Familiarize yourself with the cart so you can be on top of your game if this emergency happens on your watch! If your patient’s wound (usually a belly incision) suddenly pops open, parts are gonna come out (icky but true). Giving Zofran as the patient is coming out of anesthesia is a common practice among anesthesiologists…but if they don’t get it then, be aware so you can potentially give it during the recovery period. Cover the wound with sterile gauze or a sterile drape soaked in sterile normal saline and call the MD…this patient will be going back to surgery! One of the biggies is BLEEDING, another biggie is RESPIRATORY FAILURE, yet another is CARDIAC DYSFUNCTION, and still another is MALIGNANT HYPERTHERMIA. Just like on the first day of class, consider these links your syllabus to the Straight A Nursing website. Our female escort girls are handpicked, making sure that we provide 100% real escort listings in Bristol . The big question is…will s/he replace it? You may hear stridor or the patient may have a hoarse quality to their voice. Isn’t nursing FUN? Being a successful nursing student is more than just study tips and test strategies. If your patient is obese, diabetic, on steroids or has fragile skin, you’re going to watch the wound healing closely. 1 Although pain management continues to be a major societal issue, approximately 116 people die each day from opioid overdose in the United States. M Bummer. Taking care of a patient on the floor (or ICU) after surgery involves monitoring for all those things you’d keep an eye on in PACU…only you’re not doing Aldrete scoring or giving pain meds every 5 minutes (thank goodness!). For the sake of making things colorful, let’s say your patient had a cholecystectomy (removal of the pesky gall bladder). The total cost per patient was >4 times higher for patients with infection and PAD than for those with neither [ 16 ]. The treatment for malignant hyperthermia is dantrolene diluted with sterile water. H SIRS Issues Researcher. The meaning is the same in 2 Cor. The treatment for post-op bleeding is usually MORE surgery! The treatment for each will depend on the individual rhythm and the CAUSE of the rhythm. G General anesthesia AND pain meds can cause low blood pressure…so lots of potential culprits here. By the time the patient gets to you on the surgical/tele floor, they’re going to be stable (otherwise they’d go to ICU). Hmmm…guess you better be on top of your game when identifying cardiac problems such as these: Let’s talk about bleeding for just a moment. Most wounds will be covered for 24 hours post surgery…do not remove this dressing! Hi, I’m Nurse Mo and I love mentoring nursing students! X If you see hypotension, suspect bleeding, volume depletion (dehydration) or over sedation. P This could be the aspiration of stomach contents if the patient is vomiting, or even just oral secretions. Lots of stuff to go wrong here. You want them to be able to participate in their care…not be so zonked they sleep all day. Patients at highest risk for DVT are those who: have a malignancy (cancer makes the blood really clott-y…yes, that’s a technical term , had a big abdominal surgery, pelvic surgery or surgery of the legs, patients with CHF or history of having an MI, patients on hormonal therapy (such as birth-control pills). I remember what it was like to be exactly where you are Read More…. In general, anesthesia depresses myocardial function, which is further exacerbated by opioids. Hypoxia or Hypoventilation: Thanks to all those good pain meds, hypoventilation and hypoxia are common complications after surgery. 1,711 Likes, 64 Comments - Mitch Herbert (@mitchmherbert) on Instagram: “Excited to start this journey! W Q I wish I had one of these at home! Warming blankets are awesome for getting your patient’s temp up to snuff…either the ones from the blanket warmer contraption or a specialty blanket called a “bare hugger” that is basically a hollow blanket attached to a machine that fills it with warm air. If the patient is hypertensive usually, then meds like nicardipine (a calcium channel blocker) or a vasodilator may be used. episode 118 on the Straight A Nursing podcast, Six Things You Might Worry About with Clinicals: Episode 141, The ECG Interval You’re Probably Not Measuring: Episode 138, Mottled skin thanks to massive, system-wide vasoconstriction. Your job is to: So there you have it! Signs that your patient is having laryngospasm are: hypoxia, hypoventilation, dyspnea or even complete absence of breath sounds. Edema: Laryngeal edema can occur post intubation due to irritation/inflammation and can also be a result of an allergic reaction. Monitor temp and WBC…and while you’re at it, do your SIRS/SEPSIS screening religiously. A slow heart rate may be due to pain medication…and the scarier dysrhythmias are usually a result of anesthesia plain and simple. The pathophysiology is actually pretty interesting…the short version is that the condition causes an influx of calcium ions into the myoplasm when the patient is exposed to certain anesthetics (inhalation anesthetics, locals, and also muscle relaxers). love you. Yay! Monitor