Prioritization in Post-Operative Nursing

Introduction

• Presenter: Ria Mobley
• Topic: Prioritization with post-operative nursing
• Purpose: Educational, generalized overview of post-op nursing, focusing on critical thinking and prioritization

Importance of Understanding Surgery and Anesthesia

• Types of Surgery: Knowing the type helps identify normal manifestations vs. complications
  • Example: GI surgery may delay bowel sounds
• Types of Anesthesia: General vs. local impacts patient manifestations
  • Example: Sore throat from a breathing tube in general anesthesia

Anesthesia and Normal vs. Complications

• General Anesthesia Effects: Sedation, slurred speech, decreased respiratory rate
• Critical Point: Nurses must act if patient's vitals go outside normal ranges despite anesthesia
  • Respiratory rate below 12, O2 saturation below 90, heart rate in the 40s or below, systolic BP in the 70s

Prioritization List

• Order: Airway, Breathing, Circulation, Neurological (incl. Temp), Incisions (Skin, Tubes, Drains), IVs, Urine Output, GI/Diet, Pain
• Maslow's Hierarchy: For prioritizing assessments

Detailed Assessment Criteria

• Airway: Patency, possible obstructions (tongue, secretions)
• Breathing: Respiratory rate (12-20 bpm), chest symmetry, lung sounds (no crackles or wheezes), O2 saturation
• Circulation: Heart rate, blood pressure, rhythm, skin (temperature, color, clamminess), pulses, sensation
• Neurological: Speech, orientation, LOC, temperature (risk of hypothermia)
• Incisions and Skin: Normal drainage types, look for complications (reddened area, lack of skin breakdown)
• Drains: Tubes must be patent, output normal; any sudden change in output or color must be addressed
• IVs: Ensure patency; vital for hydration especially if patient is NPO
• Urine Output: Minimum of 30 ml/hr, use bladder scanner if needed
• GI/Diet: Hypoactive bowel sounds normal, but watch for firm/distended abdomen
• Pain: Educate on pain medicine, maintain safe post-medication, reassess pain levels

Universal Post-Op Care Guidelines

• Incentive Spirometer: For good respiratory health, used 10 times an hour while awake
• Early Ambulation: Prevents DVTS, respiratory issues
• Ted stockings/SCDs & Heparin/Enoxaparin: Help prevent blood clots, but ensure no contraindications
• Positioning: Ensures airway patency and effective breathing based on surgery type
• Progression of Diet: Start slow, monitor for nausea or vomiting, maintain fluid intake
• Reportable Signs: Pain, nausea, vomiting, urinary retention

Reminder on Anesthesia-Related Nuances

• Remember, normal vitals outside ranges, still need intervention
  • E.g., RR of 7, BP 70/40, HR >130, unresponsiveness are concerning

Practice Question Breakdown

• Prioritization based on given patient data
  • Unexpected vs. expected findings
  • Labeling outcomes via Maslow’s Hierarchy for prioritization
  • Example given for practice and understanding

Conclusion

• Look for early signs to prevent patient complications
• Always act on abnormal signs regardless of anesthesia
• Use prioritization strategy to keep patients safe and ensure comprehensive care