Post operative care
Case Study: Margaret
Whilst the patient is in PACU, identify and discuss airway management (and rationales) as related to the case study
(400 words)
The post-operative patient is at risk for respiratory problems due to ineffective airway clearance related to changes in pulmonary physiology and function caused by anaesthetics, narcotics, mechanical ventilation, hypothermia and surgery. With increased tracheobronchial secretions secondary to the effects of anaesthesia, combined with ineffective coughing, and decreased functions of the mucociliary clearance mechanism. (Monahan, Neighbors, & Green, 2011) Oxygen is commonly in place as it supports the elimination of anaesthetic gases and helps meet the increased metabolic demand for oxygen caused by the surgery (deWit, 2009). The sedation and muscle relaxation drugs used often cause the tongue to occlude the airway and for that reason endotracheal tubes or artificial airways are not removed until clients are awake and able to maintain their own airway (Berman & et.al, 2012). During the immediate post anaesthetic stage an unconscious client is positioned on the side, with the face slightly down, without the support of a pillow. In this position gravity keeps the tongue forward, preventing obstruction of the pharynx and allows the drainage of any mucous or vomitus out of the mouth rather than down the respiratory tract (Berman & et.al, 2012). Suction should always be readily available to clear secretions. Alternatively if the patient cannot be positioned on their sides the airway can be opened by moving the jaw forward (the nurse’s fingers are placed behind the angle of the jaw, lifting it forward. As the Jaw moves, the tongue comes forward, opening the airway. (deWit, 2009) An artificial airway is maintained in place and the client is suctioned as needed until cough and swallowing reflexes have returned. Generally the client will spit out the oropharyngeal airway when coughing returns and the
Whilst the patient is in PACU, identify and discuss airway management (and rationales) as related to the case study
(400 words)
The post-operative patient is at risk for respiratory problems due to ineffective airway clearance related to changes in pulmonary physiology and function caused by anaesthetics, narcotics, mechanical ventilation, hypothermia and surgery. With increased tracheobronchial secretions secondary to the effects of anaesthesia, combined with ineffective coughing, and decreased functions of the mucociliary clearance mechanism. (Monahan, Neighbors, & Green, 2011) Oxygen is commonly in place as it supports the elimination of anaesthetic gases and helps meet the increased metabolic demand for oxygen caused by the surgery (deWit, 2009). The sedation and muscle relaxation drugs used often cause the tongue to occlude the airway and for that reason endotracheal tubes or artificial airways are not removed until clients are awake and able to maintain their own airway (Berman & et.al, 2012). During the immediate post anaesthetic stage an unconscious client is positioned on the side, with the face slightly down, without the support of a pillow. In this position gravity keeps the tongue forward, preventing obstruction of the pharynx and allows the drainage of any mucous or vomitus out of the mouth rather than down the respiratory tract (Berman & et.al, 2012). Suction should always be readily available to clear secretions. Alternatively if the patient cannot be positioned on their sides the airway can be opened by moving the jaw forward (the nurse’s fingers are placed behind the angle of the jaw, lifting it forward. As the Jaw moves, the tongue comes forward, opening the airway. (deWit, 2009) An artificial airway is maintained in place and the client is suctioned as needed until cough and swallowing reflexes have returned. Generally the client will spit out the oropharyngeal airway when coughing returns and the
References: Berman, & et.al. (2012). Kozier and Erbs Fundamentals of Nursing. Frenchs Forest: Pearson. deWit, S. C. (2009). Medical- Surgical Nursing Concepts and Practice. Missouri: Saunders Elsevier. Doyle, S. L., Lysaght, J., & Reynolds, J. V. (2009). Diagonositc in Obesity and Complications. Obesity and post- operative complication undergoing non-bariatric surgery. Obesity Reviews, 875-886. Fremantle Hospital and Health Service. (2012). Nurse Practitioner Wound Management- Clinical Protocol Minor Surgical Procedures. Fremantle: Department of Health. Monahan, F. D., Neighbors, M., & Green, C. J. (2011). Swearingen 's Manual of Medical-Surgical Nursing: A Care Planning Resource. Maryland Heights: Elesevier Mosby. Monash Health. (2014). A world of healthcare. Retrieved August 29, 2014, from Monash Health: https://www.monashhealth.org/page/Services/Services_O_-_Z/Post_acute_care/ Smeltzer, S. C., & Bare, B. G. (2011). Textbook of Medical-Surgical Nursing (2nd Australian And New Zealand ed. ed.). (M. Farrell, & J. Dempsey, Eds.) Sydney: Lippincott Williams & Wilkins Pty Ltd.