VS: Vital signs are going to give clues about lots of things…fluid volume status, potential bleeding occurring somewhere, pain, over-medicating, infection, atelactasis, etc… The most common VS fluctuations you’ll see after surgery are tachycardias and hypertension…caused by pain. He’s not intubated, but he does have an oropharyngeal airway in place (looks like this). The MD likely won’t order a diet until bowel sounds are audible, so keep a close ear on that. Keep an eye on that monitor and, if in doubt, get a 12-lead ASAP! In the immediate post-op period, most patients will go to the PACU (post-anesthesia care unit). Control nausea/vomiting: In addition to being an aspiration risk, vomiting can tear delicate suture lines leading to bleeding and more surgery for your patient. U Easy enough and it actually feels pretty good for the patient. How dare you! They are delightful! We use cookies to ensure that we give you the best experience on our website. Patients who are on bedrest or just flat-out refusing to get up and walk are at high risk for a DVT. If they’ve had a BIG surgery (like a mega back surgery, for instance) they’re not going to be able to move on their own. Obese patients…skin that doesn’t receive great circulation is also going to be fragile. Who are you going to be EXTRA worried about when it comes to bleeding? Why is this a big deal? You may have to help him if you notice he wakes up and starts coughing or gagging…basically he just needs to be awake enough to protect his airway. ANY. Of course, over-treating pain has its own host of problems (somnolence, over-sedation, respiratory depression, hypotension)..so make sure to assess VS before each dose and keep a close eye on your patient afterward. Keep a close eye on your patients, give ’em some O2 and when they start not breathing very much, just wake ’em up. Hypertension: Having a blood pressure that’s too high is also pretty common after surgery. Also, I imagine it hurts a LOT…especially if your patient has had abdominal surgery of any kind. If it’s severe, the patient is going to be intubated. B Ok, you’ve done all your monitoring and your patient has scored an 8 on the Aldrete scale…he is ready to go back to the Surgical Floor. Signs of post-op bleeding include a drop in blood pressure, elevation in HR and RR (with possible corresponding drop in O2 sats). The treatment will depend on the cause….if they’re bleeding they’ll get volume and go back to surgery. The surgeon will come around and remove this dressing. FMT is an effective treatment for Clostridioides difficile infection (CDI). Treatment includes supplemental positive-pressure mask ventilation, possibly medications such as racemic epi, atropine, lidocaine or steroids…and intubation if it’s severe. Knowing if your patient has a heart condition will clue you in to having a high index of suspicion for post-operative dysrhythmias. Treat that pain and a lot of other things will fall nicely into place. Provides the meaning, history, and pronunciation of over half a million words, both present and past. Y If you see a slight rise in temp and slightly lower O2 sats, suspect atelactasis and encourage coughing/deep breathing. There are three more things you’ll be keeping on top of…and that is PAIN, HYPOTHERMIA and NAUSEA/VOMITING. #columbiamed #whitecoatceremony” Monitor for poor wound healing: In a perfect world, your patient’s wound is well-approximated (meaning the edges are close together) and without signs of redness, warmth or purulent drainage. As the rockstar nurse taking care of a post-surgical patient, you’re going to know exactly what to watch for, what to assess, and what to do should something go wrong. It occurs post extubation and is more common in patients with asthma or COPD (also smokers…please don’t smoke…this is a public service announcement). The last thing you want is for your patient to throw up…not only does this leave a big mess for you, it’s really dangerous in a patient who is lethargic and aspiration is a huge risk. You’ll keep the SCDs on ’em and encourage frequent ambulation as tolerated. It’s always a concern after surgery, but in some cases more than others. Operating rooms will typically have a Malignant Hyperthermia Cart all ready to go with the necessary equipment as well as the dantrolene. So while you’re assessing your patient carefully in the PACU for all those things above, you’re also watching for complications associated with surgery, anesthesia and intubation. Encourage cough/deep breathing to prevent pneumonia. Z, Abbreviations for medical organisations and personnel, spinal cord injury without radiographic abnormality, syndrome of inappropriate antidiuretic hormone, serotonin–norepinephrine reuptake inhibitor, single-photon emission computed tomography, https://en.wikipedia.org/w/index.php?title=List_of_medical_abbreviations:_S&oldid=1013080747, Short description is different from Wikidata, Creative Commons Attribution-ShareAlike License, social history (personal habits, living situation, job), sin nombre virus (the most common type of, one-half (ss either with or without a bar over them) (from, This page was last edited