Post-Operative Phase: Module 3

Post-Operative Phase Overview

• Begins with patient admission to the PACU and ends when healing is complete.
• Divided into three stages: Immediate (1-4 hours), Intermediate (4-24 hours), and Extended (1-4 days) post-surgery.

Post Anesthesia Care Unit (PACU)

• Also known as recovery room; designed to reduce patient anxiety and promote comfort.
• Must be clean, quiet, and well-ventilated, with appropriate lighting and equipment.

Admitting the Patient to PACU

• Anesthesia team transports the patient while monitoring the incision site and potential vascular changes.
• Initial nursing assessment includes verifying patient identity, operative procedures, and surgeon.
• Vital signs (respiratory, circulatory, temperature) and stability need close evaluation.

Initial Nursing Interventions

• Maintain patent airway by keeping an airway device until the patient regains consciousness.
• Assist with suctioning excessive secretions and position the patient laterally to enhance ventilation.
• Encourage deep breathing exercises and utilize an incentive spirometer to prevent pneumonia.

Preventing Respiratory Complications

• Recognize signs of complications like atelectasis, pneumonia, and pulmonary congestion.
• Monitor breath sounds regularly; encourage early ambulation and position changes.
• Administer oxygen as prescribed to support respiratory function.

Cardiovascular Stability

• Monitor vital signs closely and check input/output; recognize factors affecting blood volume.
• Be aware of primary cardiovascular complications in PACU: shock, hypotension, hypertension, dysrhythmias, and deep vein thrombosis.
• Interventions to prevent deep vein thrombosis include leg exercises and early mobilization.

Shock and Its Indicators

• Shock is defined by inadequate blood circulation to meet metabolic demands, leading to cell damage.
• Symptoms include cool extremities, decreased urine output, slow capillary refill, hypotension, tachycardia, and cyanosis.

Phases of Wound Healing

• Hemostasis Phase: Begins immediately at injury.
• Inflammatory Phase: Lasts from immediate onset to 2-5 days.
• Proliferative Phase: 2 days to 3 weeks.
• Remodeling Phase: From 3 weeks up to 2 years, scar tissue is only 80% as strong as original tissue.

Types of Wound Healing

• First-intention healing: Clean, approximated incisions heal quickly with minimal scarring (e.g., surgical incisions).
• Second-intention healing: Occurs in wounds with granulation tissue that heal from the edges inward.
• Third-intention healing (delayed closure): Used for deep or infected wounds that are closed later, leading to wider scars.

Wound Drainage Types

• Various drainage systems include Hemovac, Jackson-Pratt, Penrose drain, and T-tube.
• Drains can be either open to a dressing or closed to a portable suction device.

Wound Dehiscence and Evisceration

• Wound dehiscence: Disruption of surgical incision edges.
• Wound evisceration: Protrusion of internal organs through the incision.

Post-Operative Care Focus Areas

• Assess thermoregulatory status and maintain adequate fluid levels.
• Promote patient comfort and safety while managing urinary and bowel elimination.
• Address stress factors related to sensory deficits, relieve pain, and control nausea/vomiting.

Readiness for Discharge from PACU

• Criteria for discharge include stable vital signs, patient orientation, uncompromised pulmonary function, adequate urine output (at least 30 ml/hr), managed nausea/vomiting, and minimal pain.

This quiz covers Module 3 of the post-operative phase, beginning with patient admission to the PACU and concluding when healing is complete. It addresses three stages: Immediate, Intermediate, and Extended, detailing care procedures at each stage following surgery.