Nursing interventions to prevent respiratory complications Proper patient positioning Lateral “recovery” position Once conscious – supine position Oxygen therapy
Full Answer
How can nursing care prevent pneumonia in the postoperative patient?
As evidence-based practice continues to evolve, nursing care to prevent pneumonia in the postoperative patient will lead to improved patient outcomes and decreased ICU length of stays and healthcare costs. The critical care nurse's knowledge of the patient's risks and evidence-based interventions such as respiratory care bundles is essential.
What is the critical care nurse plan of care for aspiration pneumonia?
Central to the critical care nurse's plan of care is the recognition of the risk of aspiration pneumonia. Anesthetic agents, pulmonary secretions, and postoperative nausea and vomiting work synergistically to increase the patient's risk of developing aspiration pneumonia.
What is included in the pneumonia nursing care guide?
This guide has pneumonia nursing care plans and nursing diagnosis, nursing interventions, and nursing assessment for pneumonia.
What are the important nursing interventions that you should do?
What are the important nursing interventions that you need to do? Some common corticosteroids are Solu-Medrol and Prednisone. Clients are given corticosteroids to decrease inflammation in the respiratory tract.
What should the nurse do to help prevent respiratory complications in a patient postoperatively?
Promoting adequate ventilation postoperatively Promoting adequate ventilation in the postoperative patient is essential to prevent pulmonary complications such as atelectasis, bronchitis or pneumonia. Nursing interventions at this stage include positioning the patient optimally and the removal of excessive secretions.
Which postoperative intervention best prevents atelectasis?
Atelectasis can be prevented or treated by adequate analgesia, incentive spirometry (IS), deep breathing exercises, continuous positive airway pressure, mobilisation of secretions and early ambulation. Pre-operative treatment of IS is more effective.
What are 3 nursing interventions for a postoperative patient?
A. Nursing interventions that are required in postoperative care include prompt pain control, assessment of the surgical site and drainage tubes, monitoring the rate and patency of IV fluids and IV access, and assessing the patient's level of sensation, circulation, and safety.
Which type of surgery is most likely to predispose a patient to postoperative atelectasis?
As with cardiac and upper abdominal surgery, atelectasis is frequently present after lung surgery and results in impaired oxygenation.
What is a nursing intervention for atelectasis?
Medical Management [9] Other interventions that have been used to decrease atelectasis include deep breathing; early ambulation; proper use of an incentive spirometer or acapella device; chest physiotherapy; tracheal suctioning if intubated; and use of positive pressure ventilation.
What can the nurse teach a client to prevent atelectasis?
To prevent atelectasis: Encourage movement and deep breathing in anyone who is bedridden for long periods. Keep small objects out of the reach of young children. Maintain deep breathing after anesthesia.
Which nursing actions would the nurse implement for a patient with atelectasis?
Nursing Interventions: Teach patient how to use incentive spirometer, pain medication to support deep breathing, ambulate 3x/day, encourage patient to cough/deep breathe, monitor temperature, monitor WBC, monitor chest X-ray, assess lung sounds, assess respiratory depth.
What are some nursing interventions to decrease respiratory complications?
Nursing interventions to prevent respiratory complicationsProper patient positioning. Lateral “recovery” position. Once conscious – supine position.Oxygen therapy.Coughing and deep breathing.Incentive spirometer.Sustained maximal inspiration.Change patient position every 1 to 2 hours.Early mobilization.Pain management.More items...
How can postoperative complications be prevented?
Common postoperative complications can be prevented using basic nursing care principles such as following:Proper andwashing.Maintaining strict surgical aseptic technique.Pulmonary exercises (e.g. turn, cough, deep breathing, and incentive spirometer use)Early ambulation.Leg exercises.Sequential compression devices.More items...
What can be done for atelectasis?
