focus on postoperative care
Download
Skip this Video
Download Presentation
Focus on Postoperative Care

Loading in 2 Seconds...

play fullscreen
1 / 157

Focus on Postoperative Care - PowerPoint PPT Presentation


  • 275 Views
  • Uploaded on

Focus on Postoperative Care. (Relates to Chapter 20, “Nursing Management: Postoperative Care,” in the textbook). Postoperative Period. Begins immediately after surgery Nursing care Protecting patient Preventing complications while body repairs.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Focus on Postoperative Care' - iram


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
focus on postoperative care

Focus on Postoperative Care

(Relates to Chapter 20, “Nursing Management:

Postoperative Care,” in the textbook)

postoperative period
Postoperative Period
  • Begins immediately after surgery
  • Nursing care
    • Protecting patient
    • Preventing complications while body repairs
care in the postanesthesia care unit pacu
Care in the Postanesthesia Care Unit (PACU)
  • Postanesthesia Care Unit
    • Patients admitted to phase I—general anesthesia
    • Phase II—local/regional anesthetic or conscious sedation to be discharged home from PACU
    • Phase III—discharge from facility
care in the pacu cont d
Care in the PACU (Cont’d)
  • PACU phase I bypass is direct admission to phase II from OR for ambulatory patients going home
care in the pacu cont d1
Care in the PACU (Cont’d)
  • Rapid PACU progression
    • Based on patient’s achievement of discharge criteria
  • Fast tracking cuts costs and increases patient satisfaction without compromising safety
care in the pacu cont d2
Care in the PACU (Cont’d)
  • Anesthesia care provider gives report to admitting PACU nurse
  • Priority care
    • Monitoring and managing respiratory and circulatory function, pain, temperature, and surgical site
care in the pacu cont d3
Care in the PACU (Cont’d)
  • Initial assessment
    • Airway patency
    • Rate and quality of respirations
    • Auscultate breath sounds in all fields
care in the pacu cont d4
Care in the PACU (Cont’d)
  • Initial assessment
    • Oxygen therapy
      • Used if patient had general anesthesia and/or ACP orders
      • Aids in elimination of anesthetic agent
      • Meets increased O2 demand from blood loss or increased metabolism
care in the pacu cont d5
Care in the PACU (Cont’d)
  • Initial assessment
    • ECG monitoring
      • Initiated for cardiac rate and rhythm
      • Note differences from preoperative findings
    • Measure BP and compare with baseline
    • Assess temperature and skin color and condition
care in the pacu cont d6
Care in the PACU (Cont’d)
  • Initial assessment
    • Initial neurologic assessment
      • Level of consciousness
      • Orientation
      • Sensory and motor status
      • Size and equality of pupils
care in the pacu cont d7
Care in the PACU (Cont’d)
  • Initial assessment
    • Initial neurologic assessment
      • Emergence delirium if agitation when waking up
      • Sensory and motor blockade may be present in patients having had regional anesthetic
care in the pacu cont d8
Care in the PACU (Cont’d)
  • Initial assessment
    • Assessment of urinary system
      • Input and output
      • Fluid balance
    • Assess surgical site and condition of dressing
      • Note amount and type of drainage
care in the pacu cont d9
Care in the PACU (Cont’d)
  • Initial assessment
    • Explain all activities from admission because hearing is first sense to return
    • Orientation
      • Explaining that surgery is over
      • Location
      • Family/friend notified
      • Who is caring for patient
potential alterations in respiratory function
Potential Alterations in Respiratory Function
  • Patients at particular risk include those who:
    • Receive general anesthesia
    • Are older
    • Smoke heavily
potential alterations in respiratory function cont d
Potential Alterations in Respiratory Function (Cont’d)
  • Patients at particular risk include those:
    • With lung disease
    • Who are obese
    • Undergoing thoracic, airway, or abdominal surgery
potential alterations in respiratory function cont d1
Potential Alterations in Respiratory Function (Cont’d)
  • Airway obstruction
    • Blockage of airway by patient’s tongue
    • Supine position
    • Extremely sleepy patient
    • Laryngospasm
    • Retained secretions
    • Laryngeal edema
potential alterations in respiratory function1
Potential Alterations in Respiratory Function
  • Hypoxemia
    • PaO2 less than 60 mm Hg
    • Ranges from agitation to somnolence, hypertension to hypotension, and tachycardia to bradycardia
