Post Op

1. 1
Postoperative CarePostoperative Care

2. 2
Care in the PACU-Care in the PACU-post anaesthetic care post anaesthetic care
unit or recovery roomunit or recovery room
•ACP gives report to admitting PACU ACP gives report to admitting PACU
nursenurse
What information would you want What information would you want
to know?to know?
•Initial Assessment Initial Assessment
What should be included?What should be included?
What is the priority?What is the priority?

3. 3
Care in the PACUCare in the PACU
What should be included in the What should be included in the
following assessments?following assessments?
•Respiratory AssessmentRespiratory Assessment
•Cardiovascular AssessmentCardiovascular Assessment
•Neurological AssessmentNeurological Assessment

4. 4
Initial Assessments cont’d in Initial Assessments cont’d in
PACUPACU
•Urinary assessmentUrinary assessment
•Wound assessmentWound assessment

5. 5
Potential AlterationsPotential Alterations
in Respiratory Functionin Respiratory Function
•Airway obstructionAirway obstruction
•HypoxemiaHypoxemia
•AtelectasisAtelectasis
•Pulmonary edemaPulmonary edema
•Aspiration of gastric secretionsAspiration of gastric secretions
•BronchospasmBronchospasm
•HypoventilationHypoventilation

6. 6
Etiology and Etiology and
relief of airway relief of airway
obstruction caused obstruction caused
by patient’s tongueby patient’s tongue
Fig. 19-2Fig. 19-2

7. 7
Nursing ManagementNursing Management
Respiratory ComplicationsRespiratory Complications
•Nursing DiagnosesNursing Diagnoses
•Ineffective airway clearanceIneffective airway clearance
•Ineffective breathing patternIneffective breathing pattern
•Impaired gas exchangeImpaired gas exchange
•Risk for aspirationRisk for aspiration
•Potential complication: hypoxemiaPotential complication: hypoxemia

8. 8
Nursing ManagementNursing Management
Respiratory ComplicationsRespiratory Complications
•Nursing ImplementationNursing Implementation
What are some nursing actions that What are some nursing actions that
the nurse can implement for a client the nurse can implement for a client
exhibiting respiratory exhibiting respiratory
complications?complications?

9. 9
Potential ComplicationsPotential Complications
in Cardiovascular Functionin Cardiovascular Function
Most common complications: Most common complications:
•hypotensionhypotension
•hypertensionhypertension
•arrhythmiaarrhythmia
Greatest risk: Greatest risk:
•Cardiac historyCardiac history
•ElderlyElderly
•Debilitated or critically illDebilitated or critically ill

10. 10
Nursing ManagementNursing Management
Cardiovascular ComplicationsCardiovascular Complications
•Nursing AssessmentNursing Assessment
What assessments need to be done to What assessments need to be done to
monitor the cardiovascular system?monitor the cardiovascular system?

11. 11
Nursing ManagementNursing Management
Cardiovascular ComplicationsCardiovascular Complications
•Nursing DiagnosesNursing Diagnoses
•Decreased cardiac outputDecreased cardiac output
•Deficient fluid volumeDeficient fluid volume
•Ineffective tissue perfusionIneffective tissue perfusion
•Excess fluid volumeExcess fluid volume
•Potential complication: hypovolemic Potential complication: hypovolemic
shockshock

12. 12
Nursing ManagementNursing Management
Cardiovascular ComplicationsCardiovascular Complications
•Nursing ImplementationNursing Implementation
What interventions can the nurse What interventions can the nurse
expect to be done for someone expect to be done for someone
exhibiting cardiovascular exhibiting cardiovascular
complications?complications?

13. 13
Nursing ManagementNursing Management
Neurologic ComplicationsNeurologic Complications
•Nursing Assessments for neurological Nursing Assessments for neurological
system?system?

