Postoperative Care in Older Adults

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Questions and Answers

What is a potential consequence of decreased physiologic reserve in older adults undergoing surgery?

  • Improved wound healing
  • Increased risk of postoperative infections
  • Decreased likelihood of postoperative complications
  • Increased likelihood of postoperative confusion and delirium (correct)

Which of these is NOT mentioned as a potential sign of postoperative complications in older adults?

  • Hypertension (correct)
  • Hypoxia
  • Hypotension
  • Hypoglycemia

What is a key consideration when administering multiple medications to an older adult post-surgery?

  • Discontinuing all medications to prevent potential drug interactions
  • Monitoring for delirium and providing appropriate cognitive support
  • Monitoring for increased confusion and reorienting as needed (correct)
  • Decreasing the dosage to reduce the risk of side effects

What is a specific concern regarding thermoregulation in older adults after surgery?

<p>Increased risk of hypothermia (A)</p> Signup and view all the answers

What type of wound healing is typically associated with sutured surgical incisions?

<p>First-intention healing (A)</p> Signup and view all the answers

Which of the following is a priority assessment for a patient with a URI?

<p>Respiratory rate and effort (C)</p> Signup and view all the answers

What is the purpose of using a room vaporizer or steam inhalation for a patient with a URI?

<p>To thin secretions and make expectoration easier (D)</p> Signup and view all the answers

Which of the following is a potential complication of a laryngectomy?

<p>All of the above (D)</p> Signup and view all the answers

What is a potential complication of URIs that can lead to a stiff neck and inability to open the mouth?

<p>Trismus (A)</p> Signup and view all the answers

What is a priority nursing intervention for a patient undergoing a laryngectomy?

<p>Providing pre-operative teaching (B)</p> Signup and view all the answers

Which of the following is a nursing intervention that can be used to promote alternative communication for a patient who has undergone a laryngectomy?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is NOT a common symptom of pharyngitis?

<p>Nuchal rigidity (B)</p> Signup and view all the answers

Which of these is a collaborative problem for a patient with pharyngitis?

<p>Medicamentosa (B)</p> Signup and view all the answers

Which of the following is a sign or symptom of a URI?

<p>All of the above (D)</p> Signup and view all the answers

What is the most likely reason a patient with pharyngitis would need to avoid alcohol?

<p>Alcohol can irritate the throat and worsen inflammation (C)</p> Signup and view all the answers

Which of the following is a priority nursing intervention for a patient with a URI?

<p>Providing supportive care (D)</p> Signup and view all the answers

What is a priority education component for a patient scheduled for a total laryngectomy?

<p>How to use a call bell and writing board for communication (D)</p> Signup and view all the answers

What is the term used to describe the loss of voice that might be a complication of pharyngitis?

<p>Aphonia (C)</p> Signup and view all the answers

Which of the following is a key factor in the assessment of a patient with a URI?

<p>The patient's medical history (D)</p> Signup and view all the answers

What does the term "Nuchal rigidity" refer to?

<p>Stiff neck (D)</p> Signup and view all the answers

What is a priority nursing intervention for a patient with a URI who is experiencing pain?

<p>Administering analgesics (B)</p> Signup and view all the answers

What is the primary reason a patient with pharyngitis should avoid secondhand smoke?

<p>All of the above (D)</p> Signup and view all the answers

What is the best way for a patient with pharyngitis to help relieve throat discomfort?

<p>All of the above (D)</p> Signup and view all the answers

What is the primary nursing goal in the immediate postoperative period?

<p>Maintenance of pulmonary function and prevention of hypoxemia and hypercapnia (D)</p> Signup and view all the answers

Which of the following is NOT included in the discharge instructions for outpatient surgery patients?

<p>Specific directions for bathing and showering (B)</p> Signup and view all the answers

What is a crucial aspect of discharge planning for outpatient surgery patients?

<p>Verifying that the patient has a reliable caregiver to drive them home. (D)</p> Signup and view all the answers

Which of these assessment parameters is NOT mentioned in the context of nursing management of a hospitalized postoperative patient?

<p>Gastrointestinal function and bowel sounds (B)</p> Signup and view all the answers

What is the primary reason why patients should not drive themselves home after outpatient surgery?

<p>The risk of drowsiness and slowed reaction times from the anesthesia. (C)</p> Signup and view all the answers

What is the primary concern when treating a patient with tuberculosis?

<p>Drug resistance (C)</p> Signup and view all the answers

Which of the following is NOT a common symptom of tuberculosis?

<p>Diarrhea (C)</p> Signup and view all the answers

What is the purpose of the continuation phase in tuberculosis treatment?

<p>To eliminate the remaining bacteria and prevent recurrence (B)</p> Signup and view all the answers

What is the significance of a positive TB skin test?

<p>It indicates that the patient has been exposed to tuberculosis (B)</p> Signup and view all the answers

What is a Ghon tubercle?

<p>A specific area of the lung affected by tuberculosis (C)</p> Signup and view all the answers

What is the most common type of atelectasis that occurs in the postoperative setting?

