PRESENTING ☺

Mshey and Mingay! ☺

In coordination of
Sheyryl and Sethlog
 Post-operative Phase
Begins with the admission of the client to the PACU
and ends when healing is complete

Activities in the POST-op

Assessing responses to surgery
Performing interventions to promote healing
Prevent complications
Planning for home-care
Assist the client to achieve optimal recovery

POST Operative Interventions

Maintain patent airway
Monitor vital signs and note for early manifestations
of complications
Monitor level of consciousness
Maintain on PROPER position
NPO until fully awake, with passage of flatus and (+)
gag reflex
Monitor the patency of the drainage
Maintain intake and output monitoring
Care of the tubes, drains and wound
 Ensure safety by side rails up
Pain medication given as ordered
Measures to PREVENT post-op Complications

Post-operative interventions
PAIN MANAGEMENT
Pain is usually greatest during the 12-36 hours after
surgery
Narcotic analgesics and NSAIDS may be prescribed
together for the early period of surgery
Provide back rub, massage, diversional activities,
position changes
 POSITIONING

Clients who have spinal anesthesia is usually placed

FLAT on bed for 8-12 hours
Unconscious client is placed side lying to drain
secretions
Other positions are utilized BASED on the type of
surgery

Post-operative Interventions
Some Examples of Position Post Op

Mastectomy Semi-fowlers’, affected

arm elevated
Thyroidectomy Semi fowlers’, head
midline
Hemorrhoidectomy Semi-prone, side-lying
Laryngectomy Fowler’s
Pneumonectomy Lateral, affected side
Lobectomy Lateral, unaffected side
 Post-operative Interventions
Some Examples of Position Post Op

Aneurysmal repair (abdomen) Fowler’s 45 degrees

Amputation of lower Flat, with stump elevated with

extremities pillow
Cataract surgery Fowler’s 45 degrees

Supratentorial craniotomy Fowlers’

Infratentorial craniotomy Flat on bed, supine

Spina bifida repair Prone

 Post-operative Interventions
Deep breathing and coughing exercises Q2-4 hours "
to remove secretions
Leg exercises Q 2 hours "to promote circulation
Ambulation ASAP" prevents respiratory, circulatory,
urinary and gastrointestinal complications

Post-operative Interventions
Hydration after NPO" to maintain fluid balance
Suction, either gastro or respiratory" to relieve
distention, to remove respiratory secretions
Diet"progressive, usually given when bowel sounds
and gag reflex return

Wound Care
Inspect dressing hourly
Change dressing as needed
Inspect for signs of infection" redness, swelling,
purulent exudate
Maintain wound drainage
 Post operative complications
Atelectasis Collapsed • Assess breath
alveoli due sounds
to secretions • Repositioning
• Deep breathing
Pneumonia Inflammation and coughing
of alveoli • Chest physio
• Suctioning
• Ambulation
Thrombophlebitis Inflammation • Leg exercises
of the veins • Monitor for
swelling
• Elevated
extremities

Hypovolemic Loss of • Determine cause

Shock circulatory and prevent
fluid volume bleeding
• O2, IVF

Urinary Involuntary • Encourage

retention accumulation ambulation
of urine • Provide privacy
• Pour warm water
• Catheterize
Pulmonary Embolus • Notify physician
embolism blocking the • Administer O2
lung blood
flow
 Constipation Infrequent • High fiber diet
passage of • Increased fluid
stool • Ambulation
Paralytic ileus Absent bowel • Encourage
sound ambulation
• NPO until
peristalsis
returns
Wound infection Occurs about • Daily wound
3 days after dressing
surgery • Antibiotics
• Maintain drain
 Wound Separation of • Cover the
dehiscence wound edges at wound with
the suture line sterile normal
saline
dressing
• Place in low-
Fowler’s
• Notify MD
Wound Protrusion of the • Cover the
evisceration internal organs wound with
and tissues saline pad
through wound • Place in low-
fowler’s
• Notify MD

To emphasize
The over-all goals of nursing care during the POST-
OPERATIVE phase are to promote healing and
comfort, restore the highest possible wellness and
prevent associated risk

Post - Operative Nursing Management

 Nursing Management in the PACU
Provide care for the patient until he/she has recovered
from the effects of anesthesia.
Patient has resumption of motor and sensory function, is
oriented, has stable VS, and shows no evidence of
hemorrhage or other complications of surgery.
Frequent skilled assessment of the patient is vital.
Responsibilities of the PACU Nurse
Review pertinent information and baseline assessment
upon admission to the unit.
Assessments include airway and respirations,
cardiovascular function, surgical site, function of the
central nervous system; also assess IVs and all tubes and
equipment.
Reassess VS and patient status every 15 minutes or more
frequently as needed.
Provide report and transfer the patient to another unit or
discharge the patient to home.

Outpatient Surgery/Direct Discharge

Discharge planning and discharge assessment

Provide written and verbal instructions regarding
follow-up care, complications, wound care, activity,
medications, and diet.
Give prescriptions and phone numbers. Discuss actions to
take if complications occur.
Give instructions to the patient and a responsible adult
who will accompany the patient.
Patients are not to drive home or be discharged to home
alone. Sedation and anesthesia may cloud memory and
judgment and affect ability.

Maintaining a Patent Airway

A primary consideration: necessary to maintain ventilation
and oxygenation!
Provide supplemental oxygen as indicated.
Assess breathing by placing hand near face to feel
movement of air.
Keep head of bed elevated 15-30o unless contraindicated.
May require suctioning.
If vomiting occurs, turn patient to the side.

Maintaining Cardiovascular Stability

Monitor all indicators of cardiovascular status.
Assess all IV lines.
Potential for hypotension and shock
Potential for hemorrhage
Potential for hypertension and dysrhythmias

Indicators of Hypovolemic Shock

Pallor
Cool, moist skin
 Rapid respirations
Cyanosis
Rapid, weak, thready pulse
Decreasing pulse pressure
Low blood pressure
Concentrated urine
Relieving Pain and Anxiety
Assess patient comfort
Control of the environment: quiet, low lights, noise level
Administer analgesics as indicated; usually short-acting
opioids IV
Controlling Nausea and Vomiting
Intervene at the first indication of nausea.
Medications
Assessment of postoperative nausea, vomiting risk, and
prophylactic treatment

Gerontologic Considerations
Elderly patients are at greater risk for postoperative
complications due to decreased homeostatic mechanisms
and physiologic reserve to deal with stresses.
Monitor carefully and frequently.
Increased likelihood of postoperative confusion and
delirium
Assess confusion carefully to exclude causes such as
hypoxia, pain, hypotension, hypoglycemia, and fluid loss.
Assess need for and doses of medications carefully.
Ensure adequate hydration.
Reorient as needed.
 Assessment for Postoperative Complications
Do frequent VS. Initially assess every 15 minutes or
according to protocols. Monitor at least every 4 hours for
the first 24 hours postop.
Assess airway and respirations; patient is at risk for
ineffective airway clearance.
Assess VS and other indicators of cardiovascular status;
patients are at risk for decreased cardiac output related to
shock or hemorrhage.
Assess pain.

Additional Nursing Diagnoses

Activity intolerance
Impaired skin integrity
Ineffective thermoregulation
Risk for imbalanced nutrition
Risk for constipation
Risk for urinary retention
Risk for injury
Anxiety
Risk for ineffective management of therapeutic regimen
Collaborative Problems
Pulmonary infection/hypoxia
Deep vein thrombosis
Hematoma/hemorrhage
Pulmonary embolism
Would dehiscence or evisceration