Post Operative Nursing

Post-operative nursing starts when the patient is transferred to the recovery room or the PACU(Post Anesthesia Care Unit) until the time the patient is discharged from the hospital or transferred to the surgical ward.

1. • AKA post anesthesia recovery room
   • Located adjacent to Operating Rooms
   • Has soft pleasing colors, soundproof ceiling, equipments that control noise(rubber)
   • Well ventilated (decrease anxiety and promote comfort)
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2. • Phase I PACU – immediate recovery phase, Intensive nursing care is provided
   • Phase II PACU – patients who require less frequent observation and nursing care ,also referred as STEP-down , Sit-up , or progressive Care units
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3. • TO provide Nursing care until the patient has recovered from the effects of ANESTHESIA .
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5. • Signs
   • Choking
   • Noisy and Irregular respirations
   • O2 Saturation Scores
   • Cyanosis
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8. • Pallor
   • Cool, moist skin
   • Rapid breathing
   • Cyanosis of the lips, gums, and tongue
   • Rapid, weak, thready pulse
   • pulse pressure
   • blood pressure and concentrated urine
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9. • Primary – VOLUME REPLACEMENT
   • Infusion of lactated Ringer’s Solution
   • Position Patient flat on bed with legs elevated at 20° and knees straight
   • Special considerations for JEHOVAH’s witness or those who decline blood transfusions
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10. • Turn patient to the one side to promote mouth drainage & prevent aspiration of vomitus ( can cause asphyxiation and death )
    • Anti-emetics:
    • Ondansetron ( Zofran )
    • Droperidol ( Inapsine )
    • Metoclopromide ( Reglan )
    • Promethazine ( Phenergan )
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15. • PR , BP and RR –every 15 mins( 1 st hour )
    • PR , BP and RR –every 30 mins( next 2 hours )
    • Less frequently = more stable VS
    • Temperature – every 4 hours ( 1 st 24 hours )
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17. • Atelectasis (alveolar collapse)
    • Pneumonia
    • Hypostatic pulmonary congestion
    • Subacute hypoxemia
    • Episodic hypoxemia
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18. • Turn frequently and deep breathing every 2 hours
    • Encourage coughing (contraindicated in head and eye injuries)
    • Encourage YAWNING (lung expansion) or take sustained maximal inspirations
    • Use of Incentive spirometer (10 deep breaths every hour while awake)
    • Encourage early ambulation (increases metabolism and pulmonary aeration) the day of surgery or no later than the 1 st post-op day – prevents pulmonary complications in elderly
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19. • PREVENTIVE approach favored over “PRN” approach
    • Hypothalamic stress response = platelet aggregation and blood viscosity (can cause phlebothrombosis and pulmonary embolism
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20. • Patient Controlled Anesthesia (PCA) – 2 reqmts: understanding of the need to self-dose and the physical ability to self-dose.
    • Epidural infusions – local opiod + anesthetic
    • Intrapleural anesthesia – administration of anesthetic between parietal & visceral pleura
    • Subcutaneous pain management – a silicone catheter is attached to a pump that delivers the local anesthetic
    • Nonpharmacologic relief measures
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21. • Establish BASELINE Vital Signs
    • Report Sys BP 90mmhg and below
    • Report if BP drops 5mmhg every 15mins
    • Intake and Output (<240ml>
    • Promote Early ambulation (prevents DVT and peristalsis)
    • Patient may sit at the edge of bed first.
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22. • Wound drains – allow escape of blood and serous fluids that could serve as culture medium for bacteria
    • Record output of wound drains
    • Mark drainage on dressings with pen. Record date and time to note if it is increasing.
    • Portable wound suction provides continues suction and this prevents formation of “dead spaces”
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24. • Inflammatory
    • Proliferative
    • Maturation
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26. Wound is usually packed with SALINE moistened sterile dressings and covered with DRY sterile dressing nursinglectures.blogspot.com
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28. • Keep wound dry and clean
    • Apply hypoallergenic tape
    • Report signs of infection : (R,W,P,C)
    • Swelling is common (Rest, Elevate)
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29. WOUND DEHISCENCE – disruption of surgical incision or wound EVISCERATION - protrusion of wound contents nursinglectures.blogspot.com
30. • N & V – common in obese, women, pts. Prone to motion sickness and those with prolonged surgery
    • Insert NGT (for persistent Vomiting)
    • Hiccups – caused by intermittent spasms of the diaphragm 2 nd to phrenic nerve irritation
    • Phenothiazine medication for persistent Hiccups
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31. • Oral intake – stimulates digestive juices, promotes gastric function & peristalsis
    • Liquids 1 st
    • Water, fruit juices, tea in increasing amounts
    • Soft foods (gelatin, custard, milk and creamed soups)
    • Solid foods
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32. • Return of peristaltic activity
    • Auscultate bowel sounds
    • Passage of Flatus
    • Paralytic ileus and intestinal obstruction – potential post-operative complications
    • Voiding – expected within 8 hours post-op
    • Letting water run
    • Apply heat to the perineum
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33. • Risk Factors
    • Dehydration
    • Venous pooling
    • Low Cardiac output
    • Bed rest
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34. • Dorsiflexion of the foot causes pain in the calf muscle
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35. • Low-dose heparin (SQ) until ambulatory
    • Low-molecular weight heparin and low-dose warfarin
    • External pneumatic compression
    • Thigh-high elastic compression stockings
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37. • 1. Your patient has a history of esophageal cancer and is HIV positive. After undergoing ambulatory surgery to insert a gastric feeding tube, he is to be discharged to home. Indicate which assessment findings would indicate his readiness for discharge. Describe a teaching plan for the patient and his family. How would you modify the plan if the patient lives alone?
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38. • 2. A patient who has undergone abdominal surgery reports severe pain and as a result is unable to cough and deep breathe. When you listen to the patient’s lungs you hear crackles in the bases. Analyze this findings and indicate the interventions you would implement in this situation. How would your care differ if the patient has a musculoskeletal disorder that makes turning and ambulation difficult?
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39. • You are visiting a 72 yr old woman who had emergency surgery for a broken hip 3 weeks ago and has returned to her home, where she is living alone. How would you direct your assessment to identify the factors that might affect her recovery? How would you modify your assessment and nursing care plan because of her age?
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