Chapter 18 - PowerPoint PPT Presentation

Chapter 18

Care of Postoperative Patients

• 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

• Respiratory
• LOC, TPR, O2 Sat, BP
• Examine surgical area
• Discharge from PACU

• 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

• Vital signs
• Heart sounds
• Cardiac monitoring
• Peripheral vascular assessment

• 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

• Intake and output
• Hydration status
• IV fluids
• Acid-base balance

• Check for urine retention.
• Consider other sources of output such as sweat, vomitus, or diarrhea stools.
• Report a urine output of <30 mL/hr.

• 30% of patients experience nausea or vomiting after general anesthesia.
• Peristalsis may be delayed for up to 24 hours.
• Monitor for bowel sounds.

• 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

• Assess drained material every 8 hr.
• Do not move or irrigate the tube after gastric surgery without an order from the surgeon.

• 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

• Pain and discomfort expected after surgery.
• Consider type, extent, and length of the surgical procedure in assessing patient’s discomfort and need for medication.

• Assess for:
• Increased pulse and blood pressure
• Increased respiratory rate
• Profuse sweating
• Restlessness
• Confusion (in older adults)
• Wincing, moaning, or crying

• Analysis of electrolytes
• CBC
• “Left-shift”
• Specimens for C&S
• ABG
• Urine and renal laboratory tests
• Others such as serum amylase, blood glucose

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

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

• Drug therapy including antibiotics and irrigations is used to treat wound infection.
• Débridement.
• Surgical management is required for wound opening.

Interventions include:

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

• 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

• Home care management
• Health teaching
• Health care resources