Postoperative Care in PACU

Postoperative Care

• First phase of postoperative care takes place during the immediate recovery period, from leaving the Operating Room (OR) to stabilization in the Post Anesthesia Care Unit (PACU) and transfer to the nursing unit.

Critical Period

• The first 1-2 hours are the most critical for assessing aftereffects of anesthesia, including airway, cardiovascular complications, temperature control, and neuro function.

Complications and Scoring Systems

• Post-anesthesia complications and problems vary by anesthesia type, and the Practical Nurse (PN) should be aware of these.
• Scoring systems, such as the Aldrete score, assess patient recovery using different parameters:
  • Score of 10 indicates full patient recovery
  • Score of 8 or less indicates additional monitoring is required

Postoperative Care

• The first phase of postoperative care takes place during the immediate recovery period, from the time the patient leaves the Operating Room (OR) to the time they are stabilized in the Post Anesthesia Care Unit (PACU) and transferred to the nursing unit.

Critical Period

• The first 1-2 hours after anesthesia are the most critical period for assessing potential aftereffects.
• Important areas to assess during this period include:
  • Airway
  • Cardio complications
  • Temperature control
  • Neuro function

Anesthesia Complications

• The Postoperative Nurse (PN) should be aware of common complications and problems associated with specific types of anesthesia.
• General Anesthesia potential side effects and symptoms include:
  • Hypotension
  • Changes in Heart Rate (HR) and rhythm
  • Lowered body temperature
  • Respiratory depression
  • Emergence of delirium, manifested as:
    • Shivering
    • Trembling
    • Confusion
    • Hallucinations

Scoring Systems

• Scoring systems, such as the Aldrete score, are used to evaluate post-operative patients before transferring them back to the floor.
• The Aldrete score uses different parameters and assigns a score from 0 to 10.
• A score of 10 indicates full recovery, while a score of 8 or less indicates that additional monitoring is required.

Post-Surgery Expectations

• Patients' breath sounds remain clear and bilateral after surgery.
• Vital signs remain within normal limits (WNL) and consistent with pre-operative baseline.
• Incision or wound edges are well-approximated, with little to no drainage noted.
• Fluid balance is maintained, as evident by matching intake and output.
• Normal bowel sounds are expected to return within 48-72 hours after general anesthesia.
• Patient and caregiver demonstrate understanding of post-operative care, including recognizing potential complications, dietary modifications, and activity restrictions.

Postoperative Care

• The first phase of postoperative care takes place during the immediate recovery period, from the time the patient leaves the OR to the time they are stabilized in the Post Anesthesia Care Unit (PACU) and transferred to the nursing unit.
• The first 1-2 hours are the most critical period for assessing aftereffects of the anesthesia.

Critical Period Assessment

• The PN should be aware of the common complications and problems associated with the specific types of anesthesia.
• Assessments during this period include:
  • Airway
  • Cardio complications
  • Temperature control
  • Neuro function

Scoring Systems

• Scoring systems, such as the Aldrete score, are used to assess post-op patients before sending them back to the floor.
• The Aldrete score uses different parameters, and a score of:
  • 10 indicates full recovery of the patient
  • 8 or less indicates that additional monitoring is required

General Anesthesia Complications

• Common complications and signs of general anesthesia include:
  • Hypotension
  • Changes in HR/rhythm
  • Lowered body temperature
  • Respiratory depression
  • Emergence of delirium (shivering, trembling, confusion, or hallucinations)

Expected Outcomes

• Following surgery, patients are expected to:
  • Have clear breath sounds bilaterally
  • Maintain vital signs within normal limits consistent with pre-op baseline
  • Have well-approximated incision/wound edges with little to no drainage
  • Show evidence of fluid balance through intake and output
  • Have normal bowel sounds within 48-72 hours
  • Display insight and ability to describe complications to watch for, dietary modifications, and activity restrictions
• If the patient is lethargic, position them with their head extended and support in a side-lying position.

Postoperative Care

• The first phase of postoperative care takes place during the immediate recovery period, from the time the patient leaves the OR to the time they are stabilized in the Post Anesthesia Care Unit (PACU) and transferred to the nursing unit.
• The first 1-2 hours are the most critical period for assessing aftereffects of the anesthesia.

