Post-Op Nursing Care PDF

Post-Operative stage Introduction - Post-Operative (Post-Op) Nursing Care starts when the patient is transferred out of the operating room. - During the first few hours, the patient is kept at the Post Anesthesia Care Unit PACU, where they receive intensive nursing care. - Followi...

Post-Operative stage Introduction - Post-Operative (Post-Op) Nursing Care starts when the patient is transferred out of the operating room. - During the first few hours, the patient is kept at the Post Anesthesia Care Unit PACU, where they receive intensive nursing care. - Following that stage, the patient enters the long postoperative stage, where nurses aim to continue stabilizing their physiology, prevent complications and rehabilitation. - Depending on the type of surgery performed and the patient’s comorbidities, this stage ranges from days to months of care. Critical components of the handoff report from the PACU: Physical Assessment data, such as pain and level of consciousness Prescribed Activity Restrictions or Joint/Limb Immobility Type/Extent of Procedure. Low Hemoglobin Management. Anesthesia Type/Duration Allergies Health Problems. Vital Signs Status. IV Fluids/Medications. Estimated Blood Loss (EBL). Urine Output Drain Placement and Output Intraoperative Complications Incisions/Dressings. Common post OP problems: During post OP assessment, patient may have one of the following: - Ineffective respirations - Acute pain - Uncontrolled nausea and vomiting - Nutrition and fluid deficiency - Constipation - Urine retention - Imbalanced body temperature - Impaired skin integrity - Risk of injury - Activity Intolerance - Venous Thromboembolism VTE 1- Ineffective Respirations: - The majority of post-op patients will be receiving opioids, and they will most likely be spending extended periods in bed. This may put the patient at risk of developing respiratory complications (Atelectasis, Pneumonia, Hypoxemia). - Prevention and early recognition of symptoms are crucial to avoiding pulmonary complications. While assessing the patient’s respiratory system, look out for any changes in their breathing pattern, unusual breath sounds or sputum production. - Encourage your patient to change their position in bed frequently and regularly mobilize throughout the day, unless contraindicated. - Explain to your patient how to perform deep breathing exercises to expand the lungs fully. Coughing effectively is important to expel secretions and clear the airway. However, it is contraindicated if the patient had a head injury, intracranial surgery or eye surgery. - If the patient is too frail to cough up secretions, chest physiotherapy might be used to clear the airways. And lastly, oxygen therapy may be prescribed in some patients to prevent hypoxia. 2- Acute pain: - Postoperative pain management focuses on preventing pain rather than treating pain. Analgesia treatments are often prescribed at regular intervals to keep the patient on an effective therapeutic dose. The most common approaches for postoperative pain management include: 1 - Opioid Analgesics, such as codeine, morphine and fentanyl 2 - (PCA), which usually contains opioid analgesics. 3 - Epidural or Intrapleural Infusion 4 - Local Anaesthetic Block - Ask your patient to locate their pain and give it a score from a range of 1-10, with 10 being very severe pain. This will allow you to monitor the effectiveness of the chosen pain management. - If your patient is receiving opioid analgesics, you’ll need to check their vital signs and evaluate their level of consciousness before every administration. - Explain the expected side effects to your patient. And, if the patient has a PCA, explain how to use it and reassure them that it is safely programmed to maintain therapeutic drug level and avoid overdose. - If your patient has a local anesthetic block, you should check the expected duration and monitor accordingly. 3- Nausea and Vomiting (PONV) - PONV is a very common occurrence, and it can also cause several complications, including: i. Dehydration, hypotension and electrolyte imbalance ii. Airway obstruction iii. Oesophageal tears iv. Stress on the suture lines and incision dehiscence. - Hence, you need to administer prescribed antiemetic medications or GI stimulants at the first signs of nausea. You should also position the patient upright to decrease the risk of aspiration. - If the patient is expected to have a high chance of vomiting post-operatively, a Nasogastric Tube (NGT) is inserted before initiating the surgery. And it is kept in place until the patient’s GI tract returns to normal function. 4- Nutrition and fluids deficiency - Most patients undergoing surgery, especially those receiving general anesthesia, have to be starved at least 6 hours before the surgery. But in reality, this period is often extended, leaving the patients at risk of fluid deficiency. - Ensure that the intake/output sheet is updated regularly, including all IV or oral fluids consumed before, during and after the surgery. As well as the volume of fluid lost through urine, NG tube, drains and even bleeding. - If the patient does have a fluid deficiency, you should inform the medical team and administer hydrating fluids as prescribed. Typically, these would come in IV form, consisting of 0.9% sodium chloride solution or Ringer Lactate’s solution. - You should also look out for factors that might be affecting your patient’s intake and adjust them accordingly. These might include: A. Difficulty with chewing or swallowing B. Nausea and vomiting (administer prescribed antiemetics) C. Depressed mood D. Difficulty with handling eating utensils E. Diet restrictions due to allergies, personal preferences such as vegans/vegetarians or religious restrictions (provide your patient with food that is within their diet) 5- Constipation - is a common complication faced by many postoperative patients, and while it may start as mild discomfort, it can progress to severe complications if left untreated. In most cases, constipation occurs as a side effect of opioid analgesics, reduced oral intake and decreased mobility. Moreover, gastrointestinal surgery can stop the intestinal movement for several days. - Assist your patient in early ambulation and encourage mobilization throughout the day, unless contraindicated. When permitted, boost fluid intake, administer stool softeners and laxatives as prescribed. 