Postoperative Nursing Management Quiz

Post Anesthesia Care Unit (PACU)

• PACU consists of two phases: Phase I for immediate recovery with intensive care, and Phase II for preparing the patient for inpatient transfer, extended care, or discharge.
• Frequent postoperative assessments focus on airway management, consciousness, cardiac and respiratory status, wound condition, pain levels, peripheral pulses, and the condition of surgical drains.

Monitoring and Assessments

• Baseline assessments include the Aldrete score upon patient arrival.
• Vital signs should be monitored every 5 to 15 minutes.
• Relevant medical history evaluations cover potential hearing impairments, seizure history, diabetes, and allergies.

Patient Handling and Airway Management

• Proper patient positioning is essential; regularly replace soiled gowns and provide warmth.
• Maintain a patent airway by addressing hypopharyngeal obstruction, using head tilt to alleviate occlusion signs like noisy respirations, decreased oxygen saturation, and cyanosis.

Cardiovascular Stability and Shock

• Monitor vital signs, consciousness level, skin condition, urine output, and IV-line patency to ensure cardiovascular stability.
• Hypotension defined as systolic BP < 90 mm Hg; a downward trend in BP warrants immediate reporting.
• Signs of hypovolemic shock include pallor, rapid breathing, cyanosis, and weak pulse.
• Treatment involves volume replacement with IV fluids like Lactated Ringer’s, normal saline, or blood products.

Hemorrhage Management

• Symptoms of hemorrhage leading to hypovolemic shock include hypotension, rapid pulse, low urine output, and cold skin.
• Urgent actions include calling the surgeon and preparing for return to the OR for possible surgical interventions.

Pain and Nausea Management

• Implement comprehensive pain assessments, including location, intensity, and quality, using validated pain scales.
• Administer pain relief with opioids, PCA for patient involvement, and multimodal analgesia to combine various medications for enhanced relief.
• Address nausea by positioning the patient to promote drainage and prevent aspiration, and recognize risk factors for postoperative nausea and vomiting (PONV).

Postoperative Patient Discharge

• Discharge criteria based on stable vital signs, adequate respiratory function, and acceptable Aldrete scores (7 to 10).
• Follow-up care includes providing prescriptions, addressing potential complications, and ensuring patients understand activity restrictions and dietary recommendations.

Special Considerations in Postoperative Care

• Gerontologic care emphasizes gentle handling, warmth, and close monitoring to prevent hypothermia and promote comfort.
• Bariatric patients face unique risks, including VTE, DVT, PE, and obstructive sleep apnea that require targeted postoperative strategies.

Wound Healing Phases

• Wound healing occurs in stages: first-intention healing involves inflammation and the arrival of neutrophils; second-intention healing emphasizes fibroblast activity and collagen synthesis.
• Enhanced Recovery After Surgery (ERAS) protocols aim to optimize recovery and minimize opioid use.

Drug Classes for Nausea and Pain Management

• Various antiemetics are used to prevent nausea: Metoclopramide, Prochlorperazine, Promethazine, Dimenhydrinate, Hydroxyzine, Scopolamine, and Ondansetron.
• Opioid analgesics, PCA, and nonpharmacologic methods support comprehensive pain management.### Healing Environment
• Absorb drainage and assess wound status regularly to maintain a clean healing environment.
• Reorient the patient frequently and introduce yourself each time to enhance comfort and familiarity.
• Employ splinting or immobilization techniques to protect surgical sites and promote healing.
• Maintain homeostasis through optimal temperature and hydration management.
• Focus on the patient's physical and mental comfort while encouraging participation in care activities.

Postoperative Dressing Changes

• First dressing change typically performed by nursing staff to ensure sterile technique.
• Utilize various types of dressing materials as appropriate for the wound type.
• Assess wound for signs of infection or complications during dressing changes.
• Document findings and patient responses meticulously to track recovery.

Physical Activity

• Promote early and progressive ambulation to prevent complications like pneumonia and deep vein thrombosis (DVT).
• Encourage regular physical activity to enhance recovery and prevent functional decline.
• Educate patients on the importance of movement and reducing prolonged sitting to prevent venous stasis.

Medication Management

• Administer medications cautiously and aim to discontinue them as soon as medically advisable to minimize side effects.
• Monitor patient response to medications closely to manage pain and prevent complications.

Preventing Postoperative Complications

• Be vigilant for potential complications: pulmonary infection, deep vein thrombosis, and wound dehiscence.
• Limit risks of hematomas and hemorrhage through careful monitoring and management.
• Take preventive measures to avoid urinary incontinence by ensuring access to call bells and commodes.

Coordination of Care

• Plan for discharge early in the hospitalization process to ensure smooth transition.
• Arrange necessary home and community-based services for ongoing support, including wound care and therapy.
• Conduct home visits to assess patient condition and pain management needs.

Nutrition and Recovery

• Collaborate with a dietitian to provide high-protein, fiber-rich meals that support optimal recovery.
• Consider nutritional supplements to aid wound healing and overall health.

Psychosocial Support

• Provide emotional support and encouragement to help patients resume daily activities at a manageable pace.
• Adapt instructions for patients with sensory deficits to ensure understanding and compliance.

Education and Resources

• Reinforce previous education on postoperative care, wound management, and follow-up appointments.
• Inform patients about signs and symptoms to monitor post-discharge.
• Suggest community resources and support groups to assist with recovery needs.

This quiz focuses on the key components of postoperative nursing management, particularly within the Post Anesthesia Care Unit (PACU). It covers critical areas such as airway management, level of consciousness, and wound condition monitoring. Test your knowledge on effective nursing strategies during immediate recovery phases.