on 19 March 2021, at 22:28. Keep those foley catheters sparkling clean and follow all the basics for CAUTI (catheter-associated UTI) prevention. The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience” associated with actual or potential tissue damage, or described in terms of such damage. Laryngospasm: When the larynx is irritated it can go into spasm which can lead to a partial or complete airway obstruction. This will stay in place until the patient is basically conscious enough to notice it’s there and cough/push the darn thing out. This leads to a generation of heat AND acid…so the patient becomes hyperthermic AND acidotic. It can be due to a number of factors…pain being a HUGE one, also fluid overload, hypothermia and shivering, increased parasympathetic response/stress or even bowel and bladder distention. Busy busy busy. S The highest costs per patient were those for hospitalization, antibiotic therapy, and surgery, and these increased with the severity of disease. If your patient starts to complain of unilateral leg pain or swelling, then you might be smart to suspect a DVT. Control pain: When patients are in pain they don’t want to cough, take deep breaths or move. Early recognition is KEY and swift intervention is CRUCIAL. As far as hypothermia goes…understand that ORs are really cold places. My best advice is to give the smallest dose you can…then re-assess…you can always give more (as long as its ordered and it’s safe, of course). Ya gotta get in there and turn ’em! Most wounds will be covered for 24 hours post surgery…do not remove this dressing! Be kind, though…pre-medicate first and stay diligent with cleanliness. And, of course, the next question is always…what are you going to do about it? On top of that, your patient’s innards were exposed to cold air for an extended period of time…they’re gonna be chilly! To treat you’re going to use cool, humidified O2 and racemic epinephrine. Get this on audio in episode 118 on the Straight A Nursing podcast. Respiratory-wise, there are all kinds of things that can go wrong after surgery. One thing you can do to help prevent an abdominal wound dehiscence is to teach your patient to splint their belly when they cough or move…this means holding a pillow against their belly to provide some counter pressure. F Note that WOUND DEHISCENCE is a thing…it happens and you need to know what to do if it does. Hypotension: When the heart is unhappy, cardiac output can be affected…so keep an eye on blood pressure. I saw an aspiration occur once and the deterioration was so incredibly sudden…patient immediately started agonal breathing and O2 sats dropped waaaaaay down. If you suspect aspiration, turn your patient on his/her side and suction the oropharynx. Your job as the nurse is to encourage the patient toward independence and prevent complications. Aspiration: Anyone who has a decreased LOC or swollen airway is at risk for aspiration. 4:1: Paul will not let any difficulties cause him to fail or grow weary." If this doesn’t work…intubate! With anesthesia and pain meds usually comes some pretty significant nausea. K Starting patients off with “sips and chips” is usually a good idea, and usually all they’re going to want in the immediate post-op period anyway. trequan says: Sep 29, 2019 at 6:57 pm. In the cases where coagulopathies are present, you will likely try to correct the coagulopathy as well…give platelets, give Vitamin K, give plasma, give blood. 0–9 Four Truth Bombs About Mental Health Nursing: Episode 136, Why Mental Health Nursing is so Challenging, BONUS EPISODE: Words of Encouragement and Advice. It’s a way of life. Your patient comes out of the OR and is brought to you, the amazing PACU nurse. Some ICUs will recover their own patients in the unit, but regardless WHERE the patient is recovering, the care is the same. O Scrub the hubs of all IV lines before accessing them to prevent line infections. How about the ol’ ticker? Anyone with a coagulopathy (clotting factor deficiency, liver disease, low platelets, high INR or PTT, and cancer). For the sake of simplicity, let’s assume we’re talking about an inpatient procedure…not a quickie same-day surgery kind of deal…but a surgery that’s going to necessitate a hospital stay. Cystic fibrosis is an inherited condition in which mucous production in the body is thick and sticky. The main things to watch for when you’re caring for a post-op patient. Anyone who takes steroids such as prednisone…again, poor skin integrity. That’s your job Sometimes the wound will just be left open to air, which is nice because then you can really see it. Leave your comments below…and be safe out there! What else would you like to learn about post-op patients? Scary stuff. Dysrhythmias: Keep an eye out for sinus tachycardia and bradycardia, SVT, A-Fib, A-Flutter and V-Tach. Sans identity, the name only remains a denotative term. In the post-op recovery period, pain medications are usually ordered q 5 or q 15 minutes…so you’re constantly giving pain meds. He’s still really out of it thanks to all that lovely general anesthesia. Reply. ... its true meaning, entailment¤ importance to the New