    • Arterial blood gas used to confirm if pulse oximetry is low
potential alterations in respiratory function cont d2
Potential Alterations in Respiratory Function (Cont’d)
  • Atelectasis
    • Most common cause of postoperative hypoxemia
    • May result from bronchial obstruction from retained secretions or decreased respiratory excursion
potential alterations in respiratory function cont d3
Potential Alterations in Respiratory Function (Cont’d)
  • Pulmonary edema
    • Caused by accumulation of fluids in alveoli
    • Can result from fluid overload, left ventricular failure, or prolonged airway obstruction, sepsis, or aspiration
    • Characterized by crackles, decreased compliance, or infiltrates on x-ray
potential alterations in respiratory function cont d4
Potential Alterations in Respiratory Function (Cont’d)
  • Aspiration of gastric contents
  • Signs/symptoms of
potential alterations in respiratory function cont d5
Potential Alterations in Respiratory Function (Cont’d)
  • Patients at risk may be premedicated with histamine-H2 receptor antagonist before induction of anesthesia to prevent HCl secretions
potential alterations in respiratory function cont d6
Potential Alterations in Respiratory Function (Cont’d)
  • Bronchospasm results from increase in bronchial smooth muscle tone with resultant closure of small airways
    • Edema develops, causing secretions to build up
    • Signs and symptoms of wheezing, dyspnea, use of accessory muscles, hypoxemia, tachypnea
potential alterations in respiratory function cont d7
Potential Alterations in Respiratory Function (Cont’d)
  • Hypoventilation may occur from depression of the central respiratory drive and/or poor respiratory muscle tone
    • Signs and symptoms of ↓ rate or effort, hypoxemia, and ↑ PaCO2
nursing management respiratory complications
Nursing ManagementRespiratory Complications
  • Assessment
    • Evaluate airway patency; chest symmetry; and depth, rate, and character of respirations
    • Breath sounds auscultated anteriorly, laterally, and posteriorly
      • Notify ACP of crackles or wheezes
nursing management respiratory complications cont d
Nursing ManagementRespiratory Complications (Cont’d)
  • Assessment
    • Presence of hypoxemia may be reflected by rapid breathing, gasping, apprehension, restlessness, and rapid, thready pulse
nursing management respiratory complications cont d1
Nursing ManagementRespiratory Complications (Cont’d)
  • Assessment
    • Regular monitoring of vital signs with pulse oximetry
    • Note characteristics of sputum
nursing management respiratory complications cont d2
Nursing ManagementRespiratory Complications (Cont’d)
  • Nursing diagnoses
    • Ineffective airway clearance
    • Ineffective breathing pattern
    • Impaired gas exchange
nursing management respiratory complications cont d3
Nursing ManagementRespiratory Complications (Cont’d)
  • Nursing diagnoses
    • Risk for aspiration
    • Potential complication: hypoxemia
nursing management respiratory complications cont d4
Nursing ManagementRespiratory Complications (Cont’d)
  • Nursing implementation
    • Proper positioning to facilitate respirations and protect airway
      • Lateral position unless contraindicated
      • Patient allowed in supine with HOB elevated once conscious
nursing management respiratory complications cont d5
Nursing ManagementRespiratory Complications (Cont’d)
  • Nursing implementation
    • Deep breathing encouraged to facilitate gas exchange and promote return to consciousness
potential complications in cardiovascular function
Potential Complications in Cardiovascular Function
  • Most common complications: hypotension, hypertension, and dysrhythmias
potential complications in cardiovascular function cont d
Potential Complications in Cardiovascular Function (Cont’d)
  • Those at greatest risk:
    • Cardiac history
    • Elderly
    • Debilitated or critically ill
potential complications in cardiovascular function cont d1
Potential Complications in Cardiovascular Function (Cont’d)
  • Hypotension
    • Most common cause is unreplaced fluid and blood loss
    • Other causes include dysrhythmias, decreased low systemic vascular resistance, and incorrect cuff
potential complications in cardiovascular function cont d2
Potential Complications in Cardiovascular Function (Cont’d)
  • Hypertension
    • Results from sympathetic stimulation from pain, anxiety, bladder distention, or respiratory compromise
potential complications in cardiovascular function cont d3
Potential Complications in Cardiovascular Function (Cont’d)