TreatmentPerforming deep-breathing exercises (incentive spirometry) and using a device to assist with deep coughing may help remove secretions and increase lung volume.Positioning your body so that your head is lower than your chest (postural drainage). ... Tapping on your chest over the collapsed area to loosen mucus.
How can postoperative pneumonia be prevented?
Preventive strategies for postoperative pneumonia should be approached as care bundles....Preventive strategies for postoperative pneumoniadeep-breathing exercises and use of the incentive spirometry (IS)coughing.positioning.early mobilization and ambulation.optimal pain management.
Which action will the nurse implement to meet the goal of preventing atelectasis for a postoperative client?
Prophylactic maneuvers for reducing the incidence and magnitude of postoperative atelectasis in high-risk patients should be encouraged. These techniques are deep-breathing exercises, coughing exercises, and incentive spirometry.
What factors contribute to postoperative atelectasis?
Generally it is due to either bronchial obstruction with distal gas absorption or to hypoventilation. Pre-existing pulmonary disease and smoking make this postoperative complication more likely.
What are the main causes of atelectasis in post operative patients?
General anesthesia is a common cause of atelectasis. It changes your regular pattern of breathing and affects the exchange of lung gases, which can cause the air sacs (alveoli) to deflate. Nearly everyone who has major surgery develops some amount of atelectasis. It often occurs after heart bypass surgery.
Why are post op patients at risk for atelectasis?
However, complete atelectasis of the remaining lung following partial lung resection may be poorly tolerated. Thoracic surgical procedures increase the risk because pain, thoracic muscle injury, chest wall instability, and diaphragmatic dysfunction impair clearance of secretions by cough.
Why does atelectasis occur postoperatively?
Postoperative atelectasis Atelectasis is a common pulmonary complication in patients following thoracic and upper abdominal procedures. General anesthesia and surgical manipulation lead to atelectasis by causing diaphragmatic dysfunction and diminished surfactant activity.
What information is needed for postoperative care?
Information on chronic disease history and allergy history are done in the pre-operative period, not in the postoperative period. Information on the environment in the operation room is checked by the circulatory nurse during the intra-operative care plan; it is not associated with the postoperative care plan.
Why do nurses check vital signs before surgery?
The nurse should assess the client's vital signs, weight, and sternal skin turgor prior to fluid restriction to serve as a baseline for comparison. The period of fluid restriction before surgery may be shortened for older adults to reduce their risk of dehydration and hypotension. Nurses check a client's self-therapy practices and cardiac status to avoid any complications of bleeding and elimination of intravenous fluids given at a standard rate.
What are the complications of a bowel surgery?
A potential complication after surgery is paralytic ileum, a condition in which there is decreased bowel functioning.
What medications affect coagulation?
Current medication use, especially use of medications that can affect coagulation status (warfarin, nonsteroidal anti-inflammatory drugs, aspirin) is important and should be reported to the surgeon.
What is emergency surgery?
An emergency surgery is a surgery required immediately for survival. Elective surgery is planned at the client's convenience; whereas, an optional surgery is performed at the client's request. When urgent surgery is required, it is necessary and done within one or two days.
When to place client in side lying position?
If the client is not fully conscious, place the client in the side-lying position, unless there is an ordered position on the client's chart.
Is appendectomy urgent?
An appendectomy is considered emergency or urgent surgery . Elective surgery can be scheduled in advance, and delay has no ill effects. Palliative surgery is done to relieve or reduce the intensity of an illness, and diagnostic surgery is done to make or confirm a diagnosis.
Why does the patient refuse the nurse's offer of PRN anlgesia?
The patient refuses the nurse's offer of PRN anlgesia and on discussion, states that this refusal is motivated by his fear of becoming addicted to pain meds. How should the nurse respond to the patient's concerns?
What is the nurse's role in an exploratory laparoscopy?
A. The nurse is preparing to send a patient to the operating room for an exploratory laparoscopy. The nurse recognizes that there is no informed consent. The nurse informs the physician who is performing the procedure. The physician asks the nurse to obtain the informed consent signature from the pt.
