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Chapter 18. Care of Postoperative Patients. PACU Recovery Room. Postanesthesia care unit (PACU) Allows for ongoing evaluation and stabilization of patients to anticipate, prevent, and treat complications after surgery

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chapter 18

Chapter 18

Care of Postoperative Patients

pacu recovery room
PACU Recovery Room
  • Postanesthesia care unit (PACU)
  • Allows for ongoing evaluation and stabilization of patients to anticipate, prevent, and treat complications after surgery
  • Circulating nurse and anesthesia provider give PACU nurse a verbal hand-off report
pacu nurses functions
PACU Nurses Functions
  • Respiratory
  • LOC, TPR, O2 Sat, BP
  • Examine surgical area
  • Discharge from PACU
respiratory system assessment
Respiratory System Assessment
  • Assess for a patent airway and adequate gas exchange
  • Note artificial airway, when applicable
  • Rate, pattern, and depth of breathing
  • Breath sounds
  • Accessory muscle use
  • Snoring and stridor
  • Respiratory depression or hypoxemia
cardiovascular assessment
Cardiovascular Assessment
  • Vital signs
  • Heart sounds
  • Cardiac monitoring
  • Peripheral vascular assessment
neurologic system
Neurologic System
  • Cerebral functioning
  • Motor and sensory assessment important after epidural or spinal anesthesia:
    • Motor function—simple commands; patient to move extremities
    • Return of sympathetic nervous system tone: gradually elevate head and monitor for hypotension
fluid electrolyte and acid base balance
Fluid, Electrolyte, and Acid-Base Balance
  • Intake and output
  • Hydration status
  • IV fluids
  • Acid-base balance
renal urinary system
Renal/Urinary System
  • Check for urine retention.
  • Consider other sources of output such as sweat, vomitus, or diarrhea stools.
  • Report a urine output of <30 mL/hr.
gastrointestinal system
Gastrointestinal System
  • 30% of patients experience nausea or vomiting after general anesthesia.
  • Peristalsis may be delayed for up to 24 hours.
  • Monitor for bowel sounds.
nasogastric tube drainage
Nasogastric Tube Drainage
  • Tube inserted during surgery to:
    • Decompress and drain the stomach
    • Promote GI rest
    • Allow the lower GI tract to heal
    • Provide an enteral feeding route
    • Monitor any gastric bleeding
    • Prevent intestinal obstruction
nasogastric tube drainage cont d
Nasogastric Tube Drainage (Cont’d)
  • Assess drained material every 8 hr.
  • Do not move or irrigate the tube after gastric surgery without an order from the surgeon.
skin assessment
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
    • Evisceration—a total separation of all wound layers and protrusion of internal organs through the open wound
discomfort pain assessment
Discomfort/Pain Assessment
  • Pain and discomfort expected after surgery.
  • Consider type, extent, and length of the surgical procedure in assessing patient’s discomfort and need for medication.
physical and emotional signs of acute pain
Physical and Emotional Signs of Acute Pain
  • Assess for:
    • Increased pulse and blood pressure
    • Increased respiratory rate
    • Profuse sweating
    • Restlessness
    • Confusion (in older adults)
    • Wincing, moaning, or crying
laboratory assessment
Laboratory Assessment
  • Analysis of electrolytes
  • CBC
  • “Left-shift”
  • Specimens for C&S
  • ABG
  • Urine and renal laboratory tests
  • Others such as serum amylase, blood glucose
impaired gas exchange
Impaired Gas Exchange

Interventions include:

  • Airway maintenance
  • Positioning the patient 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
impaired skin integrity
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
impaired skin integrity cont d
Impaired Skin Integrity (Cont’d)
  • Drug therapy including antibiotics and irrigations is used to treat wound infection.
  • Débridement.
  • Surgical management is required for wound opening.
acute pain
Acute Pain

Interventions include:

  • Drug therapy
  • Complementary and alternative therapies such as:
    • Positioning
    • Massage
    • Relaxation and diversion techniques
potential for hypoxemia
Potential for Hypoxemia
  • Highest incidence of hypoxemia after surgery occurs on the second postoperative day.
  • Interventions include:
    • Maintenance of airway patency and breathing pattern
    • Prevention of hypothermia
    • Maintenance of oxygen therapy as prescribed
community based care
Community-Based Care
  • Home care management
  • Health teaching
  • Health care resources