  • Hypertension
    • May result from hypothermia or preexisting hypertension
    • May be seen as result of revascularization during surgery
potential complications in cardiovascular function cont d4
Potential Complications in Cardiovascular Function (Cont’d)
  • Dysrhythmias
    • Often result from myocardial injury
    • Leading cause of hypokalemia, hypoxemia, alterations in pH balance, circulatory instability, or preexisting heart disease
nursing management cardiovascular complications
Nursing ManagementCardiovascular Complications
  • Nursing assessment
    • Frequently monitor vital signs
      • Compare with baseline
    • Assess apical-radial pulse carefully and report irregularities
    • Assess skin color, temperature, and moisture
nursing management cardiovascular complications cont d
Nursing ManagementCardiovascular Complications (Cont’d)
  • Nursing assessment
    • Notify ACP for
      • Systolic <90 mm Hg or >160 mm Hg
      • Pulse <60 or >120 beats per minute
      • Pulse pressure narrows
nursing management cardiovascular complications cont d1
Nursing ManagementCardiovascular Complications (Cont’d)
  • Nursing assessment
    • Notify ACP for
      • BP gradually increases
      • Irregular cardiac rhythm develops
      • Significant variation from preoperative readings
nursing management cardiovascular complications cont d2
Nursing ManagementCardiovascular Complications (Cont’d)
  • Nursing diagnoses
    • Decreased cardiac output
    • Deficient fluid volume
    • Ineffective tissue perfusion
nursing management cardiovascular complications cont d3
Nursing ManagementCardiovascular Complications (Cont’d)
  • Nursing diagnoses
    • Excess fluid volume
    • Potential complication: hypovolemic shock
nursing management cardiovascular complications cont d4
Nursing ManagementCardiovascular Complications (Cont’d)
  • Nursing implementation
    • Treatment begins with administration of oxygen therapy
    • Volume status assessed
      • IVF boluses to normalize BP
    • Drug intervention
nursing management cardiovascular complications cont d5
Nursing ManagementCardiovascular Complications (Cont’d)
  • Nursing implementation
    • Address and eliminate cause of sympathetic nervous system stimulation
      • Analgesics, voiding, correction of respiratory problems
    • Rewarming corrects hypothermia-induced hypertension
potential alterations in neurologic function
Potential Alterations in Neurologic Function
  • Emergence delirium (or violent emergence)
    • Can induce restlessness, agitation, disorientation, thrashing, and shouting
    • Caused by anesthetic agent, hypoxia, bladder distention, pain, electrolyte abnormalities, or anxiety
potential alterations in neurologic function cont d
Potential Alterations in Neurologic Function (Cont’d)
  • Delayed awakening
    • Commonly caused by prolonged drug action
nursing management neurologic complications
Nursing ManagementNeurologic Complications
  • Nursing assessment
    • LOC
    • Orientation
    • Ability to follow commands
    • Size, reactivity, and equality of pupils
    • Sensory and motor status
nursing management neurologic complications cont d
Nursing ManagementNeurologic Complications (Cont’d)
  • Nursing diagnoses
    • Disturbed sensory perception
    • Risk for injury
    • Disturbed thought processes
    • Impaired verbal communication
nursing management neurologic complications cont d1
Nursing ManagementNeurologic Complications (Cont’d)
  • Nursing implementation
    • Attention on evaluation of respiratory function
      • Hypoxemia causes postoperative agitation
    • Sedation may be beneficial for controlling agitation and providing safety
nursing management neurologic complications cont d2
Nursing ManagementNeurologic Complications (Cont’d)
  • Nursing implementation
    • Side rails up
    • Secure IV lines and artificial airways
    • Verify presence of ID and allergy bands
    • Monitor physiologic status
pain and discomfort
Pain and Discomfort
  • Result of
    • Surgical manipulation
    • Positioning
    • Internal devices
pain and discomfort cont d
Pain and Discomfort (Cont’d)
  • Common problem and significant fear for patient that can prolong stay
  • May occur as patient begins to move postoperatively
nursing management pain
Nursing ManagementPain
  • Nursing assessment
    • Indications of pain and question about the degree and characteristics of pain
    • Identify location
    • Measure before and after treatment is administered
nursing management pain cont d
Nursing ManagementPain (Cont’d)
  • Nursing diagnoses
