GENERAL GOAL OF POST-OPERATIVE CARE

JENNIFER ANNE ZAIDE BSNIII2

RECOVERY FROM BOTH THE SPECIFIC PHYSIOLOGIC CHANGES AND THE GENERAL INFLAMMATORY RESPONSE DUE TO THE SURGICAL PROCEDURE

CARING FOR WOUNDS

Types of wound healing:
Primary intention
a.k.a. primary wound healing Wound edges are brought together so that they are adjacent to each other

Secondary intention
a.k.a. secondary wound healing or spontaneous healing Wound is left open to heal without surgical intervention

CARING FOR WOUNDS

Types of wound healing:

Third intention
a.k.a. delayed primary closure or secondary suture

On-going assessment of the surgical site Inspect area around the wound

CARING FOR WOUNDS

Surgical drains
 Allow escape of fluids  Drainage from wound systems is recorded  Amount of blood drainage on the surgical dressing is assessed frequently  Spots of drainage  Excessive amounts of drainage  Increasing amounts of fresh blood on the dressing

PENROSE DRAIN

PENROSE DRAIN

PENROSE DRAIN

JACKSON-PRATT DRAIN

JACKSON-PRATT DRAIN

JACKSON-PRATT DRAIN

CARING FOR WOUNDS

Changing the dressing
 Inform the patient  Perform the dressing change at a suitable time  Provide privacy  Provide assurance  Teach the patient

MAINTAINING NORMAL BODY TEMPERATURE

Low body temperature is reported to the physician Room is maintained at a comfortable temperature

DECREASED PAIN, EARLY MOBILIZATION, AND PROMPT RETURN TO NORMAL FUNCTION

RELIEVING PAIN
Opioid analgesics Preventive approach is more effective than the as needed aproach Use of nonpharmacologic pain relief measures

ENCOURAGING ACTIVITY
Early ambulation has positive effects on recovery and the prevention of complications Ambulation reduces postoperative abdominal distention Assist the postoperative patient in getting out of bed for the first time Encourage bed exercises to improve circulation

MANAGING GI FUNCTION AND RESUMING NUTRITION

Management of hiccups Liquids Soft food Solid food

MANAGING GI FUNCTION AND RESUMING NUTRITION

Assessment and management of GI function
 Any postoperative patient may suffer from distention  Abdominal distention is further increased by immobility, anesthetic agents, and the use of opioid medications  Assess bowel sounds  Paralytic ileus and intestinal obstruction

PROMOTING BOWEL FUNCTION

Constipation Patients are advised to engage in early ambulation to prevent constipation Improve dietary intake is advised Stools softeners may be prescribed by the doctor

MANAGING VOIDING
The patient is expected to void within 8 hours after surgery All methods to encourage the patient to void should be tried Bedpan must be warm Straight intermittent catheterization is preferred over in-dwelling catheterization Take note of amount of urine voided Palpate the suprapubic area for distention or tenderness

PREVENTION AND EARLY DETECTION OF COMPLICATIONS

PREVENTING RESPIRATORY COMPLICATIONS

Common respiratory complications: atelectasis, pneumonia, and hypoxemia Encourage deep breathing, coughing exercises, and ambulation Watch out for signs and symptoms of the common respiratory complications Administer oxygen as prescribed to prevent or relieve hypoxia

MAINTAINING A SAFE ENVIRONMENT

Assess the patients level of consciousness and orientation which may place the patient at risk for injury All objects the patient may need should be within reach Instruct patient to ask for assistance with any activity

MANAGING POTENTIAL COMPLICATIONS

Deep vein thrombosis (DVT)
 Low-molecular-weight or low-dose heparin and lowdose warfarin  Advise to avoid the use of blanket rolls, pillow rolls, or any form of elevation that can constrict vessels under the knees  Prolonged dangling is not recommended

DEEP VEIN THROMBOSIS

DEEP VEIN THROMBOSIS

MANAGING POTENTIAL COMPLICATIONS

Hematoma
Sometimes concealed bleeding occurs beneath the skin at the surgical site

MANAGING POTENTIAL COMPLICATIONS

Infection
Multiple factors place the patient at risk of infection Watch out for signs and symptoms of infection
Increased PR and temperature; elevated WBC; wound swelling, warmth, tenderness, or discharge, and incisional pain

Staphylococcus aureus Antimicrobial therapy and wound care regimen

MANAGING POTENTIAL COMPLICATIONS

Wound dehiscence and evisceration
 Both are serious surgical complications  Abdominal binder

WOUND DEHISCENCE

WOUND DEHISCENCE

WOUND DEHISCENCE

WOUND EVISCERATION