<p>Acute atelectasis (D)</p> Signup and view all the answers

What is the primary intervention for managing atelectasis?

<p>Improving ventilation and removing secretions (C)</p> Signup and view all the answers

Which of the following is NOT a method used to prevent atelectasis?

<p>Antibiotic treatment (B)</p> Signup and view all the answers

What is the initial symptom of acute tracheobronchitis?

<p>Dry cough with mucoid sputum (D)</p> Signup and view all the answers

What is the purpose of cool vapor therapy or steam inhalations for tracheobronchitis?

<p>To thin secretions (A)</p> Signup and view all the answers

What is the medical management for acute tracheobronchitis? (Select all that apply)

<p>Cool vapor therapy or steam inhalations (A), Increased fluid intake (B), Antibiotics (D), Analgesics (F)</p> Signup and view all the answers

What is the primary classification of pneumonia acquired in the community setting?

<p>Community-acquired (CAP) (D)</p> Signup and view all the answers

What is the definition of pneumonia?

<p>Inflammation of the lung parenchyma caused by various microorganisms (D)</p> Signup and view all the answers

Which of the following is NOT a type of pneumonia?

<p>Idiopathic pneumonia (C)</p> Signup and view all the answers

What is the primary characteristic of community-acquired pneumonia (CAP)?

<p>It is acquired in the community setting or within the first 48 hours post hospitalization (C)</p> Signup and view all the answers

What is a patient with community-acquired pneumonia (CAP) likely to experience?

<p>Increased respiratory rate (B)</p> Signup and view all the answers

What should a nurse do to help prevent atelectasis in a postoperative patient? (Select all that apply)

<p>Turn the patient frequently (A), Encourage coughing and deep breathing (E)</p> Signup and view all the answers

Which of the following is a key strategy for managing acute tracheobronchitis?

<p>Promoting bronchial hygiene (C)</p> Signup and view all the answers

What is the purpose of increased fluid intake in the management of acute tracheobronchitis?

<p>To dilute secretions (A)</p> Signup and view all the answers

What is a common symptom of both acute and chronic atelectasis?

<p>Increased sputum production (D)</p> Signup and view all the answers

Flashcards

Postoperative nursing goal

The main aim in the immediate postoperative period is maintaining pulmonary function and preventing hypoxemia and hypercapnia.

Discharge instructions

Details provided to patients about follow-up care, complications, and medications before leaving healthcare setting.

Patient monitoring

Assessment of vital signs, respiratory function, pain levels, and mental status after surgery.

Complication actions

Guidelines given to patients on what to do if complications arise after surgery.

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Postoperative ambulation

Encouraging patients to move to enhance recovery and prevent complications.

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Decreased Physiologic Reserve

Reduced physiological capacity in older adults leading to increased risk during surgery.

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Postoperative Confusion

Increased likelihood of confusion and delirium in older adults after surgery.

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Monitoring Post-Surgery

Careful and frequent monitoring for signs like hypoxia, hypotension, and hypoglycemia in older adults.

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Pain and Hydration

Pain management and proper hydration are crucial to prevent cognitive impairment after surgery.

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First-Intention Wound Healing

Healing method that involves suturing and is often used in surgical incisions.

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Airway obstruction

A blockage in the airway that can prevent normal breathing.

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Acute otitis media

An infection of the middle ear, common in children.

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Sepsis

A severe body-wide response to infection, potentially life-threatening.

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Trismus

Inability to open the mouth due to muscle spasm or pain.

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Dysphagia

Difficulty swallowing, often caused by an illness or condition.

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Pharyngitis

Inflammation of the throat that can cause soreness and difficulty swallowing.

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Aphonia

Loss of voice, often from a respiratory infection or overuse.

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Nuchal rigidity

Stiffness of the neck, often associated with meningitis.

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Ghon tubercle

A calcified mass formed from necrotic bacteria and macrophages after TB recovery.

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TB skin test

A test (Mantoux method) to detect tuberculosis infection through a skin reaction.

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Duration of TB treatment

Patients are treated for TB typically for 6 to 12 months with a multi-drug regimen.

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Symptoms of TB

Includes cough, low-grade fever, night sweats, fatigue, and weight loss.

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Risk factors for TB

Includes conditions or situations that increase susceptibility to tuberculosis infection.

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Signs and symptoms of URI

Common indicators include headache, cough, hoarseness, fever, and fatigue.

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Airway management in URI

Focus on maintaining a clear airway and reducing aspiration risk.

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Effective pain management

Use analgesics and other methods to relieve discomfort.

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Hydration importance

Maintaining normal hydration helps in recovery from URI.

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Patient teaching for URI

Educate on prevention, signs, and when to seek care.

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Assessment after laryngectomy

Evaluate physical, psychosocial, and spiritual health post-surgery.

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Potential complications of laryngectomy

Includes respiratory distress, infection, and hemorrhage risk.

