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134 Cards in this Set

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Risk Factors that affect surgery
age, nutrition, obesity, obstructive sleep apnea, immunocompromised, fluid and electrolyte balance, Pregnancy
What effect does age have on surgery?
Very young and old clients are at risk during surgery because of immature or declining physiological status.
What effect does nutrition have on surgery?
Normal tissue repair and resistance to infection depend on adequate nutrients. A client who is malnourished is prone to poor tolerance to anesthesia, negative nitrogen balance from lack of protein, delayed blood-clotting mechanisms, infection, poor wound healing, and the potential for multiple organ failure.
What effect does obesity have on surgery?
Obesity increases surgical risk by reducing ventilatory and cardiac function. The client often has difficulty resuming normal physical activity after surgery and is susceptible to poor wound healing and wound infection because of the structure of fatty tissue, which contains a poor blood supply. It is often difficult to close the surgical wound of a client who is obese because of the thick adipose layer; thus the client is at risk for dehiscence (opening of the suture line) and evisceration (abdominal contents protruding through surgical incision).
What effect does obstructive sleep apnea have on surgery?
It often results in sleep-associated oxygen desaturation. OSA increases the risk of perioperative complications.
What effect does immunocompromised have on surgery?
bone marrow alterations can occur and increase the risk of infection. In addition, radiation therapy is sometimes given preoperatively to reduce the size of the cancerous tumor so that it can be removed surgically. Radiation has some unavoidable effects on normal tissue, such as excess thinning of skin layers, destruction of collagen, and impaired vascularization of tissue. Ideally, the surgeon waits to perform surgery 4 to 6 weeks after completion of radiation treatments.
What effect does fluid and electrolyte balance have on surgery?
Severe protein breakdown causes a negative nitrogen balance (see Chapter 44), and an elevation in blood glucose level occurs. Both of these effects decrease tissue healing and increase the risk of infection.
What effect does pregnancy have on surgery?
The pregnant client has surgery only on an emergent or urgent basis. Because all major systems of the mother are affected during pregnancy, the risk for operative complications are increased.
Pre-operative
care given before surgery
Intra-operative
care given during surgery
Post-operative
care given after surgery
Why blood diagnostic screenings are performed before surgeries?
For procedures where blood loss is expected (e.g., hip and knee replacements), a type and crossmatch would be indicated preoperatively in case the client needs a blood transfusion during surgery.
What post-operative screening is ordered if a client is over the age of 40 or has heart disease?
The health care provider often orders a chest x-ray examination or an electrocardiogram (ECG).
What postoperative screenings are ordered for clients with preexisting lung disease?
Pulmonary function testing and occasionally arterial blood gas analysis
What screening is ordered postoperatively for diabetics?
Blood glucose levels.
How do some clients reduce the risk of transfusion-related infections and transfusion reactions, and what is it called?
They chose to donate their own blood before surgery. Autologous infusion
What is Informed Consent?
Surgery cannot be legally or ethically performed until a client understands the need for a procedure, the steps involved, risks, expected results, and alternative treatments.
Who is responsible for informing the client about the surgery?
The physician
What is the nurses role concerning informed consent?
The nurse witnesses the signature, makes sure the client understands the surgery and refers the client back to the physician for questions.
What are pneumatic compression stockings?
Sleeves that wrap around the legs and are connected to a pump that alternately inflates and deflates the stocking around the leg.
What is the typical cycle of inflation/deflation of SCD?
Inflation is 10 to 15 seconds and deflation for 45 to 60 seconds.
Why are SCD/IPCs used?
To decrease venous stasis by increasing venous return through the deep veins of the legs.
How soon after surgery should SCD/IPCs be used?
For optimal results, begin use of SCD/IPCs as soon as possible and maintain it until the client becomes fully ambulatory.
What are Anti-Thrombolytic stockings?
Elastic stockings (sometimes called thromboembolic device [TED] hose) also aid in maintaining external pressure on the muscles of the lower extremities and thus promote venous return.
How do you obtain the correct size?
To obtain the correct size, measure the client's calf, thigh, and leg length accurately.
When is TED hose contraindicated?
