and view all the answers

What phase of wound healing immediately follows hemostasis?

Inflammatory Phase Signup and view all the answers

What is a primary cardiovascular complication commonly seen in the PACU?

Dysrhythmias Signup and view all the answers

Which condition is most likely to lead to deep vein thrombosis following surgery?

Decrease in hydration Signup and view all the answers

What characterizes first-intention wound healing?

Wound is closed by suturing, staples, or steri-strips Signup and view all the answers

What is a common cause of hypertension in the immediate postoperative period?

CNS stimulation from pain or hypoxia Signup and view all the answers

Which of the following is NOT typically an intervention to prevent deep vein thrombosis?

Extended bed rest Signup and view all the answers

In which phase of wound healing does new collagen formation primarily occur?

Proliferative Phase Signup and view all the answers

Which position is recommended for a patient with excessive secretions in the nasopharynx and oropharynx?

Lateral position with neck extended Signup and view all the answers

What is a common sign of atelectasis?

Crackles and decreased breath sounds Signup and view all the answers

What should be encouraged to prevent pneumonia in patients?

Deep breathing exercises Signup and view all the answers

What is the primary purpose of using an incentive spirometer for a patient?

To aid in lung aeration and expansion Signup and view all the answers

Which of the following is a potential complication of immobility in elderly patients?

Hypostatic pulmonary congestion Signup and view all the answers

How frequently should a patient be turned to facilitate breathing and ventilation?

Every 2 hours Signup and view all the answers

What vital signs should be monitored to assess cardiovascular stability?

Blood pressure, pulse, and respiration Signup and view all the answers

What symptom is typically associated with subacute hypoxemia?

Constant low level of oxygen saturation Signup and view all the answers

What is the duration of the immediate post-operative stage in the PACU?

1-4 hours Signup and view all the answers

Which of the following is NOT a focus of the initial nursing assessment in the PACU?

Assessing the patient's dietary preferences Signup and view all the answers

What environment should the PACU ideally provide to the patient to reduce anxiety?

Clean and well-ventilated with indirect lighting Signup and view all the answers

What is the recommended action regarding the airway of a patient in the PACU?

Maintain the airway until the patient begins to wake and try to eject it Signup and view all the answers

During which stage of the post-operative phase is the care given specifically during the patient's surgical convalescence up to discharge?

Intermediate Stage Signup and view all the answers

Which of the following actions is part of performing safety checks in the PACU?

Verifying side rails are in place and restraints applied as needed Signup and view all the answers

What is an important aspect of evaluating a patient's condition upon admission to the PACU?

Estimating blood loss and assessing tubes or drains Signup and view all the answers

Which of the following describes the extended stage in the post-operative phase?

1-4 days after surgery or until the last follow-up visit Signup and view all the answers

Study Notes

Post-Operative Phase Overview

Begins with patient admission to the PACU and ends when healing is complete.
Divided into three stages: Immediate (1-4 hours), Intermediate (4-24 hours), and Extended (1-4 days) post-surgery.

Post Anesthesia Care Unit (PACU)

Also known as recovery room; designed to reduce patient anxiety and promote comfort.
Must be clean, quiet, and well-ventilated, with appropriate lighting and equipment.

Admitting the Patient to PACU

Anesthesia team transports the patient while monitoring the incision site and potential vascular changes.
Initial nursing assessment includes verifying patient identity, operative procedures, and surgeon.
Vital signs (respiratory, circulatory, temperature) and stability need close evaluation.

Initial Nursing Interventions

Maintain patent airway by keeping an airway device until the patient regains consciousness.
Assist with suctioning excessive secretions and position the patient laterally to enhance ventilation.
Encourage deep breathing exercises and utilize an incentive spirometer to prevent pneumonia.

Preventing Respiratory Complications

Recognize signs of complications like atelectasis, pneumonia, and pulmonary congestion.
Monitor breath sounds regularly; encourage early ambulation and position changes.
Administer oxygen as prescribed to support respiratory function.

Cardiovascular Stability

Monitor vital signs closely and check input/output; recognize factors affecting blood volume.
Be aware of primary cardiovascular complications in PACU: shock, hypotension, hypertension, dysrhythmias, and deep vein thrombosis.
Interventions to prevent deep vein thrombosis include leg exercises and early mobilization.

Shock and Its Indicators

Shock is defined by inadequate blood circulation to meet metabolic demands, leading to cell damage.
Symptoms include cool extremities, decreased urine output, slow capillary refill, hypotension, tachycardia, and cyanosis.

Phases of Wound Healing

Hemostasis Phase: Begins immediately at injury.
Inflammatory Phase: Lasts from immediate onset to 2-5 days.
Proliferative Phase: 2 days to 3 weeks.
Remodeling Phase: From 3 weeks up to 2 years, scar tissue is only 80% as strong as original tissue.

Types of Wound Healing

First-intention healing: Clean, approximated incisions heal quickly with minimal scarring (e.g., surgical incisions).
Second-intention healing: Occurs in wounds with granulation tissue that heal from the edges inward.
Third-intention healing (delayed closure): Used for deep or infected wounds that are closed later, leading to wider scars.

Wound Drainage Types

Various drainage systems include Hemovac, Jackson-Pratt, Penrose drain, and T-tube.
Drains can be either open to a dressing or closed to a portable suction device.

Wound Dehiscence and Evisceration

Wound dehiscence: Disruption of surgical incision edges.
Wound evisceration: Protrusion of internal organs through the incision.

Post-Operative Care Focus Areas

Assess thermoregulatory status and maintain adequate fluid levels.
Promote patient comfort and safety while managing urinary and bowel elimination.
Address stress factors related to sensory deficits, relieve pain, and control nausea/vomiting.

Readiness for Discharge from PACU

Criteria for discharge include stable vital signs, patient orientation, uncompromised pulmonary function, adequate urine output (at least 30 ml/hr), managed nausea/vomiting, and minimal pain.

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Description

This quiz covers Module 3 of the post-operative phase, beginning with patient admission to the PACU and concluding when healing is complete. It addresses three stages: Immediate, Intermediate, and Extended, detailing care procedures at each stage following surgery.