perioperative nursing care

Anagray, BSN · Mar 15, 2007

hi,
i have a few questions on this topic:
1) can coughing and deep breathing be used for other purpose besides post op? such as pt who has problem with pneumonia or any lung dz?
absolutley! you would instruct someone to c and db to prevent pneumonia, to encourage expectoration of sputum.
2) does anyone know any video online that shows how to use incentive spirometer? sorry, i don't
3) for post op care, if pt is comatose/semicomatose, why do we need to position pt on the side instead of low fowler position? is it because we need to keep an open airway and prevent aspiration if the pt has too much secretion? exactly
4) why do we start with ice chips and water when po is allowed after post op? is it to prevent aspiration from clear liquid diet/regular diet because of gag reflex is slow to return after op?

yes and also because cold water and ice will be felt better by pt rather than anything at room temp. also, if there are any post op complications you do not want food in the stomach - pt may have to go back to or. pt may also have nause, because anesthesia is wearing out and you are medicating them with morphine or whatever is ordered at this point, which can induce nausea.

hop this helps!

Daytonite, BSN, RN · Mar 15, 2007

Hi, toriphile23!

1) can coughing and deep breathing be used for other purpose besides post op? such as pt who has problem with pneumonia or any lung dz?

Yes

2) does anyone know any video online that shows how to use incentive spirometer?

http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/PDFDocs/dis-cond/respirat/in-sp-mouth.pdf - How to use an incentive spirometer and cough after surgery

http://www.jlenterprise.com/recruit_demo.html#is - how to have the patient deep breathe and cough. Picture of an incentive spirometer with directions on how to use.

3) for post op care, if pt is comatose/semicomatose, why do we need to position pt on the side instead of low fowler position? is it because we need to keep an open airway and prevent aspiration if the pt has too much secretion?

Yes

4) why do we start with ice chips and water when PO is allowed after post op? is it to prevent aspiration from clear liquid diet/regular diet because of gag reflex is slow to return after op?

No. It is in the event that the patient aspirates. Water aspirated into the lungs is not as event threatening as other liquids or food. Also, the coolness of the ice is soothing and comforting if the patient was intubated for a general anesthesia and their throat is irritated.

http://www.donnjo.com/aiden/journal/072106.htm

http://surglinks.com/index.html - Finding Answers to your Questions About Surgery

Welcome to allnurses! :welcome:

toriphile23 · Mar 15, 2007

Thanks Anagray and Daytonite for the responses.

I have a few more questions:

1) Can pt with O2 ventilation such as NC do deep breathing and coughing? i mean stop the O2 supply for a moment and do DB + C for few minutes, then put back the O2?

2) i read from the text book stating "if client had spinal anesthesia, do not elevate the legs any higher than placing them on the pillow; otehrwise the diaphragm muscles could be impaired." can anyone explain this to me the physiology behind this?

3) is thrombophlebitis = DVT?

4) i am really curious how do you assess for bladder distention? does the pubic area look distended like the abdominal distention? (sorry if this is a stupid question)

5) how does pouring warm water over the perineum area promote voiding? is it because it helps to relax the smooth muscles of the bladder?

labman · Mar 16, 2007

1) Can pt with O2 ventilation such as NC do deep breathing and coughing? i mean stop the O2 supply for a moment and do DB + C for few minutes, then put back the O2? YOU DO NOT NEED TO STOP O2 TO DEEP BREATHE AND COUGH IT IS PERFECT.

2) i read from the text book stating "if client had spinal anesthesia, do not elevate the legs any higher than placing them on the pillow; otehrwise the diaphragm muscles could be impaired." can anyone explain this to me the physiology behind this? INTERESTING NEVER HEARD OF THIS

3) is thrombophlebitis = DVT? NO IT IS NOT. THOMBOSIS IS A CLOT IN A VEIN. BUT THROMBOPHLEBITIS IS INFLAMMATION OF A VEIN. USALLY FROM AN IV BEING IN TOO LONG

4) i am really curious how do you assess for bladder distention? does the pubic area look distended like the abdominal distention? (sorry if this is a stupid question) BLADDER DISTENTION. LOOK AT LAST TIME THEY VOIDED, CAN USE PERCUSSION TO HEAR HOW BIG THE BLADDER IS OR MY FAVORITE A BLADDER SCAN.