Critical Period Assessment

• The PN should be aware of the common complications and problems associated with the specific types of anesthesia.
• Assessments during this period include:
  • Airway
  • Cardio complications
  • Temperature control
  • Neuro function

Scoring Systems

• Scoring systems, such as the Aldrete score, are used to assess post-op patients before sending them back to the floor.
• The Aldrete score uses different parameters, and a score of:
  • 10 indicates full recovery of the patient
  • 8 or less indicates that additional monitoring is required

General Anesthesia Complications

• Common complications and signs of general anesthesia include:
  • Hypotension
  • Changes in HR/rhythm
  • Lowered body temperature
  • Respiratory depression
  • Emergence of delirium (shivering, trembling, confusion, or hallucinations)

Expected Outcomes

• Following surgery, patients are expected to:
  • Have clear breath sounds bilaterally
  • Maintain vital signs within normal limits consistent with pre-op baseline
  • Have well-approximated incision/wound edges with little to no drainage
  • Show evidence of fluid balance through intake and output
  • Have normal bowel sounds within 48-72 hours
  • Display insight and ability to describe complications to watch for, dietary modifications, and activity restrictions
• If the patient is lethargic, position them with their head extended and support in a side-lying position.

Post-Operative Care

• Assess vital signs at least every 4 hours or as prescribed.

Infection and Wound Care

• Monitor temperature: > 37.8°C on the third day+ after surgery may indicate wound infection, pneumonia, or phlebitis.
• Closely monitor wound healing and change dressings as ordered by the surgeon/physician.
• Wound infection often occurs 3-6 days after surgery, while wound dehiscence occurs 3-11 days after surgery.

Hygiene and Care

• Ensure dressings do not get wet and wash off excess betadine/soluprep or bodily fluids during hygiene/care.
• Monitor and maintain wound drainage devices, emptying them when half full.

Respiration and Comfort

• Provide mouth care as needed every 2 hours and offer ice chips if permitted.
• Encourage patients to turn, cough, deep breathe, and use an incentive spirometer.

Mobility and Prevention

• Monitor compression devices and apply TED stockings/anti-embolic stockings to lower extremities as prescribed.
• Promote early ambulation and activity as prescribed, considering postural/orthostatic hypotension.

Nutrition and Fluids

• Assess patient progress from NPO to clear liquids to regular diet as tolerated.
• Discontinue IV fluids after oral intake is tolerated.

Patient-Centered Care

• Involve patients and caregivers in the decision-making process and provide emotional support.

Postoperative Care

• The first phase of postoperative care takes place during the immediate recovery period, from the time the patient leaves the Operating Room (OR) to the time they are stabilized in the Post Anesthesia Care Unit (PACU) and transferred to the nursing unit.
• The first 1-2 hours are the most critical period for assessing aftereffects of the anesthesia, including airway, cardio complications, temperature control, and neuro function.

Common Complications and Problems

• The PN should be aware of common complications and problems associated with specific types of anesthesia.
• General Anesthesia complications may include:
  • Hypotension
  • Changes in heart rate/rhythm
  • Lowered body temperature
  • Respiratory depression
  • Emergence of delirium in the form of shivering, trembling, confusion, or hallucinations

Scoring Systems

• Scoring systems, such as the Aldrete score, are often used before sending post-op patients back to the floor.
• A score of 10 on the Aldrete scale indicates full recovery of the patient, while a score of 8 or less indicates that additional monitoring is required.

Expected Outcomes

• Following surgery, patients' breath sounds remain clear bilaterally.
• Vital signs remain within normal limits (WNL) consistent with pre-op baseline.
• Incision/wound edges are well-approximated with little to no drainage noted.
• Fluid balance is evident by intake and output.
• Normal bowel sounds are expected within 48-72 hours due to general anesthesia.
• Patient/caregiver displays insight, able to describe complications to watch for, dietary modifications, activity restrictions, etc.

Assessment and Care

• Assess vital signs at least every 4 hours or as prescribed.
• Monitor temperature closely, as a temperature greater than 37.8 on the third day+ after surgery may indicate wound infection, pneumonia, or phlebitis.
• Closely monitor progress of wound healing and change dressings as ordered by the surgeon/physician.
• Monitor drainage and maintain wound drainage devices, emptying them when half full.
• Provide mouth care if needed q2h and offer ice chips if permitted.
• Encourage patient to turn, cough, deep breathe, and use incentive spirometer.
• Monitor function of compression devices and apply TED stockings/anti-embolic stockings to lower extremities as prescribed.
• Promote early ambulation and activity as prescribed, while keeping in mind postural/orthostatic hypotension.

Nutrition and Hydration

• Assess patient as they progress from NPO, clear liquids, to regular diet as tolerated.
• Note that IV fluids are usually discontinued after oral intake is tolerated.

Patient Education and Support

• Always remember to include patient/caregiver in the decision-making process and provide emotional support as patients may be anxious or fearful.