Postoperative Nursing Management Quiz

Postoperative Nursing Management

• Postoperative care begins when the patient leaves the operating room and lasts until the final follow-up.
• Nursing care focuses on restoring physiological equilibrium, alleviating pain, preventing complications, and educating patients on self-care. Ongoing care may include telephone follow-up.

Post Anesthesia Care Unit (PACU) Care

• Patients are still under or recovering from anesthesia in the PACU.
• PACU care is divided into two phases:
  • Phase I: Immediate recovery phase, providing intensive care. Patients transition to a nursing unit or Phase II PACU.
  • Phase II: Preparation for self-care, transfer to an inpatient unit, extended care, or discharge.

Admitting Patients to the PACU

• The anesthesiologist or CRNA, along with other OR staff, is responsible for transferring patients.
• The anesthesia provider stays at the head of the stretcher during transport to maintain the airway, while another team member is at the opposite end.
• Crucial information, such as patient position, wounds, drains, parameters, and privacy, are considered.
• The PACU nurse reviews essential information with the anesthesiologist or CRNA.

Nursing Management in the PACU

• The goal is to monitor and provide care until patients recover.
• The criteria for recovery include: Return to baseline cognitive function, clear airway, controlled nausea/vomiting, and stabilized vital signs.
• Nurses use critical skills and training to identify early complications (e.g., hemorrhage or respiratory distress).
• Lengthy surgeries may result in direct transfer to the intensive care unit (ICU).

Assessing the Patient (PACU)

• A baseline assessment includes airway, level of consciousness, cardiac and respiratory status, wound condition, and pain.
• All drainage tubes are checked to ensure proper connection and function.
• Current IV fluids and medications are verified.

Maintaining a Patent Airway (PACU)

• Administer supplemental oxygen as prescribed.
• Monitor respiratory rate, depth, ease of breathing, oxygen saturation, and breath sounds.
• Elevate the head of the bed 15-30 degrees unless contraindicated.
• Position patients on their side if vomiting occurs to prevent aspiration.

Maintaining Cardiovascular Stability (PACU)

• Monitor the patient's level of consciousness (LOC), vital signs, cardiac rhythm, skin temperature, colour, and moisture, and urine output (UOP).
• Key cardiovascular complications monitored in the PACU include hypotension, shock, hemorrhage, hypertension, and arrhythmias.
• The nurse assesses the patency of all IV lines.

Relieving Pain and Anxiety (PACU)

• Monitor a patient's physiological status and manage pain to ease fears and concerns.
• Opioid analgesics are commonly administered intravenously.
• Non-pharmacological interventions should also be considered.

Controlling Nausea and Vomiting (PONV)

• Around 30%-50% of surgical patients experience Postoperative Nausea and Vomiting (PONV).
• It's managed with medications, both intra- and postoperatively.
• Risk Factors: female gender, age under 50, history of PONV, and opioid use.

Gerontologic Considerations (PACU)

• Older adults are more susceptible to hypothermia. Regularly adjust the patient’s position to stimulate respiration, promote circulation and maintain comfort.
• Carefully monitor for cardiopulmonary deficits.
• Be alert for and plan for postoperative confusion and delirium.

Determining Readiness for PACU Discharge

• Patients remain in the PACU until fully recovered from the anesthetic agent.
• Indicators of recovery: Stable blood pressure (BP), adequate respiratory function, and acceptable oxygen saturation(O2 sat).
• The Aldrete score is utilized to assess readiness for transfer from the PACU (scores typically between 7 and 10).

Preparing Postoperative Patients for Direct Discharge

• Ambulatory procedures often transition patients directly home from a step-down PACU
• Patient education is crucial, encompassing verbal and written instructions about postoperative changes and expected outcomes.
• The patient and caregiver should receive clear information about possible complications. Includes recovery time, prescriptions, and care instructions.

Care of the Hospitalized Postoperative Patient

• Most surgical patients requiring hospital stays have multiple needs and require frequent assessment and care interventions.
• Immediate interventions upon admission to the clinical unit include assessing breathing and administering supplemental oxygen as needed; monitoring vital signs and assessing skin color, warmth, and moisture; assessing surgical sites and wound drainage systems; connecting and monitoring closed drainage systems; assessing level of consciousness, orientation, and mobility; and evaluating pain level.

Surgical Drains

• Drains are tubes to remove fluids and prevent infection, either into a portable system or the dressings.
• Nursing care focuses on monitoring and recording drainage output frequently.

Maintaining Normal Body Temperature

• Postoperative patients are at risk for hypothermia.
• Measures to maintain a comfortable temperature include keeping the room environment warm. Blanket coverage, hydration and nutrition are also important.

Managing Gastrointestinal Function

• Decreased mobility, decreased oral intake and analgesic medications can result in difficulty with bowel movements.
• Manipulation of the abdominal organs during surgery can disrupt peristalsis (normal bowel activity) for up to 48 hours.
• Managing GI function includes monitoring bowel sounds, encouraging frequent positioning and movement (exercise), and administering stool softeners. A nasogastric tube might be used to manage vomiting and distention.

Managing Voiding

• Patients are typically expected to urinate within 8 hours of surgery.
• Encourage voiding by providing access to a bedpan or urinal and, if needed, providing fluids.
• Intermittent catheterization may be necessary if the patient cannot urinate.

Maintaining a Safe Environment

• In the immediate postoperative period, keep two-side rails up for safety.
• Position the bed at a low level.
• Assess the patient's level of consciousness and orientation.
• Maintain a call light within reach.
• Restraints may be required, following agency policy.