Postoperative Period

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Postoperative Period

• By Lisa M. Dunn RN, MSN/ED

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PACU/ RECOVERY ROOM

• Purpose
• Location
• The PACU nurse

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Collaborative Management

• Assessment
• - Assess respiration
• - Examine surgical area for bleeding
• - Monitor vital signs
• - Assess for readiness to be
• discharged once criteria have been
  
• met.

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Respiratory Assessment

• Airway assessment
• Breath sounds
• Additional respiratory assessments

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Cardiovascular Assessment

• Vital signs
• Cardiac monitoring
• Peripheral vascular assessment

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Question

• To prevent thromboembolism in the post-op client
  the nurse should include which of the following
  in the plan of care?
• Place the pillow under the knees and restrict
  fluids.
• Use strict aseptic technique including
  handwashing and sterile dressing technique.
• Assess bowel sounds in all four quadrants on
  every shift and avoid early ambulation.
• Assess for Homans sign on every shift, encourage
  early ambulation, and maintain adequate hydration.

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Neurological Assessment

• Cerebral functioning
• Motor and sensory assessment

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Fluid, Electrolyte and Acid base Balance

• Check fluid and electrolyte balance.
• Make hydration assessment.
• Intravenous fluid intake should be recorded.
• Assess acid-base balance

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Renal/Urinary System

• The effects of drugs, anesthetic agents, or
  manipulation during surgery can cause urine
  retention.
• Assess for bladder distention.
• Consider other sources of output such as sweat,
  vomitus, or diarrhea stools.
• Report a urine output of lt 30 mL/hr.

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Question

• It is 1000 P.M. and the nurse notes that an
  adult male who returned from the PACU at 200
  P.M. has not voided. The client has an out of
  bed order, but has not been up yet. The best
  action for the nurse to take is
• Insert a foley catheter into the client
• Straight-catheterize the client
• Assist the client to stand at the side of his bed
  and attempt to void into a urinal
• Encourage the client to lie on his side in bed
  and attempt to void into a urinal

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Gastrointestinal Assessment

• Nausea and vomiting are common reactions after
  surgery.
• Peristalsis may be delayed because of long
  anesthesia time, the amount of bowel handling
  during surgery, and opioid analgesic use.
• Clients who have abdominal surgery often have
  decreased peristalsis for at least 24 hours.

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Nasogastric tube Drainage

• Assess for presence of NGT/OGT
• - decompress stomach
• - drain stomach
• - promote gastrointestinal rest
• - allow gastrointestinal tract to
  heal
• - enteral feeding
• - monitor any gastric bleeding
• Do not move or irrigate after gastric surgery
  without surgeon order.

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Question

• When assessing a post-op client, the nurse notes
  a nasogastric tube to low constant suction, the
  absence of a bowel movement since surgery, and no
  bowel sounds. The most appropriate plan of care
  based on these findings is to
• Increase the clients mobility and ensure he is
  receiving adequate pain relief.
• Increase coughing, turning, and deep breathing
  exercises.
• Discontinue the nasograstric tube as the client
  does not need it any more.
• Assess for bladder pain and distention

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Skin Assessment

• Normal wound healing
• Ineffective wound healing can be seen most often
  between the 5th and 10th days after surgery
• Dehiscence a partial or complete separation of
  the outer wound layers, sometimes described as a
  splitting open of the wound.

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Skin Assessment Continued

• -Evisceration a total separation of all wound
  layers and protrusion of internal organs through
  the open wound.
• Dressings and drains, including casts and
  plastic bandages, must be assessed for bleeding
  or other drainage on admission to the PACU and
  hourly thereafter.

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Discomfort/Pain Assessment

• Client almost always has pain or discomfort after
  surgery.
• Pain assessment is started by the postanesthesia
  care unit nurse.
• Pain usually reaches its peak the second day
  after surgery, when the client is more awake,
  more active, and the anesthetic agents and drugs
  given during surgery have been excreted.

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Impaired Gas Exchange

• Interventions include
• Airway maintenance
• Positioning the client in a side-lying position
  or turning his or her head to the side to prevent
  aspiration
• Encouraging breathing exercises
• Encouraging mobilization as soon as possible to
  help remove secretions and promote lung expansion

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Impaired Skin Integrity

• Interventions include
• Nursing assessment of the surgical area
• Dressings first dressing change usually
  performed by surgeon
• Drains provide an exit route for air, blood, and
  bile as well as help prevent deep infections and
  abscess formation during healing

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Acute Pain

• Interventions include
• Drug therapy
• Complementary and alternative therapies such as
• Positioning
• Massage
• Relaxation and diversion techniques

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Potential for Hypoxia

• Interventions include
• Maintenance of airway patency and breathing
  pattern
• Prevention of hypothermia
• Maintenance of oxygen therapy as prescribed

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Health Teaching

• Prevention of infection
• Dressing care
• Nutrition
• Pain medication management
• Progressive increase in activity level
• Use of proper body mechanics

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Transfusion Therapy
Pretransfusion responsibilities to prevent
adverse transfusion reactions -Verify
prescription. -Test donors and recipients blood
for compatibility. -Examine blood bag for
identification. -Check expiration date. -Inspect
blood for discoloration, gas bubbles, or
cloudiness.
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Transfusion Responsibilities

• Provide client education.
• Assess vital signs.
• Begin transfusion slowly and stay with client
  first 15 to 30 minutes.
• Ask client to report unusual sensations such as
  chills, shortness of breath, hives, or itching.
• Administer blood product per protocol

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Types of Transfusions

• Red blood cell
• Platelet transfusions
• Plasma transfusions fresh frozen plasma
• Cryoprecipitate
• Granulocyte (white cell) transfusions
• Autologous blood transfusion

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Transfusions Reactions

• Clients can develop any of the following
  transfusion reactions
• Hemolytic
• Allergic
• Febrile
• Bacterial
• Circulatory overload

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Intravenous Fluid

• Assess size of peripheral catheter
• Assess complication related to intravenous
  therapy
• infiltration/ extravasation
• phlebitis
• thrombosis
• thrombophlebitis
• Assess type of fluid infusing