AY24-25 Fall NUR-2332 Adult Health Nursing Week 6 Postoperative PDF

College of Health Sciences Department of Nursing Bachelor of Science in Nursing (BSN) Program NUR- 3343 Adult Health Nursing Presented by: Dr. Mona Afifi  Week 6: Postoperative Student Leaning Outcomes (SLOs) P...

College of Health Sciences Department of Nursing Bachelor of Science in Nursing (BSN) Program NUR- 3343 Adult Health Nursing Presented by: Dr. Mona Afifi  Week 6: Postoperative Student Leaning Outcomes (SLOs) PLO1: Demonstrate a sound knowledge of the essential concepts and theories related to the nursing practice. By the end of this session students will be able to: 1. Describe the responsibilities of the post anesthesia care unit nurse in the prevention of immediate postoperative complications. (CLO1) 2. Identify common postoperative problems and their management. (CLO4)  Lecture Outline ✔ Introduction ✔ Postoperative ✔ Postanethesia Care Unit ✔ Complications and its intervention ✔ Critical Thinking Questions  Introduction  Postoperative Phase Begins with the admission of the patient to the PACU End With a follow-up evaluation in the clinical setting  Postoperative Phase This period may be as short as 1 week or As long as several months  During postoperative period nursing care focuses on: ✔ Physiologic equilibrium ✔ Alleviating pain ✔ Preventing complications ✔ Teaching patient self-care  Post anesthesia Care Unit (PACU) Also called post anesthesia recovery room. An area designed to:  Provide care for patients recovering from Anesthesia  Post Anesthesia Care Unit (continued) PACU is:  Kept quite, clean and, free of unnecessary equipment.  Well ventilated.  Sound proof ceiling.  Isolated but visible quarters for disruptive patient.  Pleasing colors and has indirect lighting.  Post Anesthesia Care Unit (continued) These features benefit the patient by helping to decrease anxiety and promote comfort.  Post Anesthesia Care Unit (continued) Phases of Post Anesthesia Care Phase I PACU  Used during the immediate recovery phase.  Intensive nursing care is provided. Phase II PACU  Reserved for patients who require less frequent observation.  For discharge.  Post Anesthesia Care Unit (continued) Admitting patient to the PACU The nurse who admits the patients to PACU:  Reviews information with anesthesiologist 1. Medical diagnosis and type of surgery performed 2. Pertinent past medical history and allergies 3. Age and general conditions, airway patency, vital signs 4. Anesthetics and other medications used during procedure  Post anesthesia Care Unit (continued) The nurse who admits the patients to PACU:  Reviews information with anesthesiologist 5. Problems occurred in OR that might influence postoperative care. (e.g.. Shock, extensive hemorrhage, cardiac arrest) 6. Pathology encountered. 7. Fluid administered, estimated blood loss and replacement. 8. Any tubing, drains, catheters, other supportive aids.  Post Anesthesia Care Unit (continued) Responsibilities of PACU Nurse Conducts postoperative observation of the patient:  Oxygenation The nurse should first assess the Patient’s oxygen saturation  Ventilation  Circulation status Carries postoperative medical orders Ensures client’s safety Controls and prevents infection Maintains patent airway and cardiovascular stability  Relieves pain and anxiety  Post Anesthesia Care Unit (continued)  Nursing Management in PACU  Assesses patient’s:  Checks for any allergies - Airway  And reactions to drugs and materials - Breathing used during surgery - Circulatory status  Determine the level of consciousness  Assess for any: -Drains -Description of drains -Electrosurgical burns -Other body contraptions  Post Anesthesia Care Unit (continued)  Oxygenation  Administer oxygen  Monitor oxygen saturation level  Assess need for continued oxygen  Elevate head of bed if not contraindicated  Encourage patient to take deep breaths  Post Anesthesia Care Unit (continued)  Airway Management  Determine for chin tilt or jaw thrust if patient is non-reactive without patent airway Insert artificial airway if needed.  Call physician for further assistance  Assess patient for level of comfort (pain score)  Post Anesthesia Care Unit (continued)  Circulatory Status  Check wound site for: Any excessive oozing and bleeding  Assesses peripheral circulation  Monitors and records intake and output  Administers fluid and blood products if ordered  Controlling nausea and vomiting  Post Anesthesia Care Unit (continued) Classification of Hemorrhage  Post Anesthesia Care Unit (continued) Pain Assesses Pain Scale once conscious. Monitors vital signs: -every 10 minutes for the first 30 minutes -then every 15 minutes for the next hour. Encourages patient to take deep breaths once awake.  Post Anesthesia Care Unit (continued) Temperature Take body temperature on admission; document temperature Initiate appropriate measures for hyperthermia and hypothermia Maintain ongoing vital signs -monitoring every 10 minutes for the first 30 minutes -then every 15 minutes thereafter. CLO 4 Achieved  Post Anesthesia Care Unit (continued) Modified Aldrete Score  Readiness of patient to be safely discharged : - From the PACU to a recovery area, a different hospital ward, or a home.  Postoperative Phase (continued) The major goals for the patient include:  Optimal respiratory function  Relief of pain  Optimal cardiovascular function  Increased activity tolerance  Unimpaired wound healing  Maintenance of body temperature The postoperative patient  Maintenance of nutritional balance is subject to: a number of potential complications.  Postoperative Phase (continued) Nursing Intervention to Prevent Complications:  Pneumonia and Atelectasis (VIP)  Encourage early ambulation.  Encourage the patient to do deep breathing& coughing exercise  Encourage the use of the incentive spirometer.  Provide chest physiotherapy as prescribed.  Encourage fluid intake.  Complications and its Interventions Nursing Intervention to Prevent Normal Finding at the surgical site: Complications: Serous drainage  Infection  Promoting wound healing Abnormal finding at the surgical site :  Red, hard skin  Adequate nutrition  Warm, tender skin  Rest, Proper Position  Purulent drainage  Wound care/Changing the dressing  Complications and its Interventions (continued) Nursing Intervention to Prevent Complications:  Deep Vein Thrombosis  Early ambulation  Hourly leg exercises  Avoid use of blanket rolls, pillow or  any form of elevation that can constrict vessels under the knees  Adequate hydration  External pneumatic compression  Compression stockings  Complications and its Interventions (continued) Nursing Intervention to Prevent Complications:  Wound Dehiscence and Evisceration  Abdominal binder  Avoid infection  Teach the patient to support the wound during coughing or sneezing Wound dehiscence (disruption of surgical incision or wound) and evisceration (protrusion of wound contents) CLO 1 Achieved  Critical Thinking Question No. 1 1. Which problem should the nurse identify as priority for patient who is one day post op? a. Potential for injury b. Potential for hemorrhage c. Potential for fluid volume excess d. Potential for infection 2. Jake complains of mild pain in the incision site while performing deep- breathing and coughing exercises. The nurse’s best response would be: a. “Pain will become less each day.” b. “This is a normal reaction after surgery.” c. “I will give you the pain medication the physician ordered.” d. “With a pillow, apply pressure against the incision.”  References Prescribed Text Book/s Smeltzer, S., & Bare, B., Hinkle, J., & Cheever, K. (2017). Brunner and Suddarth's textbook of medical surgical nursing (14th Ed.). Philadelphia, PA.: Lippincott. Recommended Readings Textbook Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis's Medical-surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.