Testament Church, but have not gotten good information on it. J Monitor for poor wound healing: In a perfect world, your patient’s wound is well-approximated (meaning the edges are close together) and without signs of redness, warmth or purulent drainage. This is where your Zofran comes in. If you continue to use this site we will assume that you are happy with it. Prevent and monitor for infection: Keep dressing clean, practice good hand hygiene and wear gloves anytime you’re getting near a surgical site. A C Sometimes tachycardia is just due to pain, so treat the pain. In general, a hypotensive patient will get volume and may need vasopressors. Heck no! Or, it may be caused by hypoxia…treat the hypoxia. The upside is that it’s pretty rare…the downside is that it’s so rare you might only see it once which means you haven’t practiced. Malignant hyperthermia is an EMERGENCY and is a genetically-inherited condition that occurs in susceptible patients when certain anesthetics are used…and can even be caused by stress (and surgery is definitely stressful!). Because all of those things hurt and you are the mean nurse for even suggesting it. Bristol Escorts - Escort guide provides the most exquisite and discreet massage escort girls in Bristol. I hear it’s wonderful stuff. Fecal microbiota transplant (FMT), also known as a stool transplant, is the process of transferring fecal bacteria and other microbes from a healthy individual into another individual. They’ll be awake enough to communicate and follow commands, and they’ll probably feel pretty cruddy. You could also hear a cough that sounds a lot like croup or see retractions when inspiration. T Good times. Abbreviation Meaning s̅: without (s with an overbar) (from Latin sine) : S: sacrum: S x: symptoms surgery (though deemed by some as inappropriate) : S 1: first heart sound: S 2: second heart sound: S 3: third heart sound S 4: fourth heart sound S&O: salpingo-oophorectomy If it’s going to occur, it’s usually during anesthesia induction, but can be up to 3 days later. Try to address the cause and you’ll likely fix the hypertension. If your patient is refusing pain medication (and they will…believe me…some people think they’re going to get addicted after one day of IV morphine), then your job is to educate your patient on WHY we medicate for pain…so they can cough, take deep breaths and move…all the things that prevent pneumonia and promote healing. The patient may need positive pressure mask ventilation OR even intubation if the aspiration was severe. D L If you see consistently high temps, suspect infection…especially two-ish days after surgery. Anyone with diabetes…recall that diabetes leads to poor skin integrity. If your patient had an abdominal surgery, expect the belly to be pretty silent for about a day. are they still bleeding by any chance?). During the first Match Day celebration of its kind, the UCSF School of Medicine class of 2020 logged onto their computers the morning of Friday, March 20 to be greeted by a video from Catherine Lucey, MD, MACP, Executive Vice Dean and Vice Dean for Medical Education. You may be lucky to see or feel a hematoma develop; if it’s an abdominal surgery then the abdomen would be filling up with blood leading to a distended, firm belly. For funsies, let’s say they’re going to a surgical floor that uses telemetry so we have the benefit of keeping them on the cardiac monitor. V Not really. Prevent and monitor for deep vein thrombosis (DVT). Getting further deeper into the meaning, it is understood that the name may be a convenient concept for identification but the essence behind the same is the core of identity. Prevent skin breakdown: If your patient is in pain, they’re not going to want to move. Because you’re amazing, and you can handle anything. R THING. In the lungs, it causes the airways to clog up, producing rhonchi when breathing. Monitor bowel sounds. N If you recall your muscle contraction physiology, then it makes sense that this influx of calcium is going to cause contraction…only in this case it’s prolonged and intense. Therefore, the identity is pivotal to one‘s being. A heart-lung machine (Figure 89-10) is an apparatus that does the work both of the heart (i.e., pumps blood) and the lungs (i.e., oxygenates the blood) during, for example, open-heart surgery (Galletti and Colton, 1995).The basic function of the machine is to oxygenate the body's venous supply of blood and then to pump it back into the arterial system. The surgeon will come around and remove this dressing. E So, what will you see? You’ll also have a low blood pressure if the patient is volume depleted (what was the total blood loss during surgery? During this phase you’re going to monitor: Before the patient can leave the PACU, they need to score at least 9 points using the Aldrete Score…this is a way to systematically determine a patient’s readiness for a less intensive level of care (such as going from PACU out to the Surgical Floor). Sit the patient up and do your best to keep them calm. Because…. I As you advance the diet, keep an eye on nausea and go slow. 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