Post-Operative Care

Question 1

Where does post-operative care start?

Answer 1

The recovery area

Question 2

What constitutes discharge criteria, for the patient?

Answer 2

• Awake and orientated
• Stable vital signs
• Warm
• Pain controlled w/ analgesia
• Nausea + vomiting controlled
• Day surgery → eat/drink, urinate, mobilise

Next steps could be to the ward, or temp facilities in hospital before they go home. For day cases, pts must have someone to collect them from the hospital.

Question 3

Hypoxia is a complication that can occur in the recovery room.

What is the difference between hypoxia and hypoxaemia?

Answer 3

• Hypoxia → insufficient levels of oxygen in tissues
• Hypoxaemia → insufficient levels of oxygen in arterial blood

Question 4

What are the 4 types of hypoxia?

Answer 4

• Hypoxic → insufficient oxygen reaching blood (eg. chest infection)
• Anaemic → reduced carrying capacity of blood due to low/altered Hb
• Cyto/Histotoxic→ impaired ability of tissues to utilise oxygen
• Stagnant → failure to transport oxygen (inadequate blood flow)

Question 5

What significant impacts does hypoxia bear?

Answer 5

• Resp → SoB, hyperventilation
• CVS → tachycardia, HTN
• Neuro → headaches, euphoria, nausea, confusion, unconsciousness

Question 6

How do you manage hypoxia?

Answer 6

• ABCDE
• Call for help
• Open airways (suction any secretions)
• Give oxygen
• Ventilate w/ bag and mask
• Diagnose and treat cause

Question 7

What significant impacts does post-operative pain have on the body?

Answer 7

• Resp → Poor ventilation and risk hypoxia
• CVS → ↑HR, ↑BP, ↑Oxygen demand
• ↓ Mobility

Question 8

How can pain be measured?

Answer 8

• Category rating scales (none, mild, mod, sev, unbearable)
• Visual analogue scales (VAS)
• Numerical rating scale
• Wong-Baker faces

Question 9

What does the oxford league table of analgesics, in regard to NNT show?

Answer 9

• Numbers needed to treat
• NNT = number of patients you need to treat to prevent one additional bad outcome (death, stroke, etc.)
• Most effective drugs have a low NNT of just over 2
• Interpretation → for every 2 patients who receive the drug, one patient will get at least 50% relief bc of the treatment (the other patient may or may not obtain relief but it does not reach the 50% level)
• No drug gives NNT of 1

Question 10

What significant impact does nausea and vomiting have, post-operatively?

Answer 10

• ↑ Anxiety & discomfort
• ↑ Risk of aspiration
• ↑ Surgical complications (eye surgery, neurosurg)
• Fluid + electrolyte imbalances
• Immobility
• Delayed discharge

Question 11

What is the Apfel score?

Answer 11

• Includes four variables and assigns one point for each

Question 12

What is the management of post-operative nausea and vomiting?

Answer 12

• Avoid precipitating factors
• 5HT₃ antagonists → ondansetron
• Anti-histamines → cyclizine
• Anti-cholinergic → hyosine
• Dopamine receptor antagonist → phenothiazine
• Increase gastric emptying → metoclopramide