    • Acute pain
    • Anxiety
nursing management pain cont d1
Nursing ManagementPain (Cont’d)
  • Nursing implementation
    • IV opioids
    • Epidural catheters, PCA, or regional anesthetic blockade
nursing management pain cont d2
Nursing ManagementPain (Cont’d)
  • Nursing implementation
    • Comfort measures
      • Touch
      • Family
      • Rewarming
hypothermia
Hypothermia
  • Core temperature less than 96.8º F occurs when heat loss exceeds production
  • Loss of heat to cold OR from body organs exposed to the air
hypothermia cont d
Hypothermia (Cont’d)
  • Increased risk associated with
    • Age
    • Debility
    • Intoxication
    • Prolonged anesthetic administration
hypothermia cont d1
Hypothermia (Cont’d)
  • Complications
    • Compromised immune function
    • Postoperative pain
    • Increased bleeding
    • Myocardial ischemia
    • Delayed drug metabolism
nursing management hypothermia
Nursing ManagementHypothermia
  • Nursing assessment
    • Vital signs
      • Oral, tympanic, or axillary temperature
    • Assess color and temperature of skin
nursing management hypothermia cont d
Nursing ManagementHypothermia (Cont’d)
  • Nursing diagnoses
    • Hypothermia
    • Risk for imbalanced body temperature
nursing management hypothermia cont d1
Nursing ManagementHypothermia (Cont’d)
  • Nursing implementation
    • Passive rewarming raises basal metabolism
    • Active rewarming requires application of warming devices
      • Blankets, heated aerosols, radiant warmers, forced air warmers, or heated water
nursing management hypothermia cont d2
Nursing ManagementHypothermia (Cont’d)
  • Nursing implementation
    • Monitor body temperature at 15-minute intervals when using any external warming device
    • Skin care to prevent injuries
    • Oxygen therapy for increasing demand
nausea and vomiting
Nausea and Vomiting
  • Significant problems in postoperative period
    • Responsible for unanticipated admission, increased discomfort, delays in discharge, and dissatisfaction with surgical experience
nursing management nausea and vomiting cont d
Nursing Management Nausea and Vomiting (Cont’d)
  • Nursing assessment
    • Question about feelings of nausea
    • Document characteristics of vomit
nursing management nausea and vomiting cont d1
Nursing Management Nausea and Vomiting (Cont’d)
  • Nursing diagnoses
    • Nausea
    • Risk for aspiration
    • Risk for deficient fluid volume
nursing management nausea and vomiting cont d2
Nursing Management Nausea and Vomiting (Cont’d)
  • Nursing implementation
    • Antiemetic drugs
    • Oral fluids as tolerated
    • Suction at bedside
nursing management nausea and vomiting cont d3
Nursing Management Nausea and Vomiting (Cont’d)
  • Nursing implementation
    • Turn patient’s head to side to protect from aspiration
    • Upright position
    • Slow, deep breathing
discharge from pacu
Discharge from PACU
  • Ambulatory surgery discharge
    • Difficult to do all required teaching due to short time frame
    • Patient must be mobile and alert and can provide a degree of self-care
    • Pain, nausea, and vomiting must be controlled
discharge from pacu cont d
Discharge from PACU (Cont’d)
  • Ambulatory surgery discharge
    • Patient must be at or near preoperative functioning
    • Instructions are specific to type of anesthesia used
      • Verbal and written directions
discharge from pacu cont d1
Discharge from PACU (Cont’d)
  • Ambulatory surgery discharge
    • Patient may not drive
    • Follow-up by phone
care of postoperative patient on clinical unit
Care of Postoperative Patient on Clinical Unit
  • PACU nurse gives report to receiving nurse summarizing operative and postoperative periods
  • Receiving nurse assists with transfer onto bed
care of postoperative patient on clinical unit cont d
Care of Postoperative Patient on Clinical Unit (Cont’d)
  • Vital signs obtained and compared with report
  • After transfer, in-depth assessment performed
care of postoperative patient on clinical unit cont d1
Care of Postoperative Patient on Clinical Unit (Cont’d)
  • Initiation of postoperative orders
  • Early ambulation for muscle tone, gastrointestinal and urinary function, stimulation of circulation, and normal respiratory function
potential complications in respiratory function
Potential Complications in Respiratory Function
  • Atelectasis and pneumonia commonly occur after abdominal and thoracic surgery
    • Related to mucous plugs and decreased surfactant, hypoventilation, recumbent position, ineffective coughing, and smoking
postoperative atelectasis
Postoperative Atelectasis