Do people who are not addicted to drugs before surgery develop tolerance?
a. "Actually people who are not addicted to drugs before thier surgery never develop a tolerance or addiction during recovery."
What are the goals of nursing interventions for pneumonia?
Nursing interventions for pneumonia and care plan goals for patients with pneumonia include measures to assist in effective coughing, maintain a patent airway, decreasing viscosity and tenaciousness of secretions, and assist in suctioning.
What is the name of the condition that results from vomiting and aspiration of gastric contents into the trache?
Aspiration pneumonia , another type of pneumonia, results from vomiting and aspiration of gastric or oropharyngeal contents into the trachea and lungs.
What is Pneumonia?
Pneumonia is an inflammation of the lung parenchyma, associated with alveolar edema and congestion that impair gas exchange. Pneumonia is caused by a bacterial or viral infection spread by droplets or by contact and is the sixth leading cause of death in the United States.
What is ineffective airway clearance?
Ineffective Airway Clearance is a common NANDA nursing diagnosis for pneumonia nursing care plans. This diagnosis is related to excessive secretions and ineffective cough or nonproductive coughing. Inflammation and increased secretions in pneumonia make it difficult to maintain a patent airway.
What happens if you leave pneumonia untreated?
If left untreated, pneumonia could complicate to hypoxemia, respiratory failure, pleural effusion, empyema, lung abscess, and bacteremia. Nursing care plan (NCP) and care management for patients with pneumonia start with an assessment of the patient’ medical history, performing respiratory assessment every four (4) hours, physical examination, ...
Why do you give analgesics to help with cough?
Analgesics are given to improve cough effort by reducing discomfort, but should be used cautiously because they can decrease cough effort and depress respirations.
What does "ineffective health management" mean?
Ineffective Health Management. May be related to deficient knowledge on self-care and therapeutic management of the disease.
How often should you take deep breaths after pneumonia?
Teach the patient to take three or four deep breaths every 5 to 10 minutes.
What are the most common PPCs after surgery?
The most clinically significant PPCs are infection (including bronchitis and pneumonia), prolonged mechanical ventilation, respiratory failure, atelectasis, bronchospasm, and COPD exacerbation. 1
What is HCAP in medical terms?
HCAP is defined as pneumonia that occurs in a nonhospitalized patient with extensive healthcare contact, including I.V. therapy, wound care, or I.V. chemotherapy within the preceding 30 days; residence in a long-term-care facility; hospitalization in an acute care hospital for 2 or more days within the previous 90 days; or attendance at a hospital or hemodialysis clinic within the previous 30 days. This article focuses on HAP and VAP in the postoperative setting.
What are the causes of PPCs?
The type of surgical incision and the invasiveness of the surgical procedure can also pose a risk for PPCs. 6 Atelectasis and pneumonia are common causes of PPCs particularly after abdominal and thoracic surgery. Patients who smoke have an increased risk for postoperative infection and mortality.
What is the benefit of using a device in the ICU?
High-risk postoperative patients may benefit from the use of devices that assist in clearing secretions. The devices are used in concert with respiratory care bundles. Collaboration with respiratory therapy can assist the ICU nurse in selecting a device that is appropriate for their patient. Incorporating its use in to the patient's plan of care can greatly reduce the incidence of pneumonia in at-risk populations.
What is a bundle in critical care?
Preventive strategies for postoperative pneumonia should be approached as care bundles. A bundle is a structured way of improving care by collectively and reliably performing a set of evidence-based practices to improve patient outcomes. 26
What are the risks of smoking after surgery?
While all patients are at risk for postoperative pulmonary complications after anesthesia and surgery, a patient's lifestyle, for example being a smoker, increases their odds of developing infections including bronchitis, COPD, and pneumonia.
How high should a bed be to prevent aspiration?
H ead of bed elevation. Elevate the head of the bed higher than 30 degrees to prevent aspiration.