5) how does pouring warm water over the perineum area promote voiding? is it because it helps to relax the smooth muscles of the bladder? WARM WATER OVER THE PERINEUM DOES HELP VOIDING,

Daytonite, BSN, RN · Mar 16, 2007

think about this. why would you want to take off a patient's oxygen while they were taking deep breaths and coughing? what purpose would it serve? wouldn't you want the patient to get every molecule of that oxygen as he/she takes each deep breath? so, the answer to your question is no, you wouldn't remove a nasal cannula just to deep breath and cough a patient. in fact, you'd want to leave it on. and, if the patient was on a ventilator you sure wouldn't want to remove them from their source of oxygen!

i used to work on a stepdown unit where we had a lot of people on ventilators or with chest tubes. anyone with a pulmonary diagnosis was encouraged to cough and deep breathe unless for some reason it was contraindicated. you don't want that sputum to linger down in the lungs to ferment and grow all kinds of bacteria. anytime you catch a cold and start getting congested you should start doing deep breathing yourself and attempt to do some productive coughing if there is any sputum.

i can't answer your second question other than knowing that with spinal anesthesia the patient is to remain flat, otherwise they will get a spinal headache. i could see where raising the legs too high could put pressure on the abdominal cavity forcing all the internal structures upward which would push on the diaphragm, but i don't know that it is the answer.

a phlebitis is what results from an iv being in a vein too long. a thrombophlebitis is an inflammation of a vein accompanied by a blood clot. most thrombophlebitis occurs in the lower extremities and it is not from the presence of an iv.

thromb(o) = blood clot
phleb = vein
-itis = inflammation

a dvt, deep vein thrombosis, is a blood clot within the vascular system. the term itself presupposes that there is no inflammation associated with it. however, there is some controversy in the medical community regarding this. in it's strict definition, however, it is merely a stationary blood clot in a vein.

thromb(o) = blood clot
-osis = condition of

you have a lot of curiosity about things. much of this information can be found in the right resources if you know where to look. you should have a good medical dictionary, such as taber's, to find information like definitions. you will find weblinks in this thread to a number of sites on physical assessment where you can find information on assessment of the pelvis and abdomen:

https://allnurses.com/forums/f205/health-assessment-resources-techniques-forms-145091.html - health assessment resources, techniques, and forms (in nursing student assistance forum)

in addition, there are "stickys" attached to some of the threads at the very top of the thread listings of each forum. that is because those threads contain frequently asked information or have links that are frequently asked about. the student forums have a lot of these "stickys". you should check them all out to see what is there. i'm sure you will find a lot of helpful websites. here is a listing of some websites that you should bookmark. you can search for all kinds of related medical information that you will need to know for nursing school.

for sites aimed more at the consumer (easier to read and understand!):

medline plus (use the search box) http://www.medlineplus.gov/

healthfinder (use the search box) http://www.healthfinder.gov/

medicine net diseases & conditions a to z index http://www.medicinenet.com/diseases_and_conditions/article.htm

medicine net symptoms & signs a to z index http://www.medicinenet.com/symptoms_and_signs/article.htm

medicine net procedures & tests a to z index http://www.medicinenet.com/procedures_and_tests/article.htm

health a to z - diseases and conditions page (use the search box) http://www.healthatoz.com/healthatoz/atoz/common/standard/transform.jsp?requesturi=/healthatoz/atoz/dc/index.jsp

aetna intelihealth (use the search box) http://www.intelihealth.com/ih/ihtih/wsihw000/408/408.html

peacehealth consumer information (use the search box) http://www.peacehealth.org/

emedicinehealth first aid and consumer health information list of topics from a to z http://www.emedicinehealth.com/script/main/art.asp?articlekey=60185

encyclopedia of surgery http://www.surgeryencyclopedia.com/index.html

lab tests online http://www.labtestsonline.org/

for sites aimed more at healthcare personnel:

merck manual of diagnosis and therapy (use search box) http://www.merck.com/mrkshared/mmanual/sections.jsp

family practice notebook (use search box) http://www.fpnotebook.com/index.htm

medicine net diseases & conditions a to z index http://www.medicinenet.com/diseases_and_conditions/article.htm

cleveland clinic disease management project (only major diseases)http://www.clevelandclinicmeded.com/diseasemanagement/medicineindex.htm

emedicine http://www.emedicine.com/ (you may have to register to view articles, but registration is free)

web md index list of tests http://www.webmd.com/a_to_z_guide/medical_tests.htm

web md index list of medical conditions http://www.webmd.com/a_to_z_guide/health_topics.htm

web md index list of symptoms http://www.webmd.com/a_to_z_guide/health_symptoms.htm

surgical tutor.org (links are at left and top of page) http://www.surgical-tutor.org.uk/default-home.htm?core/trauma/shock.htm~right

toriphile23 · Mar 16, 2007

Thanks A LOT guys! I think all of you are really helpful, especially Daytonite.