By: Kristen Glavin, Katherine Baumes

Colleen Ryan, & Kasey Gates

Postoperative

Care

What is Postoperative Care?

Postoperative care refers to the care a patient receives following a surgical procedure. It begins immediately after surgery, continues through the duration of the patient’s stay until discharge, and may continue past discharge from the hospital.

Purpose of Postoperative CareThe purpose of postoperative care is to:●Promote healing to return the patient to a functional level of wellness●Prevent complications ●Facilitate quicker recovery for earlier discharge

Postoperative complications include:●Airway Obstruction●Atelectasis●Pneumonia●PE●Hemorrhage-Internal or External●Thrombophlebitis-DVT●Infection●Pain●Muscle Atrophy●Hypothermia●Hypotension and Hypertension●Residual narcosis●Restlessness

Can you name 3 postoperative complications?

What is Involved in Postoperative Care

Postoperative care involves:●Assessing VS and LOC●Assessing “ABCs”●Surgical wound assessment●Pain Management●Intake and Output (know EBL)●Fluid Management●Nutrition/Diet●Post-operative medications●Assessing Labs●DVT prophylaxis●Position and safety●Post-operative exercises/teaching

You are the RN Receiving a Postoperative Patient On Your Unit…

Here is What You Do● When a patient is ready to be discharged from the PACU, the PACU RN will call

the receiving unit with report.

● The patient coming to your floor will have orders for post-op care based on the procedure, facilities policies, and providing surgeon/doctor. - For example, vital signs, IV fluids and rate, medications, dressings, etc.

● Immediately upon arrival on the unit, the PACU RN and receiving RN will perform a handoff. This includes identification of patient, review of VS, type of surgery and anesthesia performed, blood loss, LOC, general physical condition, IV lines, drainage tubes, and dressings.

●The PACU RN will review the surgeon’s orders, recovery room record, the patient’s condition, and the course of care as well.

●The Receiving RN MUST assess the patient's VS with the PACU RN, comparing them to the last set taken in the PACU to check for patient stability.

●After all of this is completed the PACU RN can leave.

● Once the patient is admitted to the unit, VS should generally be taken every 15 minutes twice, every 30 minutes twice, hourly for 2 hours, and then every 4 hours OR per MD orders. (Perry and Potter pg 1276)

● The receiving RN will continue to monitor the post-op patient’s VS, I&O, surgical wounds/dressings, pain, and labs throughout the patients stay on the unit until discharge.

● Accurate recording of I&O is needed to assess renal and circulatory function. Urinary output can be impaired following surgical procedures due to anesthesia. Part of the I&O assessment would also include EBL from surgery and output from surgical drains.

● Controlling the postoperative patients pain level is crucial. Not only will it provide comfort, but it will also help to facilitate participation in postoperative exercises.

True or False:Since report was given to the receiving unit and RN over the phone, the PACU RN can leave once the post-op patient is on the

unit.

This is FALSE

The PACU RN must stay with the patient and the receiving RN until the receiving RN takes a

complete set of vitals and compares it to the PACU findings, or the patient’s baseline. During this time, the PACU RN will also review the surgeon’s orders, recovery room record, the patient’s condition, and

the course of care.

Postoperative Exercises/Teaching

● Part of postoperative care includes teaching post-op exercises to promote recovery and prevent complications.

● Exercises that you should teach and encourage during the postoperative period include:

- Incentive spirometer- TCDB- Splinting- Ambulation- ROM

Get Your Patient Moving● Encouraging early mobilization of your postoperative patient will help to prevent

complications that develop when there is a decrease in activity such as DVT, pneumonia, and paralytic ileus.

● Ambulation should be implemented as soon as the patient is able to do so, unless otherwise ordered.

● Ambulation promotes recovery, mobilization of secretions in the airways, promotes peristalsis, and facilitates venous return.

● If the post-op patient is unable to ambulate, other forms of activity should be implemented every 1-2 hours when awake. These include: - ROM exercises, heel pumps, SCDs, TEDs, frequent turning and positioning

Preventing Respiratory Complications

● Anesthesia and pain both play a role in preventing adequate ventilation and perfusion of oxygen throughout the body during the postoperative period.

● Exercises to prevent respiratory complications include encouraging the use of the incentive spirometer (IS), and TCDB.

● Coughing and deep breathing work together to clear mucus from the airways and allow for better oxygenation. If the patient experiences pain with TCDB exercises, you can implement splinting to support the patient’s incision and decrease discomfort. These exercises should be performed 3-5 times every hour while awake.

● Encouraging use of the incentive spirometer prevents alveolar collapse and facilitates removal of secretions. The IS should be used 10 times every hour while the patient is awake.

Evidence Based Practice

“Postoperative patients are at risk of clinical deterioration and it is vital that this is minimised. Knowledge and understanding of the key areas of risk and local policies will help to reduce potential postoperative problems.”

Evidence based practice has shown that, “A combined effort in preoperative optimization and information, stress-reduced surgery, efficient postoperative pain treatment, adjustment of perioperative care principles to existing evidence, and nursing care focusing on early mobilization and oral nutrition enhance recovery, decrease morbidity, and shorten hospital stays.”

Can you state 3 reasons for providing post-operative care?

Does anyone have any experience with postoperative care? Either as a patient or

as the individual caring for the patient.

From Simple Nursing.com on YouTube

https://www.youtube.com/watch?v=sdnM5ZuPfl0

https://www.youtube.com/watch?v=FVH80V0sExY&spfreload=10

Video

ReferencesKehlet, H., & Wilmore, D. (2008). Evidence-Based Surgical Care and the Evolution of Fast-Track Surgery. Lippincott Williams & Wilkins:

Annals of Surgery, 248(2), 189-198. Retrieved April 6, 2015, from http://www.stolav.no/StOlav/Avdelinger/Ortopedi/Fast-track

seminar 2011/Kehlet 2008 Evidence-Based Surgical Care and the Evolution of Fast-track surgery.pdf

Liddle, C. (2013). Principles of Monitoring Postoperative Patients. Nursing Times, 109(22), 24-26. Retrieved April 6, 2015, from

http://www.nursingtimes.net/Journals/2013/05/31/g/l/a/050613-Principles-of-monitoring-postoperative-patients.pdf

Postoperative Care. (2003). Retrieved April 6, 2015, from http://www.who.int/surgery/publications/Postoperativecare.pdf

Potter, P., & Perry, A. (2009). Care of Surgical Patients. In Fundamentals of nursing (8th ed., pp. 1274-1292). St. Louis, Mo.: Mosby Elsevier.

SECTION IV. POSTOPERATIVE PATIENT CARE. Retrieved April 6, 2015 from

http://www.brooksidepress.org/Products/Nursing_Fundamentals_II/lesson_8_Section_4.htm