NURS 4200 CH 20.pdf

Postoperative Care Overview Postoperative Care begins immediately after surgery and is usually next to the operating room (OR). The focus is on maintaining patient safety and identifying potential problems. Frequent assessment and intervention are necessary for patients. The patient's safet...

Postoperative Care Overview Postoperative Care begins immediately after surgery and is usually next to the operating room (OR). The focus is on maintaining patient safety and identifying potential problems. Frequent assessment and intervention are necessary for patients. The patient's safety is the primary determinant of the level of care. The patient is admitted directly to Phase II, where patient safety is the primary determinant of care. The patient undergoes an initial recovery period in the PACU, with a hand-off report. The nursing care focus is on immediate postoperative care, including initial assessment of the aortic canals (ABCs), constant vigilance, and ECG monitoring. The patient is transitioned to Phase II. Postanesthesia Phase I includes various types and sizes of artificial airways, ventilators, oxygen delivery methods, acoustic transducers/sensors, suction equipment, and supplies to measure blood pressure and vital signs. The patient's vital signs are stable, and her abdominal dressing is clean and dry. Other postoperative assessments include airway, breathing, respiratory rate and quality, blood sounds, supplemental oxygen, pulse oximetry, capnography, coagulation, ECG monitoring, vital signs, peripheral pulses, capillary refill, skin color and temperature, neurologic, gastrointestinal, and gastrointestinal assessments. Postoperative Complications in Medical Hypothermia Postoperative Complications Airway obstruction, hypoxemia, atelectasis, pulmonary edema, pulmonary embolism, aspiration, bronchospasm, and hypopoventilation are potential postoperative complications. Proper patient positioning, oxygen therapy, coughing and deep breathing, and sustained maximal inspiration are key interventions. Splinting with a pillow or blanket can prevent hypertension, hypertension, dysrhythmias, VTE, and syncope. Cardiovascular and fluid and electrolyte complications can be prevented through frequent vital signs monitoring, continuous ECG monitoring, adequate fluid replacement, and early ambulation. Neuropsychologic complications can be prevented through monitoring oxygen levels, oxygen therapy, pain management, and reverse agents. Pain and discomfort can be prevented through behavioral modalities, single modalities, multimodal analgesia, and patient-controlled analgesia (PCA). Hypothermia, shivering, fever, malignant hyperthermia, and temperature changes can be managed through passive or active warming, oxygen therapy, opioids, and modalities like Dantrolene. Postoperative gastrointestinal (GI) complications can be prevented through NPO, IV fluids, clear liquids, antiemetics/prokinetics, alternative therapy, adequate hydration, and early mobilization. Urinary complications can be prevented through monitoring urine output, hydration, removal of urinary catheter, normal positioning for elimination, bladder scan, and removal of the urinary catheter. Nursing Interventions for Wound Infections in M.H. Oral and intestinal flora: Fluid accumulation in the wound, postoperative complications, and surgical site infection. Nursing Interventions: Assessing the wound, noting drainage color, consistency, and amount, and assessing the effect of position changes on wound/drain tube drainage. Decision to discharge: Based on written criteria, approved by anesthesiology and medical staff. Discharge criteria: Consciousness, activity, respiration, and oxygen saturation. Pain management: Controlled nausea and vomiting. Phase I discharge: Observation, assessment, and recommendation. Postoperative care: Preparation for self-care at home, extended observation, and same-day surgery. Discharge teaching: Verbal and written instructions, teach-back method, document teaching, care of incisions and dressings, actions and side effects of medications, activities allowed and prohibited, dietary restrictions and modifications. Common reasons to seek help after discharge: Unrelieved pain, questions about medications. Postoperative Recovery and Complications Postoperative Recovery Patient M.H. is 2 days into postoperative recovery.  Vital signs include BP 155/74, HR 87 (regular), RR 20, oral temperature 101.6° F. SaO2 is 93% on room air. Crackles are heard upon auscultation in her bilateral lower lobes. Skin is warm and dry. Absence of bowel sounds in all four quadrants. Abdomen is tender and slightly distended. NG is connected to intermittent low wall suction and draining brownish-green drainage. Postoperative Complications Possible complications include atelectasis, pneumonia, dehydration, wound infection, phalebitis, and urinary infection. Priority interventions include notifying the surgeon, using SBAR to communicate concerns to the surgeon, increasing mobility, giving pain medication, and increasing fluid intake. Discharge Five days after surgery, M.H. is being discharged. Priorities include hemodynamic stability, pain and comfort management, surgical site and dressings/drainage tubes, fluid/hydration status, mobility status, emotional status, patient safety needs, and significant other interactions. Discharge Criteria Decreased respiratory function, altered vascular function, drug toxicity, mental status changes, and pain control are the discharge criteria. Gerontologic Considerations A patient becomes restless and agitated in the postanesthesia care unit (PACU). The nurse should check the patient’s oxygen saturation, increase the rate of IV fluids, notify the anesthesia care provider, perform neurovascular checks on the lower extremities, and use a cardiac monitor to assess the patient’s heart rhythm.