14. 14
Nursing ManagementNursing Management
Neurologic ComplicationsNeurologic Complications
•Nursing DiagnosesNursing Diagnoses
•Disturbed sensory perceptionDisturbed sensory perception
•Risk for injuryRisk for injury
•Disturbed thought processesDisturbed thought processes
•Impaired verbal communicationImpaired verbal communication
•Nursing Implementation?Nursing Implementation?

15. 15
Pain and DiscomfortPain and Discomfort
•What nursing assessments can be done to What nursing assessments can be done to
assess for pain and discomfort?assess for pain and discomfort?
•Nursing DiagnosesNursing Diagnoses
•Acute painAcute pain
•AnxietyAnxiety
•Nursing Implementation for pain Nursing Implementation for pain
management?management?

16. 16
HypothermiaHypothermia
•Nursing Assessment?Nursing Assessment?
•Nursing DiagnosesNursing Diagnoses
•HypothermiaHypothermia
•Risk for imbalanced body temperatureRisk for imbalanced body temperature
•Nursing Implementation?Nursing Implementation?

17. 17
Nausea and VomitingNausea and Vomiting
•Significant problems in postoperative Significant problems in postoperative
periodperiod
•Responsible for unanticipated Responsible for unanticipated
admission, increased discomfort, admission, increased discomfort,
delays in discharge, and dissatisfaction delays in discharge, and dissatisfaction
with surgical experiencewith surgical experience

18. 18
Nausea and VomitingNausea and Vomiting
•Nursing Assessment?Nursing Assessment?
•Nursing DiagnosesNursing Diagnoses
•NauseaNausea
•Risk for aspirationRisk for aspiration
•Risk for deficient fluid volumeRisk for deficient fluid volume
•Nursing ImplementationNursing Implementation

19. 19
Care of Postoperative PatientCare of Postoperative Patient
on Clinical Uniton Clinical Unit
•PACU nurse gives report to receiving PACU nurse gives report to receiving
nurse summarizing operative and nurse summarizing operative and
postoperative periodspostoperative periods
•Receiving nurse assists with transfer onto Receiving nurse assists with transfer onto
bedbed
•Vital signs obtained and compared to Vital signs obtained and compared to
reportreport

20. 20
Potential Complications Potential Complications
in Respiratory Functionin Respiratory Function
•Atelectasis and pneumonia commonly Atelectasis and pneumonia commonly
occur after abdominal and thoracic occur after abdominal and thoracic
surgerysurgery

21. 21
Postoperative AtelectasisPostoperative Atelectasis
Fig. 19-4Fig. 19-4
A.A.Normal Normal
bronchiole andbronchiole and
alveolusalveolus
B. Mucous plug inB. Mucous plug in
bronchiolebronchiole
C. Collapse of alveoliC. Collapse of alveoli
due to absorption of airdue to absorption of air

22. 22
Potential Complications Potential Complications
in Respiratory Functionin Respiratory Function
•Nursing DiagnosesNursing Diagnoses
•Ineffective airway clearanceIneffective airway clearance
•Ineffective breathing patternIneffective breathing pattern
•Impaired gas exchangeImpaired gas exchange
•Potential complication: pneumoniaPotential complication: pneumonia
•Potential complication: atelectasisPotential complication: atelectasis

23. 23
Potential Complications Potential Complications
in Respiratory Functionin Respiratory Function
•Nursing ImplementationNursing Implementation
•Deep breathing and cough helps Deep breathing and cough helps
prevent alveolar collapseprevent alveolar collapse
•Incentive spirometerIncentive spirometer
•SplintingSplinting
•Diaphragmatic breathingDiaphragmatic breathing
•Change position q2hChange position q2h

24. 24
Techniques for Splinting Wound Techniques for Splinting Wound
When CoughingWhen Coughing
Fig. 19-5Fig. 19-5

25. 25
Potential AlterationsPotential Alterations
in Cardiovascular Functionin Cardiovascular Function
•Fluid and electrolyte imbalances Fluid and electrolyte imbalances
contribute to alterationscontribute to alterations
•Hypokalemia can result from urinary Hypokalemia can result from urinary
or GI lossesor GI losses
•DVT and pulmonary embolismDVT and pulmonary embolism
•SyncopeSyncope