Do not apply the stockings if the client has a local condition affecting the leg (e.g., any skin lesion, gangrenous condition, or recent vein ligation), because application compromises circulation.
How often should the stockings be applied?
Remove and reapply them at least twice a day. Be sure to assess circulation at the toes to ensure the TEDs are not too tight.
Pre-operative
care given before surgery,
What are the benefits of ambulatory (out patient) surgery
Anesthetic drugs that metabolize rapidly with few aftereffects allow shorter operative times and faster recovery time.
Possibility of acquiring health care–associated infections is reduced.
Laparoscopic procedures instead of traditional surgical procedures decreases the length of surgery, hospitalization, and associated costs.
What is Major surgery? Give an example.
Involves extensive reconstruction or alteration in body parts; poses great risks to well-being. Example Coronary artery bypass, colon resection, removal of larynx, resection of lung lobe
What is Minor surgery? Give an example.
Involves minimal alteration in body parts; often designed to correct deformities; involves minimal risks compared with major procedures. Example Cataract extraction, facial plastic surgery, tooth extraction
What is Elective surgery? Give and example.
Performed on basis of client's choice; is not essential and is not always necessary for health. Example Bunionectomy, facial plastic surgery, hernia repair, breast reconstruction
What is Urgent surgery? Give an example
Necessary for client's health, often prevents additional problems from developing (e.g., tissue destruction or impaired organ function); not necessarily emergency. Example Excision of cancerous tumor, removal of gallbladder for stones, vascular repair for obstructed artery (e.g., coronary artery bypass)
What is an Emergency surgery? Give an example.
Must be done immediately to save life or preserve function of body part. Example Repair of perforated appendix, repair of traumatic amputation, control of internal hemorrhaging
What is a Diagnostic surgery? Give an example.
Surgical exploration that allows health care providers to confirm diagnosis; often involves removal of tissue for further diagnostic testing Example Exploratory laparotomy (incision into peritoneal cavity to inspect abdominal organs), breast mass biopsy
What is Ablative Surgery? Give an example.
Excision or removal of diseased body part. Example Amputation, removal of appendix, cholecystectomy
What is a Palliative surgery? Give an example.
Relieves or reduces intensity of disease symptoms; will not produce cure. Example Colostomy, debridement of necrotic tissue, resection of nerve roots
What is Reconstructive/Restorative surgery? Give an example
Restores function or appearance to traumatized or malfunctioning tissues. Example Internal fixation of fractures, scar revision
What is Procurement for transplant? Give an example.
Removal of organs and/or tissues from a person pronounced brain dead for transplantation into another person. Example Kidney, heart, or liver transplant
What is Constructive surgery? Give an example.
Restores function lost or reduced as result of congenital anomalies. Example Repair of cleft palate, closure of atrial septal defect in heart
What is Cosmetic surgery? Give an example
Performed to improve personal appearance. Example Blepharoplasty to correct eyelid deformities; rhinoplasty to reshape nose
How is Thrombocytopenia a risk for surgery?
Increase risk of hemorrhaging during and after surgery.
How is Diabetes mellitus a risk for surgery?
Increases susceptibility to infection and impairs wound healing from altered glucose metabolism and associated circulatory impairment. Stress of surgery often causes increases in blood glucose levels.
How is Heart Disease a risk for surgery?
Stress of surgery causes increased demands on myocardium to maintain cardiac output. General anesthetic agents depress cardiac function.
How is Obstructive sleep apnea a risk for surgery?
Administration of opioids increases risk of airway obstruction postoperatively. Clients will desaturate as revealed by drop in O2 saturation by pulse oximetry.
How is Upper respiratory infection a risk for surgery?
Increases risk of respiratory complications during anesthesia (e.g., pneumonia and spasm of laryngeal muscles).
How is Liver disease a risk for surgery?
Alters metabolism and elimination of drugs administered during surgery and impairs wound healing and clotting time because of alterations in protein metabolism.
How is Fever a risk for surgery?
Predisposes client to fluid and electrolyte imbalances and may indicate underlying infection.
How is Emphysema a risk for surgery?
Reduces client's means to compensate for acid-base alterations. Anesthetic agents reduce respiratory function, increasing risk for severe hypoventilation.
