Postoperative Care Flashcards
Postoperative period is
Begins immediately after surgery until they are discharged
Phase 1 PACU
- initial recovery period in PACU
2. Hand-off reporting (ACP) stays until ready to accept
Nursing care focus for phase 1
i. Immediate postoperative care
1. Constant vigilance is required
2. ECG and more intense monitoring required
3. ABCs
Intraoperative management (6 things)
i. Anesthetic agents
ii. Other drugs received preop or intraop
iii. Last dose of opioids admin/p! management plan
iv. Total fluid replacements, including blood transfusions
v. Total fluid loss (e.g. blood, NG drainage)
vi. Urine Output
Intraoperative course (5 things)
i. Unexpected anesthetic events or reactions
ii. Unexpected surgical events
iii. Most recent VS and monitoring trends
iv. Results of lab tests/x-rays
Postoperative Assessment (6 things)
- ABCs
- Neuro
- GU/GI
- Surgical site
- Pain
- Lab/diagnostic tests
Potential post-op complications (5 things)
- Airway obstruction
- Hypoxemia
- Aspiration
- Bronchospasm
- Hypoventilation
Hypoxemia (4 things)
- Atelectasis (risk of leading to pneumonia)
- Pulmonary edema
- Smokers are at greatest risk
- Lung disease
Hypoventilation related to
opioid use or blocker
smoking
Proper patient positioning
i. Lateral “recovery” position
ii. Once conscious—supine position
Sustained maximal inspiration
Pt inhale deeply, hold breath for few seconds, exhale, then inhale & cough
Postoperative complications cardiovascular
a. Hypotension
b. Hypertension
c. Dysrhythmias
i. Looking at EKG
d. VTE
e. syncope
Directly affects cardiac output
fluid & electrolytes
Nursing Interventions to Prevent Neuropsychologic Complications
a. Monitor oxygen levels with pulse oximetry
b. Oxygen therapy
c. Pain management
d. Reversal agents (Phase I)
e. Assess for anxiety and depression
f. Alcohol protocols
Postoperative Complication Alterations in Temperature
Hypothermia/shivering
fever
malignant hyperthermia
Postoperative Complications Gastrointestinal
a. Postop nausea/vomiting (PONV)
b. Constipation (secondary to anesthesia & immobility, opioids)
c. Postoperative ileus
i. Intolerance of oral intake
d. Delayed gastric emptying
e. Hiccups
Phase 1 Discharge Criteria
a. Patients awake (or at baseline)
b. Vital signs at baseline or stable
c. No excess bleeding or drainage
d. No respiratory depression
e. Oxygen saturation greater than 92%
f. Pain management
g. Nausea and vomiting controlled
Contamination of the wound
Exogenous flora
oral flora
intestinal flora
s/s of infection
- Fever
- Pain
- Increased amount of drainage
- Redness/edema
PACU Progression Post-anesthesia Phase II, occurs in
impatient setting
intensive care area
Nursing care focus
i. Preparation for care in the home
ii. Extended observation
Discharge criteria phase II ambulatory surgery
i. All PACU discharge criteria (Phase I) met
ii. No IV opioids in past 30 minutes-cannot go home
iii. Voided if appropriate to surgical procedure
iv. Able to ambulate if not contraindicated
v. Responsible adult present to drive patient home
vi. Written discharge instructions given and understood
Common reasons to seek help after discharge (ambulatory surgery)
i. Unrelieved pain
ii. Questions about medications
iii. Wound drainage and/or bleeding
iv. Increased drainage from a drainage device
v. Fever greater than 100°F
Phase II Discharge criteria
a. Hemodynamic stability
b. Pain and comfort management
c. Condition of surgical site and dressings/drainage tubes
d. Fluid/hydration status (voided if appropriate)
e. Mobility status—can ambulate if not contraindicated
f. Emotional status
g. Patient safety needs
h. Significant other interactions