B. Mucous plug in

bronchiole

  • Normal bronchiole and alveolus

C. Collapse of alveoli

due to absorption of air

Fig. 20-3

potential complications in respiratory function cont d
Potential Complications in Respiratory Function (Cont’d)
  • Nursing assessment
    • Respiratory rate and breath sounds
potential complications in respiratory function cont d1
Potential Complications in Respiratory Function (Cont’d)
  • Nursing diagnoses
    • Ineffective airway clearance
    • Ineffective breathing pattern
    • Impaired gas exchange
    • Potential complication: pneumonia
    • Potential complication: atelectasis
potential complications in respiratory function cont d2
Potential Complications in Respiratory Function (Cont’d)
  • Nursing implementation
    • Deep breathing and cough help prevent alveolar collapse
      • Incentive spirometer
      • Splinting
      • Diaphragmatic breathing
      • Change position q2hr
potential alterations in cardiovascular function
Potential Alterations in Cardiovascular Function
  • Fluid and electrolyte imbalances contribute to alterations
    • Fluid retention during first 2 to 5 days postop from stress response
potential alterations in cardiovascular function cont d
Potential Alterations in Cardiovascular Function (Cont’d)
  • Fluid and electrolyte imbalances contribute to alterations
    • Fluid overload may occur when IVF administered too rapidly, when chronic disease exists, or when patient is older
potential alterations in cardiovascular function cont d1
Potential Alterations in Cardiovascular Function (Cont’d)
  • Fluid and electrolyte imbalances contribute to alterations
    • Fluid deficit may result from inadequate fluid replacement
      • Decreased cardiac output and tissue perfusion
potential alterations in cardiovascular function cont d2
Potential Alterations in Cardiovascular Function (Cont’d)
  • Fluid and electrolyte imbalances contribute to alterations
    • Hypokalemia can result from urinary or gastrointestinal losses
      • Directly affects contractility of heart
potential alterations in cardiovascular function cont d3
Potential Alterations in Cardiovascular Function (Cont’d)
  • Fluid and electrolyte imbalances contribute to alterations
    • Stress response contributes to increased clotting factors
      • Deep vein thrombosis and pulmonary embolism
potential alterations in cardiovascular function cont d4
Potential Alterations in Cardiovascular Function (Cont’d)
  • Fluid and electrolyte imbalances contribute to alterations
    • Syncope may indicate decreased cardiac output, fluid deficits, or deficits in cerebral perfusion
      • Frequently occurs from postural hypotension on ambulation
      • Common in immobile and elderly
nursing management cardiovascular complications cont d6
Nursing ManagementCardiovascular Complications (Cont’d)
  • Nursing assessment
    • Regular monitoring of BP, HR, pulse, and skin temperature and color
      • Compare with preoperative status and postoperative findings
nursing management cardiovascular complications cont d7
Nursing ManagementCardiovascular Complications (Cont’d)
  • Nursing diagnoses
    • Decreased cardiac output
    • Deficient fluid volume
    • Excess fluid volume
nursing management cardiovascular complications cont d8
Nursing ManagementCardiovascular Complications (Cont’d)
  • Nursing diagnoses
    • Ineffective tissue perfusion
    • Activity intolerance
    • Potential complication: thromboemboli
nursing management cardiovascular complications cont d9
Nursing ManagementCardiovascular Complications (Cont’d)
  • Nursing Implementation
    • Accurate I & Os
    • Monitor laboratory findings
    • Assessment of infusion rate of fluid replacement and infusion site
    • Adequate mouth care
    • Leg exercises
nursing management cardiovascular complications cont d10
Nursing ManagementCardiovascular Complications (Cont’d)
  • Nursing implementation
    • Elastic stockings or compressive devices
    • Unfractionated or low-molecular-weight heparin
nursing management cardiovascular complications cont d11
Nursing ManagementCardiovascular Complications (Cont’d)
  • Nursing implementation
    • Ambulation
      • Slowly progress
      • Monitor pulse
      • Assess for feelings of faintness
potential alterations in urinary function
Potential Alterations in Urinary Function
  • Low urinary output may be expected in the first 24 hours, regardless of intake
    • ↑ Aldosterone and ADH from stress of surgery, fluid restriction, fluid losses during surgery, drainage, or diaphoresis
potential alterations in urinary function cont d
Potential Alterations in Urinary Function (Cont’d)
  • Low urinary output
    • Anesthesia depresses nervous system, allowing bladder to fill more than normally before urge to void is felt