How is AIDS a risk for surgery?
Increases risk of infection and delayed wound healing after surgery.
How is Abuse of Street Drugs a risk for surgery?
Persons abusing drugs sometimes have underlying disease (HIV, hepatitis) that affects healing.
How is Chronic Pain a risk for surgery?
Regular use of pain medications often results in higher tolerance. Increased doses of analgesics are sometimes necessary to achieve postoperative pain control.
Name six risk factors for a malnourished client?
poor tolerance to anesthesia,
negative nitrogen balance from lack of protein,
delayed blood-clotting mechanisms,
infection,
poor wound healing,
the potential for multiple organ failure.
Name four risks for the obese client?
Client often has difficulty resuming normal physical activity after surgery,
Poor wound healing and wound infection because of the structure of fatty tissue,
which contains a poor blood supply.
The client is at risk for dehiscence (opening of the suture line)
The client is at risk for evisceration (abdominal contents protruding through surgical incision).
Name six body systems that increase surgery risks for older adults
Cardiovascular, Integument, Pulmonary, Renal, Neurological, Metabolic.
Cardiovascular System risks for older adults
Degenerative change in myocardium and valves. Reduced cardiac reserve.
Integumentary System risks for older adults
Decreased subcutaneous tissue and increased fragility of skin. Prone to pressure ulcers and skin tears.
Pulmonary System risks for older adults
Rib cage stiffened and reduced in size. Reduced vital capacity.
Renal System risks for older adults
Reduced blood flow to kidneys. Increased risk of shock when blood loss occurs.
Neurological System risks for older adults
Sensory losses, including reduced tactile sense and increased pain tolerance. Decreased ability to respond to early warning signs of surgical complications.
Metabolic System risks for older adults
Lower basal metabolic rate. Reduced total oxygen consumption.
How do Antibiotics affect the client during surgery?
Antibiotics potentiate (enhance action of) anesthetic agents. If taken within 2 weeks before surgery, aminoglycosides (gentamicin, tobramycin, neomycin) may cause mild respiratory depression from depressed neuromuscular transmission.
How do Anticoagulants affect the client during surgery?
Anticoagulants, such as warfarin (Coumadin), alter normal clotting factors and thus increase risk of hemorrhaging. Discontinued at least 48 hours before surgery. Aspirin is a commonly used medication that alters clotting mechanisms.
How do Anticonvulsants affect the client during surgery?
Long-term use of certain anticonvulsants (e.g., phenytoin [Dilantin] and phenobarbital) alters metabolism of anesthetic agents.
How do Corticosteroids affect the client during surgery?
With prolonged use, corticosteroids, such as prednisone, cause adrenal atrophy, which reduces the body's ability to withstand stress. Before and during surgery, dosages are often temporarily increased.
How does Insulin affect the client after surgery?
Clients' need for insulin changes after surgery. Stress response and intravenous (IV) administration of glucose solutions often increase dosage requirements after surgery. Decreased nutritional intake often decreases dosage requirements.
How do Diuretics affect the client after surgery?
Diuretics such as furosemide (Lasix) potentiate electrolyte imbalances (particularly potassium) after surgery.
How do Nonsteroidal antiinflammatory drugs (NSAIDs) affect the client during surgery?
NSAIDs (e.g., ibuprofen) inhibit platelet aggregation and prolong bleeding time, increasing susceptibility to postoperative bleeding.
How do Herbal therapies affect the client during surgery?
ginger, gingko, ginseng These herbal therapies have the ability to affect platelet activity and increase susceptibility to postoperative bleeding. Ginseng is reported to increase hypoglycemia with insulin therapy.
How do Smoking Habits affect postoperative patients?
The client who smokes is at greater risk for postoperative pulmonary complications than a client who does not. The chronic smoker already has an increased amount and thickness of mucous secretions in the lungs. General anesthetics increase airway irritation and stimulate pulmonary secretions, which the airways retain as a result of reduction in ciliary activity during anesthesia. After surgery the client who smokes has greater difficulty clearing the airways of mucous secretions and needs emphasis on the importance of postoperative deep breathing and coughing.
