Postoperative Nursing Care Quiz

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Questions and Answers

What is the primary responsibility of the postanesthesia care nurse?

Administering medications post-surgery

Preventing immediate postoperative complications (correct)

Conducting preoperative assessments

Preparing patients for discharge

In the postoperative care of an ambulatory surgery patient, which aspect differs from that of a hospitalized surgery patient?

Extent of postoperative monitoring (correct)

Surgical incision care

Types of wound healing involved

Pain management strategies

Which of the following describes a common postoperative complication?

Prolonged anesthesia effects

Dehiscence of the incision site (correct)

Improved wound healing

Increased mobility

What is a significant gerontologic consideration in postoperative management?

Increased recovery time due to slower metabolic rates Signup and view all the answers

Which factor significantly affects wound healing?

Patient's nutritional status Signup and view all the answers

Which dressing technique should be demonstrated to ensure proper postoperative care?

Keeping the surgical site clean and dry Signup and view all the answers

Which assessment parameter is crucial for early detection of postoperative complications?

Observing for changes in body temperature Signup and view all the answers

What should be emphasized in patient education after surgery?

Recognizing signs of potential complications Signup and view all the answers

What activity is advised against in the first 24 to 48 hours post-surgery?

Driving a vehicle Signup and view all the answers

Which of the following is essential for a patient's discharge preparation?

Written instructions about postoperative care Signup and view all the answers

What should patients avoid due to impaired decision-making ability following surgery?

Making important decisions Signup and view all the answers

Who is primarily responsible for assessing a patient's need for transitional care?

The home, community, or transitional care nurse Signup and view all the answers

Which instruction is typically NOT given to the patient post-surgery?

To take larger than normal meal portions Signup and view all the answers

What should patients and caregivers be encouraged to do after discharge?

Schedule follow-up appointments Signup and view all the answers

What type of patients may require referral for continuing or transitional care?

Older or frail patients with self-care issues Signup and view all the answers

Which of the following is part of the nurse's responsibility post-discharge?

Monitoring the patency of a drainage system Signup and view all the answers

What should be assessed to monitor for peripheral nerve damage after extremity surgery?

Movement and sensation in the hand or foot distal to the surgical site Signup and view all the answers

Which of the following complications is specifically related to vascular surgeries?

Thrombus formation leading to ischemia Signup and view all the answers

What is an important nursing intervention to help reduce postoperative anxiety for patients?

Reassure the patient by providing information about their recovery Signup and view all the answers

What is a recommended action to enhance a patient's environment for recovery post-surgery?

Reduce noise and adjust lighting to enhance rest and relaxation Signup and view all the answers

When should patients expect to receive information on when they can start eating post-surgery?

As part of postoperative nursing assessments Signup and view all the answers

Which factor is NOT typically a contributor to postoperative stress and anxiety?

Complete familiarity with all hospital staff Signup and view all the answers

What proactive measure is commonly taken for patients at high risk for venous thromboembolism (VTE) post-surgery?

Administering anticoagulants prophylactically Signup and view all the answers

To effectively support family involvement in the patient’s post-surgery care, what strategy should a nurse employ?

Encourage family participation and acknowledge their concerns Signup and view all the answers

Study Notes

Postoperative Nursing Management

Learning Objectives: Learners will be able to describe the responsibilities of the postanesthesia care nurse in preventing immediate postoperative complications, compare postoperative care of ambulatory and hospitalized surgical patients, identify common postoperative problems and their management, describe gerontologic considerations related to postoperative management, describe variables that affect wound healing, demonstrate postoperative dressing techniques, and identify assessment parameters for early detection of postoperative complications.

Glossary

Dehiscence: Partial or complete separation of wound edges.
Evisceration: Protrusion of organs through the surgical incision.
First-intention healing: Surgical approximation of wound edges without granulation.
Phase I PACU: Area for immediate postoperative care requiring close monitoring.
Phase II PACU: Area for patients whose condition no longer necessitates intensive monitoring.
Phase III PACU: Setting for immediate postoperative care before discharge.
PACU: Postanesthesia care unit (recovery room); area for postoperative patient monitoring.
Second-intention healing: Healing method where wound edges are not surgically approximated but healed by granulation.
Third-intention healing: Healing method where surgical approximation of wound edges is delayed.

Care of the Patient in the PACU

Location: Adjacent to OR suite.
Personnel: Experienced nurses, anesthesia providers, surgeons, advanced hemodynamic/pulmonary monitors.
Equipment/Medications: Easy access to special equipment and medications.

Phases of Postanesthesia Care

Phase I: Intensive nursing care.
Phase II: Preparation for self-care or extended care.
Phase III: Preparation for discharge.

Nursing Management in the PACU

Nursing Objectives: Provide care until the patient recovers from anesthesia, is oriented, has stable vital signs, and shows no evidence of hemorrhage or other complications

Admitting the Patient

Responsibility: Anesthesiologist or CRNA and OR team.
Transport: Careful attention to incision site, potential vascular changes, and potential orthostatic hypotension during transfer
Positioning: Position patient away from obstructions (e.g., drains or tubes). Avoid rapid position changes.
Equipment: Oxygen, monitoring equipment attached immediately.

