- Monitoring and managing resp and circ function

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- Pain

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- Temp

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- Surgical Site

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- Airway patency, rate and quality of resp, and auscultation of breath sounds in all fields will be assessed

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- O2 therapy may be establihed

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- Cardiac monitoring, including rate and rhythm of the client\'s heartbeat, will be compared to the preop findings

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- BP and temp compaired to preop baseline

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- Neuro assessment - LOC, orientation, sensory and motor status, size and equality of pupils

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- Intake and output

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*hearing is the first sense to return*

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Clients who are particulary at risk for resp problems include those recieving general anaesth., older adults, heavy smokers, obese, and clients who are undergoing thoracic, airway or abdominal surgery. Potential alteration in resp function include airway obstruction, hypoxemia, atelectasis, pulmonary edema, aspiration of gastric contents, bronchospasms, and hypoventilation. To prevent these potential resp problems, the client should be placed in the proper position to facilitate resp and protect the airway (lateral position). Once conscious the client will be allowed in the supine position with the head of the bed elevated. Deep breathing is encouraged.

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Most common complications of the cardio system include hypotension, hypertension, and dysrhythmias. Clients at greatest risk for developing these complications are those with previous cardiac history, older adults, and those who are debilitated or critically ill. Frequent monitoring of vital signs and skin color, temp and moisture, cardiac rhythms to prevent complications.

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Management of complications may include o2 therapy, IV fluids, antidysrhythmic meds, analgesics, warming the client and emptying the clients bladder.

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Emergence delirium and delayed awakening are neuro complications that may develop. Due to a variety of factors and may manifest as restlessness, agitation, disorientation, etc.

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Pain and discomfort are common concerns for clients. Analgesics in the form of IV narcs, epidural caths, patient-controlled analgesia (PCA) or regional anaesthetic blocks.

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Prolonged anaesthetic admin may lead to redistribution of body heat and increase the risk of hypothermia. Complications related to hypothermia include compriming the immune function, postop pain, bleeding, myocardial ischemia, and delayed drug metabolism. Passive warming increased metab rate - Active rewarming requires an application of warming devices (blankets).

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Nausea and vomiting can be signif postop problems. To treat these symptoms the nurse may give an antiemetic or prokinetic drug.

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In order for the client to be discharged (to another unit) - mobile, alert, and able to provide a degree of selfcare. Pain, nausea and vomiting should be controlled.

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Fluid and electrolyte imbalances may contribute to cardio alterations. Fluid retention in the first 2-5 days could occur due to the stress response. The stress response can contribute to an increase in clotting factors.

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Syncope (loss of consciousness) can indicate a decreased CO, fluid deficiets or deficits in cerebral perfusion.

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A low urinary output can be expected for the first 24 hrs due to an increase in aldosterone and ADH levels due to stress response of surgery, fluid losses, drainage and diaphoresis.

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Anticholinergic and narcotic drugs may interfere with ability to initiate voiding. 30ml/hr!! If the client does not have a catheter, he or she should be able to void about 200 mL following surgery.

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The client will remain NPO until the gag reflux has returned and the client has bowel sounds. Clear fluids are introduced first and advanced fluids as tolerated

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Adequate nutrition is important to help fight the catabolic effect of the stress response and assist in wound healing.

NURSING PHARMACOLOGY Med-surg Nursing