How does Alcohol Ingestion and Substance Use and Abuse affect the postoperative patient?
Habitual use of alcohol and illegal drugs predisposes the client to adverse reactions to anesthetic agents. Some clients also experience a cross-tolerance to anesthetic agents, necessitating higher-than-normal doses. In addition, the health care provider may need to increase postoperative dosages of analgesics. Clients with a history of excessive alcohol ingestion are often malnourished, which delays wound healing. These clients are also at risk for liver disease, portal hypertension, and esophageal varices (predisposing the client to bleeding disorders). The client who habitually uses alcohol and is required to remain in the hospital longer than 24 hours is also at risk for acute alcohol withdrawal and its more severe form, delirium tremens (DTs).
How does Self-concept affect the postoperative patient?
Clients with a positive self-concept are more likely to approach surgical experiences appropriately. Poor self-concept hinders the ability to adapt to the stress of surgery and aggravates feelings of guilt or inadequacy.
How does Body Image affect the postoperative patient?
Surgical removal of any diseased body part often leaves permanent disfigurement, alteration in body function, or concern over mutilation. Loss of certain body functions (e.g., with a colostomy or amputation) may compound a client's fears. Assess for body image alterations that clients perceive will result from surgery.
How do Coping Resources affect the postoperative patient?
The physiological effects of stress are well documented. Activation of the endocrine system results in the release of hormones and catecholamines, which increases blood pressure, heart rate, and respiration. Platelet aggregation also occurs, along with many other physiological responses. Be aware of these responses, and assist with stress management (see Chapter 31).
What does the physical examination before surgery include?
General Survey,
Head and Neck,
Integument,
Thorax and lungs,
Heart and Vascular,
Abdomen,
Neurological stasis
How can NPO be enforced with the preoperative patient?
Remove fluids and solid foods from the client's bedside, and post a sign over the bed to alert hospital personnel and family members about fasting restrictions. Some clients take specific medications (e.g., anticoagulants, cardiovascular medications, anticonvulsants, and antibiotics) with a sip of water as ordered by the health care providers.
Can the client brush their teeth the day of surgery?
Yes. Allow the client to rinse the mouth with water or mouthwash and brush the teeth immediately before surgery as long as the client does not swallow water. Notify the surgeon and anesthesia provider if the client eats or drinks during the fasting period.
What foods is the client encouraged to eat preoperatively?
The client is encouraged to eat foods high in protein, with sufficient carbohydrates, fat, and vitamins. If a client cannot eat because of gastrointestinal alterations or impairments in consciousness, you will probably start an IV route for fluid replacement.
How is surgical wound infection reduced the day of surgrey?
Antibiotics may be ordered in the preoperative period. A reduction in wound infection rates occurs when an antibiotic is present in sufficient concentrations at the wound site before incision.
What risks are involved with shaving the preoperative client?
Hair removal can damage and cause breaks in the client's skin, which allows for the entry of microorganisms. If required, perform hair removal, preferably with a clipper or shaver, as close to the time of surgery as possible.
What kind of bowel preparation is performed on the day of surgery?
Some clients receive a bowel preparation (e.g., a cathartic or enema) if the surgery involves the lower gastrointestinal system or lower abdominal organs. Manipulation of portions of the gastrointestinal tract during surgery results in absence of peristalsis for 24 hours and sometimes longer.
What interventions are given post-operative for bowels?
Enemas and cathartics, such as GoLytely, cleanse the gastrointestinal tract to prevent intraoperative incontinence and postoperative constipation.
Why is it important to have an empty bowel for GI surgeries?
An empty bowel reduces risk of injury to the intestines and minimizes contamination of the operative wound if a portion of the bowel is incised or opened accidentally or if colon surgery is planned.
What does “give enemas until clear.” mean?
This means that you administer enemas until the enema return contains no solid fecal material. Too many enemas given over a short time can cause serious fluid and electrolyte imbalances. Most agencies limit the number of enemas (usually three) a nurse may administer successively.
What should be checked after completing bowel preparation?
Recheck potassium level.
Why do patients need sleep before surgery?