potential alterations in urinary function cont d1
Potential Alterations in Urinary Function (Cont’d)
  • Anticholinergic and opioid drugs may also interfere with ability to initiate voiding or fully empty bladder
potential alterations in urinary function cont d2
Potential Alterations in Urinary Function (Cont’d)
  • Retention more likely with lower abdominal or pelvic surgery
    • Pain may alter perception of filling bladder
potential alterations in urinary function cont d3
Potential Alterations in Urinary Function (Cont’d)
  • Recumbent position greatly impairs ability to void
    • ↓ Smooth muscle tone and reduces the ability to relax perineal muscles and external sphincter
nursing management urinary complications
Nursing ManagementUrinary Complications
  • Nursing assessment
    • Urine examined for quantity and quality
      • Note color, amount, consistency, and odor
    • Assess indwelling catheters for patency
    • Urine output should be at least 0.5 ml/kg/hr
nursing management urinary complications cont d
Nursing ManagementUrinary Complications (Cont’d)
  • Nursing assessment
    • If no catheter, patient should be able to void 200 ml after surgery
      • If no voiding, abdominal contour inspected and bladder palpated and percussed for distention
nursing management urinary complications cont d1
Nursing ManagementUrinary Complications (Cont’d)
  • Nursing diagnoses
    • Impaired urinary elimination
    • Potential complication: acute urinary retention
nursing management urinary complications cont d2
Nursing ManagementUrinary Complications (Cont’d)
  • Nursing implementation
    • Position patient for normal voiding
    • Reassure patient of ability to void
    • Use techniques such as running water, drinking water, pouring water over perineum, ambulation, or use of bedside commode
potential alterations in gastrointestinal function
Potential Alterations in Gastrointestinal Function
  • Nausea and vomiting
    • Caused by
      • Anesthetic agents
      • Opioids
      • Delayed gastric emptying
      • Slowed peristalsis
      • Resumption of oral intake too soon after surgery
potential alterations in gastrointestinal function cont d
Potential Alterations in Gastrointestinal Function (Cont’d)
  • Abdominal distention from decreased peristalsis caused by handling of bowel during surgery
potential alterations in gastrointestinal function cont d1
Potential Alterations in Gastrointestinal Function (Cont’d)
  • Swallowed air and gastrointestinal secretions may accumulate in colon, producing distention and gas pains
  • Hiccups from irritation of phrenic nerve
nursing management gastrointestinal complications
Nursing ManagementGastrointestinal Complications
  • Nursing assessment
    • Auscultate abdomen in all four quadrants for presence, frequency, and characteristics of bowel sounds
      • Can be absent or diminished in immediate postoperative period
      • Return of bowel motility accompanied by flatus
potential alterations in gastrointestinal function1
Potential Alterations in Gastrointestinal Function
  • Nursing diagnoses
    • Nausea
    • Imbalanced nutrition: less than body requirements
    • Potential complication: paralytic ileus
    • Potential complication: hiccups
potential alterations in gastrointestinal function cont d2
Potential Alterations in Gastrointestinal Function (Cont’d)
  • Nursing implementation
    • May resume intake upon return of gag reflex
    • NPO until return of bowel sounds for patient with abdominal surgery
      • IV, NG for decompression
potential alterations in gastrointestinal function cont d3
Potential Alterations in Gastrointestinal Function (Cont’d)
  • Nursing implementation
    • Clear liquids, advance as tolerated
    • Regular mouth care when NPO
    • Antiemetics administered for nausea
      • NG tube if symptoms persist
potential alterations in gastrointestinal function cont d4
Potential Alterations in Gastrointestinal Function (Cont’d)
  • Nursing implementation
    • Early and frequent ambulation to prevent abdominal distention
    • Assess patient regularly for resumption of normal peristalsis
potential alterations in gastrointestinal function cont d5
Potential Alterations in Gastrointestinal Function (Cont’d)
  • Nursing implementation
    • Encourage patient to expel flatus and explain that it is necessary and desirable
    • Relief of gas pains by frequent ambulation and repositioning
potential alterations in gastrointestinal function cont d6
Potential Alterations in Gastrointestinal Function (Cont’d)
  • Nursing implementation
    • Suppositories as needed
    • Determine cause of hiccups
potential alterations of the integument
Potential Alterations of the Integument
  • Incision disrupts skin barrier, and healing is major concern during postoperative period
