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PRESENTING
Mshey and Mingay!
In coordination ofSheyryl and Sethlog
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Post-operative PhaseBegins with the admission of the client to the PACU
and ends when healing is complete
Activities in the POST-opAssessing responses to surgery
Performing interventions to promote healingPrevent complicationsPlanning for home-care
Assist the client to achieve optimal recovery
POST Operative InterventionsMaintain patent airway
Monitor vital signs and note for early manifestationsof complications
Monitor level of consciousnessMaintain on PROPER position
NPO until fully awake, with passage of flatus and (+)gag reflex
Monitor the patency of the drainageMaintain intake and output monitoringCare of the tubes, drains and wound
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Ensure safety by side rails upPain medication given as ordered
Measures to PREVENT post-op Complications
Post-operative interventionsPAIN MANAGEMENT
Pain is usually greatest during the 12-36 hours aftersurgery
Narcotic analgesics and NSAIDS may be prescribedtogether for the early period of surgery
Provide back rub, massage, diversional activities,position changes
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POSITIONING
Clients who have spinal anesthesia is usually placedFLAT on bed for 8-12 hours
Unconscious client is placed side lying to drainsecretions
Other positions are utilized BASED on the type ofsurgery
Post-operative InterventionsSome Examples of Position Post Op
Mastectomy Semi-fowlers, affected
arm elevated
Thyroidectomy Semi fowlers, headmidline
Hemorrhoidectomy Semi-prone, side-lying
Laryngectomy Fowlers
Pneumonectomy Lateral, affected sideLobectomy Lateral, unaffected side
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Post-operative InterventionsSome Examples of Position Post Op
Aneurysmal repair (abdomen) Fowlers 45 degrees
Amputation of lowerextremities
Flat, with stump elevated withpillow
Cataract surgery Fowlers 45 degrees
Supratentorial craniotomy Fowlers
Infratentorial craniotomy Flat on bed, supine
Spina bifida repair Prone
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Post-operative InterventionsDeep breathing and coughing exercises Q2-4 hours"to remove secretions
Leg exercises Q 2 hours"to promote circulationAmbulation ASAP"prevents respiratory, circulatory,
urinary and gastrointestinal complications
Post-operative Interventions
Hydration after NPO"to maintain fluid balanceSuction, either gastro or respiratory" to relieve
distention, to remove respiratory secretionsDiet"progressive, usually given when bowel sounds
and gag reflex return
WoundCareInspect dressing hourly
Change dressing as neededInspect for signs of infection"redness, swelling,
purulent exudateMaintain wound drainage
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Post operative complications
Atelectasis
Pneumonia
Collapsedalveoli due
to secretions
Inflammationof alveoli
Assess breathsounds
Repositioning Deep breathing
and coughing Chest physio Suctioning Ambulation
Thrombophlebitis Inflammation
of the veins
Leg exercises
Monitor forswelling
Elevatedextremities
HypovolemicShock
Loss ofcirculatory
fluid volume
Determine causeand prevent
bleeding O2, IVF
Urinaryretention
Involuntaryaccumulation
of urine
Encourageambulation
Provide privacy Pour warm water
Catheterize
Pulmonaryembolism
Embolusblocking thelung blood
flow
Notify physician Administer O2
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Constipation Infrequentpassage of
stool
High fiber diet Increased fluid
Ambulation
Paralytic ileus Absent bowelsound
Encourageambulation
NPO untilperistalsis
returns
Wound infection Occurs about3 days aftersurgery
Daily wounddressing Antibiotics
Maintain drain
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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 andprevent associated risk
Post - Operative Nursing Management
Wounddehiscence
Separation ofwound edges at
the suture line
Cover thewound with
sterile normalsaline
dressing Place in low-
Fowlers Notify MD
Wound
evisceration
Protrusion of the
internal organsand tissues
through wound
Cover the
wound withsaline pad
Place in low-fowlers
Notify MD
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Nursing Management in the PACUProvide care for the patient until he/she has recovered
from the effects of anesthesia.
Patient has resumption of motor and sensory function, isoriented, has stable VS, and shows no evidence ofhemorrhage or other complications of surgery.
Frequent skilled assessment of the patient is vital.Responsibilities of the PACU Nurse
Review pertinent information and baseline assessmentupon admission to the unit.
Assessments include airway and respirations,
cardiovascular function, surgical site, function of thecentral 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 assessmentProvide written andverbalinstructions regardingfollow-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.
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Patients are not to drive home or be discharged to homealone. Sedation and anesthesia may cloud memory and
judgment and affect ability.
Maintaining a Patent AirwayA primary consideration: necessary to maintain ventilation
and oxygenation!Provide supplemental oxygen as indicated.
Assess breathing by placing hand near face to feelmovement of air.
Keep head of bed elevated 15-30o unless contraindicated.
May require suctioning.If vomiting occurs, turn patient to the side.
Maintaining Cardiovascular StabilityMonitor all indicators of cardiovascular status.
Assess all IV lines.Potential for hypotension and shock
Potential for hemorrhagePotential for hypertension and dysrhythmias
Indicators of Hypovolemic ShockPallor
Cool, moist skin
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Rapid respirationsCyanosis
Rapid, weak, thready pulse
Decreasing pulse pressureLow blood pressureConcentrated urine
Relieving Pain and AnxietyAssess patient comfort
Control of the environment: quiet, low lights, noise levelAdminister analgesics as indicated; usually short-acting
opioids IV
Controlling Nausea and VomitingIntervene at the first indication of nausea.
MedicationsAssessment of postoperative nausea, vomiting risk, and
prophylactic treatment
Gerontologic Considerations
Elderly patients are at greater risk for postoperativecomplications due to decreased homeostatic mechanisms
and physiologic reserve to deal with stresses.Monitor carefully and frequently.
Increased likelihood of postoperative confusion anddelirium
Assess confusion carefully to exclude causes such ashypoxia, pain, hypotension, hypoglycemia, and fluid loss.
Assess need for and doses of medications carefully.Ensure adequate hydration.
Reorient as needed.
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Assessment for Postoperative ComplicationsDo 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 forineffective 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 DiagnosesActivity intolerance
Impaired skin integrityIneffective thermoregulationRisk for imbalanced nutrition
Risk for constipationRisk for urinary retention
Risk for injuryAnxiety
Risk for ineffective management of therapeutic regimenCollaborative Problems
Pulmonary infection/hypoxiaDeep vein thrombosis
Hematoma/hemorrhagePulmonary embolism
Would dehiscence or evisceration