Rest is essential for normal healing. Anxiety about the impending surgery can easily interfere with the ability to relax or sleep. The underlying condition requiring surgery is often painful, further impairing rest. Attempt to make the client's environment quiet and comfortable. The health care provider may order a sedative-hypnotic or anxiolytic agent for the night before surgery. Sedative-hypnotics (e.g., temazepam [Restoril]) affect and promote sleep. Anxiolytic agents (e.g., alprazolam [Xanax]) act on the cerebral cortex and limbic system to relieve anxiety.
What are the three principles of protocol for surgery?
The three principles of the protocol include a PREOPERATIVE VERIFICATION that ensures all relevant documents and studies are available before the start of the procedure and consistent with the client's expectations;
MARKING OF THE OPERATIVE SITE with indelible ink to mark left and right distinction, multiple structures (e.g., fingers), and levels of the spine;
and a “TIME OUT” just before starting the procedure for final verification of the correct client, procedure, site, and any implants. All members of the surgical/procedure team perform the time out. This protocol includes active client or legally designated representative involvement in the entire process. If the client refuses a mark, note this on the procedure checklist.
What are the signs and symptoms of Latex reaction?
Signs and symptoms of a latex reaction include local effects ranging from urticaria and flat or raised red patches to vesicular, scaling, or bleeding eruptions. Acute dermatitis is sometimes present. Rhinitis and/or rhinorrhea are other common reactions in both mild and severe latex reactions. Immediate hypersensitivity reactions are life threatening, with the client exhibiting focal or generalized urticaria, edema, bronchospasm, and mucous hypersecretion, which can compromise respiratory status. Vasodilation compounded by increased capillary permeability can lead to circulatory collapse and eventual death. Because the client is often draped during surgery, investigate any unexplained acute deterioration in a previously healthy client for possible latex allergy.
Post-operative Complication, Atelectasis
Collapse of alveoli with retained mucous secretions. Signs and symptoms include elevated respiratory rate, dyspnea, fever, crackles auscultated over involved lobes of lungs, and productive cough.
Post-operative Complication, Inadequate lung expansion
Anesthesia, analgesia, and immobilized position prevent full lung expansion. There is greater risk in clients with upper abdominal surgery who have pain during inspiration and repress deep breathing.
Pneumonia
Inflammation of alveoli. It may involve one or several lobes of lung. Development in lower dependent lobes of lung is common in immobilized surgical client. Signs and symptoms include fever, chills, productive cough, chest pain, purulent mucus, and dyspnea. Poor lung expansion with retained secretions or aspirated secretions. Common resident bacterium in respiratory tract is Diplococcus pneumoniae, which causes most cases of pneumonia.
Post-operative Complication, Hypoxemia
Inadequate concentration of oxygen in arterial blood. Signs and symptoms include restlessness, confusion, dyspnea, high or low blood pressure, tachycardia or bradycardia, diaphoresis, and cyanosis.Anesthetics and analgesics depress respirations. Increased retention of mucus with impaired ventilation occurs because of pain or poor positioning. Clients with OSA at increased risk for hypoxemia.
Post-operative Complication, Pulmonary embolism
Embolus blocking pulmonary arterial blood flow to one or more lobes of lung. Signs and symptoms include dyspnea, sudden chest pain, cyanosis, tachycardia, and drop in blood pressure. Same factors lead to formation of thrombus or embolus. Immobilized surgical client with preexisting circulatory or coagulation disorders is at risk.
Post-operative Complication, Hemorrhage, what are the s/s?
Loss of large amount of blood externally or internally in short period of time. Signs and symptoms include hypotension, weak and rapid pulse, cool and clammy skin, rapid breathing, restlessness, and reduced urine output. Slipping of suture or dislodged clot at incisional site. Clients with coagulation disorders are at greater risk.
Hypovolemic shock
Inadequate perfusion of tissues and cells from loss of circulatory fluid volume. Signs and symptoms are same as for hemorrhage. In surgical client, hemorrhage usually causes hypovolemic shock.
Post-operative Complication, Thrombophlebitis, what are the s/s?
Inflammation of vein often accompanied by clot formation. Veins in legs are most commonly affected. Signs and symptoms include swelling and inflammation of involved site and aching or cramping pain. Vein feels hard, cordlike, and sensitive to touch. Prolonged sitting or immobilization aggravates venous stasis. Trauma to vessel wall and hypercoagulability of blood increase risk of vessel inflammation.