potential alterations of the integument cont d
Potential Alterations of the Integument (Cont’d)
  • Adequate nutrition
    • Amino acids for catabolic effect of stress response
    • Nutritional deficits from chronic disease
potential alterations of the integument cont d1
Potential Alterations of the Integument (Cont’d)
  • Impaired wound healing with chronic disease and elderly
potential alterations of the integument cont d2
Potential Alterations of the Integument (Cont’d)
  • Wound infection may result from
    • Exogenous flora in environment and on skin
    • Oral flora
    • Intestinal flora
potential alterations of the integument cont d3
Potential Alterations of the Integument (Cont’d)
  • Increased incidence of wound sepsis in
    • Malnourished
    • Immunosuppressed
    • Advanced age
    • Prolonged hospital stays
potential alterations of the integument cont d4
Potential Alterations of the Integument (Cont’d)
  • Evidence of wound infection usually not apparent until third to fifth postoperative day
    • Local manifestations of redness, edema, pain, and tenderness
    • Systemic manifestations of leukocytosis and fever
potential alterations of the integument cont d5
Potential Alterations of the Integument (Cont’d)
  • Accumulation of fluid in wound may impair healing and predispose to infection
    • Drain may be placed
nursing management surgical wounds
Nursing ManagementSurgical Wounds
  • Nursing assessment
    • Knowledge of type of wound, drains, and expected drainage
    • Drainage should change from sanguineous to serosanguineous to serous with decreasing output
nursing management surgical wounds cont d
Nursing ManagementSurgical Wounds (Cont’d)
  • Nursing assessment
    • Wound dehiscence may be preceded by sudden brown, pink, or clear discharge
potential alterations of the integument1
Potential Alterations of the Integument
  • Nursing diagnoses
    • Risk for infection
    • Potential complication: impaired wound healing
potential alterations of the integument cont d6
Potential Alterations of the Integument (Cont’d)
  • Nursing implementation
    • Note type, amount, color, and consistency of drainage
    • Assess affect of position changes on drainage
potential alterations of the integument cont d7
Potential Alterations of the Integument (Cont’d)
  • Nursing implementation
    • Notify surgeon of excessive or abnormal drainage and significant changes in vitals
    • Note number and type of drains when changing dressing
      • Examine incision site
      • Clean gloves and sterile technique
pain and discomfort1
Pain and Discomfort
  • Postoperative pain caused by a several physiologic and psychologic interactions
    • Traumatization of skin and tissues
    • Reflex muscle spasms
    • Anxiety/fear increase muscle tone and spasm
nursing management pain1
Nursing ManagementPain
  • Nursing assessment
    • Observe for behavioral clues
    • Question patients who are able to verbalize
nursing management pain cont d3
Nursing ManagementPain (Cont’d)
  • Nursing diagnoses
    • Acute pain
    • Disturbed sensory perception
nursing management pain cont d4
Nursing ManagementPain (Cont’d)
  • Nursing implementation
    • Analgesic administration timed to ensure effectiveness during activities and comfort
    • Assess nature of pain
      • Location, intensity, quality
nursing management pain cont d5
Nursing ManagementPain (Cont’d)
  • Nursing implementation
    • Notify physician and request change of medication if order fails to relieve pain or makes patient excessively somnolent
nursing management pain cont d6
Nursing ManagementPain (Cont’d)
  • Nursing implementation
    • Patient-controlled analgesia (PCA) and epidural analgesia
      • Provide immediate analgesia and maintain constant, steady blood level of agent
      • Self-administration of premetered doses with PCA
potential alterations in temperature
Potential Alterations in Temperature
  • Hypothermia may be present in immediate postoperative period
potential alterations in temperature cont d
Potential Alterations in Temperature (Cont’d)
  • Fever may occur at any time
    • Mild elevation (up to 100.4ºF) may result from stress response
    • Moderate elevation (over 100.4º F) usually caused by respiratory congestion or atelectasis and rarely by dehydration
potential alterations in temperature cont d1
Potential Alterations in Temperature (Cont’d)
  • Wound infection often accompanied by fever spiking in afternoon and near-normal in morning
  • Intermittent high with shaking chills and diaphoresis indicates septicemia
potential alterations in temperature cont d2
Potential Alterations in Temperature (Cont’d)
  • Can signal Clostridium difficile when accompanied by diarrhea and abdominal pain
nursing management altered temperature
Nursing ManagementAltered Temperature