6- Urine Retention - In post OP phase can result from anesthetics, opioid medications and irritation to the urethra (from intra-op catheterization). Also, patient may find it uncomfortable to void in bedpan or urine bottle in bed. - Start by checking the volume of administered fluids and urine voided intra- operatively and in the PACU. Dehydration will likely cause ↓ in urine volume, so administer IV hydration or oral fluids as permitted. - If your patient has urine retention, urinary catheter may be used to empty the bladder. 7- Imbalanced body Temperature 🌡️ - The risk of hypothermia during the surgery is increasingly high. This is because the operating rooms are kept at a relatively low temperature, and, more so, the patients have to lay still on the theatre table with their light hospital gowns. - To manage hypothermia, start by obtaining a temperature reading and evaluating the patient’s environment. Change their soiled gown and sheets with a new clean and warm pair, and use a lightweight blanket to cover their body. If the patient remains cold or has a severely low temperature, you can use patient warming devices. You can also use a fluid warmer when administering IV fluids. - On the other hand, the patient might have been overheated in the operating room or had an ongoing infection that could cause hyperthermia. - In this case, start by adjusting the patient’s environment. Remove any unnecessary blankets and sheets and lower the room temp. Apply cold packs or cold towels to help the patient cool down and continue to administer the fluids at room temperature. If the patient has a fever secondary to an infection, administer paracetamol and antibiotics as prescribed. 8- Skin integrity - Impaired skin integrity in postoperative patients results from inadequate moving and decreased nutrition. The first Ares to be affected are the pressure points over the body bony prominences. - If your patient is bedbound, place padding under their bony prominences and assist them in changing their position frequently. If available, you can also change the patient’s mattress to Air Mattress. Keep the patient’s gown and sheets dry, and avoid friction whenever you ambulate the patient. If your patient is incontinent, change their nappy every time it’s soiled and use a barrier cream as necessary. - Next, check that your patient meets their daily fluid, nutritional requirements, administer any supplemental nutrition as prescribed. Regularly assess their incision site and clean it using an aseptic non-touch technique to avoid surgical site infections. 9- Risk for injury 🤕 - While patients awake from general anesthesia, they may have disturbance in their consciousness and gait, leaving them at a greater risk of falls. Additionally, patients can accidentally pull out their IV lines, catheters or drains, which can cause trauma. - When you admit your patient, keep both of the bed’s side rails up and keep the bed at the lowest level possible. Keep all the necessary items within the patient’s reach to avoid unnecessary movements and show them how to use the nursing call bell. - If your patient is confused and can be a harm to themselves, you should provide cushioning around the bed rails and remove unnecessary items from within their reach. 10- Activity intolerance - Prolonged periods of inactivity contribute to several complications, including atelectasis, constipations, deep vein thrombosis, pressure sores and pneumonia. And unfortunately, most postoperative patients will have a decreased tolerance for activity due to fatigue, pain, depressed moods or misinformation. - After patient moves, recheck his blood pressure and ask if he has any feelings of dizziness or weakness. These symptoms and a drop in blood pressure are signs of orthostatic hypotension. If that occurs, advise your patient to remain seated until the symptoms subside and blood pressure returns to normal. - Disconnect any unnecessary monitoring devices, and secure all IV lines, drains or catheters onto a moving stand. Evaluate their gait, and always remain by the patient’s side until they’re fully stable. - If your patient is bedbound, you should instruct them to perform in bed exercises such as rotating and flexing their arms and legs and contracting their abdominal and gluteal muscles. Moreover, apply VTE prophylaxis measures. 11- Venous Thromboembolism VTE - (DVT) is formation of a blood clot (thrombus) in a deep vein, usually in the legs. It can be manifested by unilateral redness, warmth, edema, and possible calf pain. - If DVT is suspected, you should inform the resident doctor to arrange for venous duplex to confirm. - Pulmonary embolism occurs when thrombus id dislodged from the vein and block the pulmonary artery. It may be manifested by dyspnea, chest pain, hemoptysis (coughing up blood) or restlessness. - It’s a serous complication, so VTE prophylaxis is a must. - Administer prophylactic interventions for prevention of clots and DVTs as prescribed. Interventions may include anticoagulant therapy, good hydration, sequential compression devices (SCD), anti-embolism stockings, and early ambulation. - Continue to monitor for signs of DVT and promptly report any concerns to the resident doctor. **PCA→ Patient-Controlled Analgesia