Nursing Management: Postoperative Care PDF

Nursing management: Postoperative care Virginia Plummer Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Learning Out...

Nursing management: Postoperative care Virginia Plummer Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Learning Outcomes By the end of this topic, learners should be able to; demonstrate an in-depth understanding of the pathophysiology of alterations in oxygenation, perfusion, renal/urological function, regulation, digestion, absorption, elimination and metabolism and the problem of pain. explain methods and techniques used to conduct a comprehensive nursing history and focused physical assessment, using a systematic primary and secondary survey approach; explain the way in which pain assessment frameworks and tools can be used to assess pain in surgical contexts, and across diverse population groups; recognize the clinical cues for patient deterioration with reference to the postoperative period. apply a critical analysis of assessment findings and an in-depth understanding of clinical reasoning cycle to develop a therapeutic plan of care for patients during the postoperative period. outline the collaborative management strategies for patients in the acute care setting and the role of the registered nurse within the team. identify the different roles and responsibilities of the registered nurse in the perioperative setting. develop customized post-operative care processes that are specific to the assessment requirements for range of surgical operations. OFFICIAL  Post anesthesia care unit (PACU) Begins immediately upon completion of surgery ⮚ PACU is located adjacent to OR Priority to protecting patient and preventing post-anaesthetic and post-surgical complications. Patient bays in PACU in Werribee Mercy Hospital Post Anaesthetic Care Unit, Victoria, Australia. (Foran et.al, 2022) OFFICIAL  U ROLE: 1. PRIMARY SURVEY (Rothrock, 2019) 2. HEAD TO TOE ASSESSMENT OFFICIAL Source: Alexander's Care of the Patient in Surgery, Odom-Forren, Jan© 2023. Airway obstruction Causes and relief of airway obstruction from patient’s tongue Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL Postoperative complications ⬤ Respiratory ⬤ Cardiovascular ⬤ Fluid and electrolyte ⬤ Neuropsychological ⬤ Integumentary ⬤ Gastrointestinal ⬤ Urinary Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Decreased respiratory function Altered vascular function Considerations Medication toxicity for older postoperative Mental status changes patients Postoperative delirium (acute confusion) more common in older people Pain control Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  OFFICIAL Discharge systems scoring Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 Discharge criteria from PACU? Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Day surgery DISCHARGE CRITERIA Must be mobile and alert Cannot drive (responsible adult present) No IV opioids in past 30 minutes Minimal nausea/vomiting May use postanaesthesia discharge scoring system (e.g. PADSS) to determine readiness for discharge. Voided if appropriate to surgical procedure Written discharge instructions given and understood. Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Review of week 1 case scenario Grace Kim is a 72-year-old retired teacher, she was brought in by ambulance to Monash Health post fall (this morning). Grace was playing golf with a friend and slipped on the frosty ground, falling onto her left side. Grace is complaining of pain 8-9/10, localised to her left hip and buttocks. Grace is distressed and has asked if you can contact her next of kin. Grace is sent for an Xray and diagnosed with a left fractured neck of femur (#NOF). She is scheduled for surgery tomorrow morning 0700hrs. Temperature – 36.2°C BP – 138/92 HR – 113 RR – 20 SpO2 – 98% RA, GCS = 15; PEARTL On Examination: Grace’s left leg is internally rotated, and bruising is noted on her left hip and buttocks. Past history: Osteoporosis (left hip and cervical spine), Gastroesophageal Reflux Disease (GORD), Smoker (approx. 20 cigarettes/day). Type 2 diabetes Family history: Osteoporosis, Peptic Ulcer Disease (PUD) (mother); T2DM (father) Current medications: Caltrate 1200 mg/d; Ranitidine 150mg/d; Paracetamol 1g PRN Social: Grace is a widower and lives alone. She has an adult daughter, who lives Interstate. Grace states that she has a close network of friends. OFFICIAL  Postoperative information Grace has just been transferred from the operating room to the post anaesthesia care unit (PACU). You receive the following handover: You will need to note this down Drowsy but rousable Temp – 36.5 BP – 115/65mmHg HR – 87bpm RR – 16bpm SpO2 – 98% (6L via Hudson Mask) PLEASE BRING YOUR HANDOVER TO THE TUTORIAL THIS WEEK OFFICIAL Please complete the fluid and electrolyte online activity OFFICIAL  References Brown, D., Buckley, T., Aitken, R., & Edwards, H. (2023). Lewis’s Medical-Surgical Nursing 6th Australia and New Zealand Edition: Assessment and Management of Clinical Problems. Elsevier Health Sciences Foran P, Johns K, Davies M, CHAPTER 12 - Postanaesthesia nursing care, Perioperative Nursing (Third Edition), edited by Sutherland-Fraser Sally,Davies Menna,Gillespie Brigid M.,Lockwood Ben, 2022, Pages 415-446. Lemone, P., Burke, K., Bauldoff, G., Gubrud-Howe, P., Levett-Jones, T., Dwyer, T., Moxham, L., Reid- Searl, K., Berry, K., Carville,M, Hales, & Knox, N. (2020). Lemone and Burke’s medical-surgical nursing : critical thinking for person-centred care, Vol.1-3. Pearson Australia. Odom-Forren Jan, Chapter 10 - Postoperative Patient Care and Pain Management, Alexander's Care of the Patient in Surgery (Seventeenth Edition), edited by Rothrock Jane C. PhD RN CNOR FAAN, 2023, Pages 256-283, ISBN 978-0-323-77680-6, http://dx.doi.org/10.1016/B978-0-323-77680-6.00010-8. OFFICIAL