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Preoperative teaching for laryngectomy

Educate patients to reduce anxiety and inform on procedures.

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Nutrition monitoring post-laryngectomy

Assess and support adequate nutrition and hydration needs.

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Complications of URI

Severe complications may include aspiration and infection.

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Atelectasis

Closure or collapse of alveoli, often seen postoperatively.

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Symptoms of Acute Atelectasis

Includes dyspnea, cough, and tachycardia.

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Chronic Atelectasis Symptoms

Similar to acute, but may involve pulmonary infection.

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Assessment for Atelectasis

Characterized by increased work of breathing and hypoxemia.

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Management of Atelectasis

Involves improving ventilation and removing secretions.

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ICOUGH Protocol

A multidisciplinary approach to prevent atelectasis.

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Acute Tracheobronchitis

Inflammation of the trachea usually post-viral infection.

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Management of Acute Tracheobronchitis

Includes antibiotics and increased fluid intake.

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Pneumonia

Inflammation of the lung caused by microorganisms.

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Types of Pneumonia

Includes community-acquired, hospital-acquired, and more.

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Preventing Atelectasis

Frequent turning and lung expansion strategies.

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Clinical Manifestations of Tracheobronchitis

Initially dry cough which progresses to dyspnea.

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Chest X-ray for Atelectasis

Can suggest diagnosis before symptoms appear.

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Pulmonary Infection Symptoms

May present similarly in acute vs chronic atelectasis.

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Bronchial Hygiene Care

Maintains clear airways in tracheobronchitis.

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Study Notes

Fluid and Electrolytes

  • Fluid is approximately 60% of a typical adult's body weight.
  • Fluid content varies with age, body fat, and gender.
  • Intracellular fluid (ICF) forms roughly two-thirds of the total body fluids; found in cells.
  • Extracellular fluid (ECF) is outside of cells.
  • Intravascular fluid is within blood vessels, includes plasma, red blood cells, white blood cells, and platelets.
  • Interstitial fluid surrounds cells.
  • Transcellular fluids include cerebrospinal, pericardial, and synovial fluids.
  • Electrolytes are active chemicals carrying positive (cations) and negative (anions) charges.
  • Major cations include sodium, potassium, calcium, magnesium, and hydrogen ions.
  • Major anions include chloride, bicarbonate, phosphate, sulfate, and negatively charged protein ions.
  • Electrolyte concentrations differ in ICF and ECF compartments, expressed in terms of milliequivalents (mEq) per liter.
  • Fluid regulation involves osmosis, diffusion, and filtration.
  • Osmosis is the diffusion of water across the cell membrane due to differences in solute concentration.
  • Diffusion is the movement of solutes from an area of higher concentration to one of lower concentration.
  • Filtration is the movement of fluids and solutes across a membrane due to pressure differences.
  • Active transport, like the sodium-potassium pump, requires energy.
  • Daily water intake and output should usually be balanced.
  • The kidneys, heart and blood vessels, lungs, and other systems maintain homeostasis.

Fluid Volume Deficit (Hypovolemia)

  • Loss of ECF exceeds intake.
  • Electrolytes are lost in the same proportions as in normal body fluids; often due to vomiting, diarrhea, or excessive sweating.
  • Dehydration is the loss of water alone with raised serum sodium levels.
  • Causes include abnormal fluid losses (vomiting, diarrhea, sweating), decreased intake (nausea, lack of access to fluids), third-space fluid shifts (burns, ascites), and other factors like diabetes insipidus, adrenal insufficiency, and hemorrhage.
  • Clinical manifestations, assessment, and diagnostic findings can differ depending on the severity of the loss.

Fluid Volume Excess (Hypervolemia)

  • ECF expands due to abnormal water and sodium retention.
  • Causes often involve fluid overload or diminished homeostatic mechanisms such as heart failure, kidney injury, or cirrhosis of the liver.
  • Consumption of excessive sodium salts or excessive administration of sodium-containing fluids also contribute.
  • Clinical manifestations include edema, distended neck veins, and crackles.

Electrolyte Imbalances

  • Electrolyte imbalances often include hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypomagnesemia, hypermagnesemia, hypophosphatemia, hyperphosphatemia, hypochloremia, and hyperchloremia.
  • These imbalances can result in various symptoms and require specific medical intervention.

Perioperative Nursing Management

  • Perioperative nursing covers the preoperative, intraoperative, and postoperative phases of surgical care.
  • Preoperative phase begins with the decision for surgical intervention and ends with transfer to the operating room.
  • Intraoperative phase begins with transfer to the operating room bed and ends with admission to the postanesthesia care unit.
  • Postoperative phase begins with admission to the postanesthesia care unit and ends with a follow-up evaluation at home or in a clinical setting.

Surgical Classification

  • Surgical procedures can be classified on how they are determined.
  • Procedures are sometimes categorized by the urgency of their performance.
  • Emergent procedures are often lifesaving and needed immediately.
  • Urgent cases are not immediate but need quicker handling than elective procedures.

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