  • Nursing assessment
    • Frequent temperature assessment
    • Observe for early signs of inflammation and infection
nursing management altered temperature cont d
Nursing ManagementAltered Temperature (Cont’d)
  • Nursing diagnoses
    • Risk for imbalanced body temperature
    • Hyperthermia
    • Hypothermia
nursing management altered temperature cont d1
Nursing ManagementAltered Temperature (Cont’d)
  • Nursing implementation
    • Measure temperature q4hr for first 48 hours postoperatively
    • Asepsis with wound and IV sites
nursing management altered temperature cont d2
Nursing ManagementAltered Temperature (Cont’d)
  • Nursing implementation
    • Encourage airway clearance
    • Chest x-rays and cultures if infection suspected
    • Antipyretics and body-cooling over 103º F
potential alterations in psychologic function
Potential Alterations in Psychologic Function
  • Anxiety and depression may be more pronounced
    • Attention with history of neurotic or psychotic disorder
    • Responses may be part of grief process
    • Risks with lack of knowledge, assistance, or resources
potential alterations in psychologic function cont d
Potential Alterations in PsychologicFunction (Cont’d)
  • Confusion and delirium may result from psychologic and physiologic sources
    • Fluid and electrolyte imbalances, hypoxemia, drug effects, sleep deprivation, sensory alteration or overload
    • Delirium tremens from alcohol withdrawal
nursing management psychologic function
Nursing ManagementPsychologic Function
  • Nursing diagnoses
    • Anxiety
    • Ineffective coping
    • Disturbed body image
    • Decisional conflict
nursing management psychologic function cont d
Nursing ManagementPsychologicFunction (Cont’d)
  • Nursing implementation
    • Provide adequate support
      • Listen and talk with patient, offer explanations, reassure, and encourage involvement of significant other
      • Discuss expectation of activity and assistance needed after discharge
nursing management psychologic function cont d1
Nursing ManagementPsychologicFunction (Cont’d)
  • Nursing implementation
    • Patient must be included in discharge planning and provided with information and support to make informed decisions about continuing care
nursing management psychologic function cont d2
Nursing ManagementPsychologicFunction (Cont’d)
  • Nursing implementation
    • Recognition of alcohol withdrawal syndrome
    • Report any unusual behavior for immediate diagnosis and treatment
planning for discharge and follow up care
Planning for Discharge and Follow-up Care
  • Planning for discharge begins in preoperative period
    • Patient is informed and prepared and gradually assumes greater responsibility for self-care
planning for discharge and follow up care cont d
Planning for Discharge and Follow-up Care (Cont’d)
  • Provide information to patient and caregivers
    • Care of wound site and dressings
    • Action and side effects of drugs and when/how to take them
    • Dietary restrictions/modifications
planning for discharge and follow up care cont d1
Planning for Discharge and Follow-up Care (Cont’d)
  • Provide information
    • Symptoms to be reported
    • Where and when to return for follow-up care
planning for discharge and follow up care cont d2
Planning for Discharge and Follow-up Care (Cont’d)
  • Provide information
    • Answers to questions or concerns
    • Activity prescriptions or restrictions
    • Written instructions for reinforcement
planning for discharge and follow up care cont d3
Planning for Discharge and Follow-up Care (Cont’d)
  • Follow-up call or visit may assess and evaluate patient after discharge
planning for discharge and follow up care cont d4
Planning for Discharge and Follow-up Care (Cont’d)
  • Working with discharge planner or case manager can facilitate transition of care from hospital-based to community-based and home care
case study1
Case Study
  • 55-year-old male who had a prostate resection is transferred from Phase I to Phase II postanesthesia
  • His vital signs are stable
  • His pain is 3/10
case study cont d
Case Study (Cont’d)
  • Continuous bladder irrigation is stopped and a leg bag is applied
  • His wife is brought in for patient and family post-op teaching
  • He and his wife are anxious for him to be discharged
discussion questions
Discussion Questions
  • What are some potential complications, even at this stage of recovery, of which he and his wife should be aware?
  • How can some of these complications be prevented?
discussion questions cont d
Discussion Questions (Cont’d)
  • He states that he does not want to take Vicodin because he fears addiction. What can you do to encourage him to obtain adequate pain relief?
  • What skills should you teach to him and his wife?
ad