Post-operative Complication, Thrombus
Formation of clot attached to interior wall of a vein or artery, which can occlude the vessel lumen. Symptoms include localized tenderness along distribution of the venous system, swollen calf or thigh, calf swelling >3 cm compared to asymptomatic leg, pitting edema in symptomatic leg, and decrease in pulse below location of thrombus (if arterial).
Embolus
Piece of thrombus that has dislodged and circulates in bloodstream until it lodges in another vessel, commonly lungs, heart, brain, or mesentery.
Post-operative Complication, Paralytic ileus
Nonmechanical obstruction of the bowel caused by physiological, neurogenic, or chemical imbalance associated with decreased peristalsis. Common in initial hours after abdominal surgery.
Post-operative Complication, Abdominal distention, what are the s/s?
Retention of air within intestines and abdominal cavity during gastrointestinal surgery. Signs and symptoms include increased abdominal girth, tympanic percussion over abdominal quadrants, client complaints of fullness and “gas pains.”
Post-operative Complication, Nausea and vomiting
Symptoms of improper gastric emptying or chemical stimulation of vomiting center. Client complains of gagging or feeling full or sick to stomach. Abdominal distention, fear, severe pain, medications, eating or drinking before peristalsis returns, and initiation of gag reflex.
Urinary retention
Involuntary accumulation of urine in bladder as result of loss of muscle tone. Signs and symptoms include inability to void, restlessness, and bladder distention. It appears 6-8 hours after surgery. Effects of anesthesia and narcotic analgesics. Local manipulation of tissues surrounding bladder and edema interfere with bladder tone. Poor positioning of client impairs voiding reflexes.
Post-operative Complication, Urinary tract infection
An infection of the urinary tract as a result of bacterial or yeast contamination. Signs and symptoms include dysuria, itching, abdominal pain, possible fever, cloudy urine, WBCs and leukocyte esterase positive on urinalysis. Most frequently a result of catheterization of the bladder.
Post-operative Complication, Wound infection
An invasion of deep or superficial wound tissues by pathogenic microorganisms; signs and symptoms include warm, red, and tender skin around incision; fever and chills; purulent material exiting from drains or from separated wound edges. Infection usually appears 3-6 days after surgery.
Post-operative Complication, Wound dehiscence
Separation of wound edges at suture line. Signs and symptoms include increased drainage and appearance of underlying tissues. This usually occurs 6-8 days after surgery. Malnutrition, obesity, preoperative radiation to surgical site, old age, poor circulation to tissues, and unusual strain on suture line from coughing or positioning cause dehiscence.
Post-operative Complication, Wound evisceration
Protrusion of internal organs and tissues through incision. Incidence usually occurs 6-8 days after surgery.
Post-operative Complication, Skin breakdown
Result of pressure or shearing forces. Surgical clients are at increased risk if alterations in nutrition and circulation are present, resulting in edema and delayed healing.Prolonged periods on the OR table and in the bed postoperatively lead to pressure breakdown. Skin breakdown results from shearing during positioning on the OR table and improper pulling of the client up in bed.
Intractable pain
Pain that is not amenable to analgesics and pain-alleviating interventions.Intractable pain may be related to the wound or dressing, anxiety, or positioning.
What is the most common post-operative complication?
Respiratory Depression
Intra-operative Complication, Malignant hyperthermia
In rare instances malignant hyperthermia, a life-threatening complication of anesthesia, develops. Malignant hyperthermia causes hypercarbia, tachypnea, tachycardia, premature ventricular contractions (PVCs), unstable blood pressure, cyanosis, skin mottling, and muscular rigidity. Despite the name, an elevated temperature occurs late. The increased expired carbon dioxide is one of the first signs. Although it often occurs during the induction phase of anesthesia, symptoms can occur postoperatively or with repeated exposures to anesthesia. Without prompt detection and treatment, it is potentially fatal.
Why are CBC values important post-operatively?
Peripheral venous sample of blood may reveal infection, low blood volume, and potential for oxygenation problems. Surgeon may order blood replacement.