Assessing the Patient

Focus: Airway, respiratory function, cardiovascular function, skin color, level of consciousness, response to commands.
Frequency: Frequent, skilled assessments.
Documentation: Baseline vital signs, level of consciousness, documented.

Maintaining a Patent Airway

Objective: Maintain ventilation to prevent hypoxemia and hypercapnia.
Assessment: Respiratory rate, depth, ease of respirations, oxygen saturation, and breath sounds.

Maintaining Cardiovascular Stability

Assessment: Level of consciousness, vital signs, cardiac rhythm, skin temperature, color, moisture, and urine output.
Complications: Hypotension, shock, hemorrhage, hypertension, and dysrhythmias.
Monitoring: Central venous pressure, pulmonary artery pressure, pulmonary artery wedge pressure, and cardiac output (if necessary)

Shock

Causes: Hypovolemia, decreased intravascular volume, inadequate fluid replacement
Classifications: Hypovolemic, cardiogenic, neurogenic, anaphylactic, and septic
Signs and Symptoms: Pallor, cool/moist skin, rapid breathing, cyanosis, rapid/weak pulse, low blood pressure, and concentrated urine.

Hemorrhage

Classification: Primary, intermediary, secondary, by type of vessel (capillary, venous, or arterial)
Immediate treatment: Infusions of IV fluids, blood, blood products, and relevant medications, elevating or positioning the wound appropriately.

Relieving Pain and Anxiety

Objectives: Manage pain and provide psychological support.
Medications: Opioid analgesics (typically administered IV).
Family Involvement: Allowing for family visits in the PACU is beneficial and may reduce anxiety.

Controlling Nausea and Vomiting

Frequency: Occurs in approximately 10% of patients.
Interventions: Intervene at initial report; do not wait for vomiting to occur.

Postoperative Management - Hospitalized Patients

Goals: Stable vital signs, pain management, preventing complications, adequate self-care, and successful return home.

Discharge After Surgery

Indicators of recovery: Stable vital signs, adequate respiratory function, and adequate oxygen saturation level compared to baseline.
Aldrete score: Used for determining readiness for transfer.
Instructions: Extensive instruction for discharge provided both orally and in writing.

Maintenance of Blood Pressure and Circulation

Assessment: Monitoring vital signs, checking IV lines, ensuring correct fluid administration and rate, monitoring intake and output.
Risk factors: Changes in circulating volume, effects of medications, preoperative preparations.
Interventions: Patient positioning, IV fluid replacement.

Promoting Cardiac Output

Monitoring: Monitoring vital signs, intake/output, monitoring for signs of shock, and maintaining proper positioning to prevent circulatory issues.
Treatment: Addressing complications as they arise (e.g., shock).
Other Considerations: Fluid volume deficit, altered tissue perfusion, and decreased cardiac output.

Preventing Respiratory Complications

Interventions: Deep-breathing exercises, incentive spirometry, frequent turning to avoid atelectasis and pneumonia.
Monitoring: Oxygen saturation levels, breath sounds.
Risk factors: Decreased lung expansion, pain, decreased mobility.

Preventing Wound Complications

Hygiene: Wound care, appropriate dressing techniques, keeping wound dry, avoiding infection.
Assessment: Redness, swelling, unusual tenderness, discharge, or drainage

Managing Gastrointestinal Function

Nausea/Vomiting/Constipation: Management strategies are employed to ensure comfort.
Bowel function: Promoting bowel movements.
Preventing distention: Regular turning, walking (when tolerated).
Clear liquids: Starting with clear liquids, gradually progressing to soft foods.

Managing Voiding

Assessing bladder: Monitoring output, palpating suprapubic area for distention or tenderness.
Intervention: Identifying potential need for catheterization if patient unable to void.
Other considerations: Orthostatic hypotension (especially in older patients).

Risk of Infection

Surgical site: Identifying potential signs of infection.
Preventing infection: Measures to prevent infection in the operative area, use of sterile techniques and dressings, and maintaining wound integrity.
Reporting: Reporting changes or unusual signs.

Gerontologic Considerations

Slower recovery: Older adults have slower recovery from anesthesia and increased risk.
Multiple conditions: Often have preexisting conditions.
Mobility issues: Maintaining mobility to reduce orthostatic hypotension and complications.

Pain Management

Interventions: Managing postoperative pain.
PCA: Patient-controlled analgesia.
Nonpharmacological methods: Music, healing touch.

Wound Healing and Drainage

First-intention healing: Wound edges approximated.
Second-intention healing: Wound edges not approximated, healing by granulation.
Third-intention healing: Wound edges are re-approximated later.

Potential Complications

VTE (Venous Thromboembolism): Signs include pain, calf swelling, redness, and fever.
Hematoma: Swelling, bruising, pain.
Infection: Redness, swelling, warmth, drainage, and fever.
Dehiscence: Partial or complete separation of surgical incision. Possible protrusion of organs (evisceration).
Delirium/Confusion: Disorientation.

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Description

Test your knowledge on the essential responsibilities and considerations of postoperative nursing care. This quiz covers various aspects, including complications, wound healing, and patient education relevant to postoperative management. Ideal for nursing students and professionals looking to refresh their understanding.