Originally posted by P_RN
Head to toe, wound, CSM etc on arrival then q30x2, q4x2 q 1hx2 then q4. As long as stable. People w/epidurals have resp checked q1 and pain assessed w/vitals.
Okay...I figured the head to toe assess, wound/dsg check and neurovascular checks were a given....lol cause we do all that too. if there is an epidural or a PCA involved, the V/S monitoring stays q4h and LOC is monitored as well.
nrw, we are looking for s/s of hemmorhage, wound dehissance, depressed resperations, increase or decrease in pulse/BP, quality of pain and effectiveness of pain meds, pupilary reactions, presence of BSx4 quads, neurovascular checks and neuromuscular blockade from epidural........I am sure I missed something but one must be on top of their game to avoid and avert post op complications.
Yes, it is alot but a nurse with excellent assessment and organizational skills can do all that with in 10 minutes and pick up on the slightest change.