Who is an important resource in planning the patient's postoperative care?
Vital signs should be assessed every __________ during the recovery phase
airway, breathing, consciousness, circulation, systems review
What are the interventions associated with Immediate Recovery?
maintain patency, note presence or absence of gag reflex, suction, provide oxygen
What interventions are done in the Airway assessment mode?
evaluate breathing, assess color of mucous membranes, initiate coughing and deep breathing, chart discontiuation of oxygen, monitor oxygen stats
What interventions are done in the Breathing assessment mode?
extubate patient, assess patients response to commands and stimuli, patient is verbal
What interventions are done in the Consciousness mode of assessment?
Monitor vitals every 15 minutes, assess pulse, color of skin and nail beds, monitor IV, assess wound and drainage
What interventions are done in the Circulation mode of assessment?
assess neuro function, muscle strength, check dressings, evaluate pain, check for allergic reactions, assess urinary output
What interventions are done in the Systems Review mode of assessment?
What is the minimum body temp. for a patient to be discharged from the PACU?
a genetic disorder characterized by uncontrolled skeletal muscle contractions leading to potentially fatal hyperthermia.
Patients are usually monitored until they are discharged for the PACU for about __________
a condition of having a core temperature of less than 98.6.
body exposure to cold solutions, consequences of anesthesia are contributing factors of __________
Patient must have a patent airway, stable vitals, be conscious and response to stimuli to be transferred to ___________
IV fluids, medications, blood products, surgical dressing, complications, risk for hemorrhage or cardiac irregularities
the OR nurse provides what information to the PACU
When a patient returns to the nursing unit, what procedure is done immediately?
response to surgery, anesthesia and body exposure
Hypothermia within the first 12 hours after surgery may be caused by
dehydration, decreased lung activity, inflammatory response to surgery
Hypothermia within 24-48 hours after surgery may be caused by
infection: respiratory, wound, urinary and circulatory
Hypothermia after day 2 may be caused by
increased HR, thready pulse, decreased BP, cool clammy skin, decreased urine output, restlessness
What are 6 signs of shock?
movement from OR table, jarring of gurney during transport, reactions to drugs/anesthesia, loss of body fluids, cardiac dysrhythmias, cardiac failure, poor ventilation, pain
Possible causes of Postoperative shock
Hypovolemic shock in the postoperative period is often caused by
Is a drop in blood pressure below patients baseline, post-op, common after surgery?
hemorrhage, circulatory failure, fluid shift
A significant drop in blood pressure and increased HR may indicate __________, _______________, or ___________
Give oxygen, raise legs above heart, increase IV fluids, notify anesthesia provider and surgeon, provide meds as ordered, assess
If a patient is going into shock, what measures should be taken?
decrease stimuli, reduce interuptions, eliminate odors, nursing interventions
Postoperative comfort measures for pain