CNOR: Postoperative Care

Once the system recovers, the perioperative nurse who provided the care must transcribe the downtime documentation into the electronic health record to ensure continuity of care and accurate billing. Option A is incorrect because simply scanning the document without entering discrete data into the electronic flowsheets often prevents the system from generating automated safety alerts or accurate medication reconciliation. Option C is entirely inappropriate because the original downtime paper record is a legal document that must be retained according to facility policy, often placed in the physical chart alongside the electronic entry. Option D shifts the responsibility inappropriately; the PACU nurse did not witness the intraoperative events and cannot legally or accurately document them. The circulator must complete the data entry.

Patients with an active prescription for buprenorphine have high-affinity partial agonist binding at the mu-opioid receptors, which blocks standard full-agonist opioids and complicates postoperative pain management. The best approach for refractory severe pain is to implement multimodal non-opioid analgesics and regional anesthesia. Option A is incorrect because administering an antagonist like naloxone will precipitate severe acute withdrawal and worsen the pain. Option B is incorrect because the high receptor affinity of buprenorphine prevents standard opioid doses from achieving a normal therapeutic effect. Option C is incorrect and unethical; withholding all analgesia violates the standard of care for pain management, as alternative non-opioid modalities can and should be utilized.

The patient is exhibiting classic signs of negative pressure pulmonary edema (NPPE), a well-documented complication following a severe laryngospasm. This occurs frequently in young, muscular males who can generate massive negative intrathoracic pressure by attempting to inhale against a closed glottis, drawing fluid into the alveoli. The primary treatment is supportive respiratory care, often requiring positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) to push fluid back out of the alveolar space. Pink frothy sputum is a hallmark of pulmonary edema, not a pulmonary embolism. Anaphylactic shock would present with hypotension and wheezing, making epinephrine inappropriate for this specific fluid-shift complication.

According to standard surveillance criteria, procedures involving implants such as a total hip arthroplasty are monitored for 90 days postoperatively. Because the purulent drainage specifically involves the subfascial tissue, it meets the criteria for a deep incisional SSI. Option A correctly identifies both the classification and the appropriate action of alerting infection prevention. Option B is incorrect because superficial infections only involve the skin and subcutaneous tissue. Option C is incorrect because the infection falls within the 90-day window, linking it directly to the index surgery. Option D is incorrect because organ/space infections involve anatomy manipulated below the fascial layer, rather than the fascia itself.

Option A is the most appropriate initial intervention. In obese patients recovering from abdominal surgery, the supine position causes abdominal contents to press against the diaphragm, significantly reducing functional residual capacity. Elevating the head of the bed uses gravity to pull the abdominal contents downward, improving diaphragmatic excursion and rapidly increasing oxygenation. Option B is incorrect as a first step; while supplemental oxygen may be needed, applying a non-rebreather mask is excessive before attempting simple repositioning. Option C is premature because the patient is arousable, indicating that severe opioid-induced respiratory depression requiring a reversal agent is unlikely at this moment. Option D is invasive, uncomfortable, and unnecessary, as there is no indication in the assessment that the patient has excessive secretions blocking the airway.