What is the normal RBC for Men?
4.7-6.1 million/mm3
What is the normal RBC for Women?
4.2-5.4 million/mm3
What are normal Hgb values?
Men 14-18 g/100 mL
Women 12-16 g/100 mL
What are normal Hct values?
Men 42%-52%;
Women 37%-47%
Normal Sodium (Na) values
136-145 mEq/L
Normal Potassium (K) values
3.5-5.0 mEq/L
Normal Chloride (Cl) values
98-106 mEq/L
Normal Bicarbonate values
21-28 mEq/L
Normal pro-thrombin time (PTT)
11-12.5 seconds
Normal INR values
0.76-1.27
APTT
30-40 seconds
Normal value for Platelets
150,000-400,000/mm3
Serum creatinine
Men 0.6-1.2 mg/100 mL
Women 0.5-1.1 mg/100 mL
What are the normal values for Blood urea nitrogen (BUN)?
10-20 mg/100 mL
Glucose
Fasting 70-105 mg/100 mL
Name six post-operative interventions the nurse should do to promote respiratory health.
1. Encourage diaphragmatic breathing exercises every hour while the clients are awake.
2. Provide oral hygiene to facilitate expectoration of mucus. The oral mucosa becomes dry when clients are NPO or placed on limited fluid intake.
3. Initiate orotracheal or nasotrachal suction for clients who are too weak or are unable to cough.
4. Administer oxygen as ordered, and monitor oxygen saturation with a pulse oximeter. Preventing circulatory Complications.
5. Encourage coughing exercises every 2 hours while clients are awake, and maintain pain control to promote a deep, productive cough.
6. Instruct clients to use incentive spirometer.
What instructions need to be given to the post-operative patient concerning the incentive spirometer?
Instruct the clients to use an incentive spirometer for maximum inspiration. The client should try to reach the inspiratory volume achieved preoperatively on the spirometer.
Name three post-operative interventions the nurse should do to promote muscle health.
Encourage early ambulation.
Help clients who ar resticted to bed to turn on their sides every 1 to 2 hours while awake and to sit when possible.
Keep the client comfortable.
Name five post-operative interventions the nurse should do to promote circulation, and avoid skin breakdown.
Encourage clients to perform leg exercises at least every hour while awake.
Apply elastic antiemboism stockings or sequential compression devices as ordered by the health care provider. remove the stockings every 8 hours, and leave off for 1 hour. Perform a through assessment of the skin of the lower extremities at this time.
Encourage early ambulation.
Avoid positioning clients in a manner that interrupts blood flow to the extremities.
Maintain a gradual progression in dietary intake. Encourage intake of foods high in protein and vitamin C.
Maintain an adequate fluid intake.
Name seven post-operative interventions the nurse should do to promote nutrition.
• Promote adequate food intake by stimulating the client's appetite.
• Remove sources of noxious odors, and provide small servings of nonspicy foods.
• Assist the client to a comfortable position during mealtime.
• Provide desired servings of food. For example, some clients are more willing to face the first meal when servings are not large.
• Provide frequent oral hygiene.
• Administer fiber supplements, stool softeners, and rectal suppositories as ordered. If constipation or distention develops, the health care provider attempts to stimulate peristalsis with cathartics or enemas.
• Provide meals when the client is rested and free from pain.
Name four interventions the nurse should do to promote urinary health.
• Help the client with assuming normal positions during voiding.
• Check the client frequently for the need to void.
• Assess for bladder distention.
• Monitor intake and output (I&O).
Name six measures to help maintain the client's self concept.
• Provide privacy during dressing changes or inspection of the wound.
• Maintain the client's hygiene.
• Prevent drainage devices from overflowing.
• Maintain a pleasant environment.
• Offer opportunities for the client to discuss feelings about appearance.
• Provide the family with opportunities to discuss ways to promote the client's self-concept.
What interventions should the nurse do promote wound health?
Protect the wound, and promote healing. Use aseptic technique during dressing changes and wound care. Keep surgical drains patent so that accumulated secretions can escape from the wound bed. Ongoing observation of the wound identifies early signs and symptoms of infection.