What are the effects of postoperative pulmonary complications?
Postoperative pulmonary complications (PPCs) can increase hospital costs, 30-day mortality, and length of stay. PPCs (such as atelectasis, acute respiratory distress syndrome, and postoperative pneumonia) have an occurrence rate of 6% to 80%. Fernandez-Bustamante and colleagues, in a study of a high-risk surgical population, found that the presence of at least one mild or severe PPC was significantly associated with increased early postoperative mortality, intensive care unit admission, and prolonged stays. PPCs occur in one-third of noncardiothoracic surgical patients with severe systemic disease. According to the National Surgical Quality Improvement Program, PPCs include pneumonia, reintubation, and failure to wean from mechanical ventilation after 48 hours; they can cost up to $52,466 per patient.
How does PPC affect hospital costs?
Fernandez-Bustamante and colleagues, in a study of a high-risk surgical population, found that the presence of at least one mild or severe PPC was significantly associated with increased early postoperative mortality, intensive care unit admission, and prolonged stays. PPCs occur in one-third of noncardiothoracic surgical patients with severe systemic disease. According to the National Surgical Quality Improvement Program, PPCs include pneumonia, reintubation, and failure to wean from mechanical ventilation after 48 hours; they can cost up to $52,466 per patient.
What is the goal of the enhanced recovery after surgery protocol?
The goal of the enhanced recovery after surgery (ERAS) protocol is to reduce the risk of postoperative complications. The protocol follows patients from pre-admission through discharge.
What is the risk of OSA?
OSA reduces airway muscle tone and has been linked to postoperative hypoxia, intensive care unit transfers, and increased lengths of stay. Between 9% and 24% of all surgical patients are at high risk for OSA, underscoring the importance of preoperative screening.
How does anesthesia affect the lung?
Anesthesia affects lung wall elasticity pressures by reducing lung volume and compliance, potentially resulting in atelectasis, ventilation-perfusion mismatch , impaired gas exchange, and hypoxia.
Who conducted the systematic review of smoking cessation?
Systematic reviews (conducted by Batchelor and colleagues and Gustafsson and colleagues) examined studies assessing smoking cessation interventions and preoperative pulmonary rehabilitation to reduce PPC risk.
Why do you need antibiotics for pulmonary fibrosis?
Remember, antibiotics and corticosteroids are essential in preventing infection and decreasing inflammation so that the fluid will not progress into multiple complications like pulmonary fibrosis or multi-organ dysfunction syndrome (MODS). Hopefully, this nursing intervention will reverse the condition, and the client will regain normal breathing.
Why are intravenous fluids not given?
Intravenous fluids are not given because the lungs are already filled with fluid and , as the nurse in charge, you do not want to introduce further fluids that will add up to the ones that are already pooling inside the lungs.
Why do antibiotics help with ARDS?
For this reason, antibiotics are necessary to protect the respiratory tract from developing complications and get rid of inflammation.
Why do you give corticosteroids to ARDS patients?
Take note; if you provide corticosteroids to your client with ARDS, you are also decreasing the movement of WBCs, thereby decreasing the immune response.
How to get a client to breathe?
Put the client in a 45-degree or 90-degree sitting position, and turn your client every hour to make sure that the fluid inside the lungs is not stagnant in one place. This will give parts of the lungs to breathe. Moving the client will also facilitate drainage as steroids are provided.
Why are diuretics not given?
On the other hand, diuretics are not given due to perfusion issues. Diuretics can cause concentrated blood, making it harder for hemoglobin and oxygen to move around the body. You have to make the most of the oxygen that’s left inside the body to be properly distributed to different parts and systems.
Why are antibiotics important?
For this reason, antibiotics are necessary to protect the respiratory tract from developing complications and get rid of inflammation. Remember that the primary goal why antibiotics are given is to alleviate inflammation and bring the client’s breathing back to normal.