26. 26
Nursing ManagementNursing Management
Cardiovascular ComplicationsCardiovascular Complications
•Nursing AssessmentNursing Assessment
•Regular monitoring of BP, HR, pulse, Regular monitoring of BP, HR, pulse,
and skin temperature and colorand skin temperature and color
•Compare with preoperative status Compare with preoperative status
and postoperative findingsand postoperative findings

27. 27
Nursing ManagementNursing Management
Cardiovascular ComplicationsCardiovascular Complications
•Nursing DiagnosesNursing Diagnoses
•Decreased cardiac outputDecreased cardiac output
•Deficient fluid volumeDeficient fluid volume
•Excess fluid volumeExcess fluid volume
•Ineffective tissue perfusionIneffective tissue perfusion
•Activity intoleranceActivity intolerance
•Potential complication: thromboembolismPotential complication: thromboembolism

28. 28
Nursing ManagementNursing Management
Cardiovascular ComplicationsCardiovascular Complications
•Nursing ImplementationNursing Implementation
•Accurate I&OsAccurate I&Os
•Monitor laboratory findingsMonitor laboratory findings
•Assessment of infusion rate of fluid Assessment of infusion rate of fluid
replacement and infusion sitereplacement and infusion site
•Adequate mouth careAdequate mouth care
•Leg exercisesLeg exercises

29. 29
Postoperative Leg ExercisesPostoperative Leg Exercises
Fig. 19-6Fig. 19-6

30. 30
Nursing ManagementNursing Management
Cardiovascular ComplicationsCardiovascular Complications
•Elastic stockings or compressive Elastic stockings or compressive
devicesdevices
•Unfractionated or low-molecular-Unfractionated or low-molecular-
weight heparinweight heparin
•AmbulationAmbulation
•Slowly progressSlowly progress
•Monitor pulseMonitor pulse
•Assess for feelings of faintnessAssess for feelings of faintness

31. 31
Potential AlterationsPotential Alterations
in Urinary Functionin Urinary Function
•Low urinary output may be expected Low urinary output may be expected
in the first 24 hours, regardless of in the first 24 hours, regardless of
intakeintake

32. 32
Nursing ManagementNursing Management
Urinary ComplicationsUrinary Complications
•Nursing AssessmentNursing Assessment
•Urine examined for quantity and Urine examined for quantity and
qualityquality
•Note color, amount, consistency, and Note color, amount, consistency, and
odorodor
•Assess indwelling catheters for patencyAssess indwelling catheters for patency
•Urine output should be at least 0.5 Urine output should be at least 0.5
ml/kg per hour or 30cc/hr.ml/kg per hour or 30cc/hr.

33. 33
Nursing ManagementNursing Management
Urinary ComplicationsUrinary Complications
•Nursing DiagnosesNursing Diagnoses
•Impaired urinary eliminationImpaired urinary elimination
•Potential complication: acute urinary Potential complication: acute urinary
retentionretention

34. 34
Nursing ManagementNursing Management
Urinary ComplicationsUrinary Complications
•Nursing ImplementationNursing Implementation
•Position patient for normal voidingPosition patient for normal voiding
•Reassure patient of ability to voidReassure patient of ability to void
•Use techniques such as running water, Use techniques such as running water,
drinking water, pouring water over drinking water, pouring water over
perineum, ambulation, or use of perineum, ambulation, or use of
bedside commodebedside commode

35. 35
Potential AlterationsPotential Alterations
in Gastrointestinal Functionin Gastrointestinal Function
•Nausea and vomiting may be caused Nausea and vomiting may be caused
from anesthetic agents or narcotics, from anesthetic agents or narcotics,
delayed gastric emptying, slowed delayed gastric emptying, slowed
peristalsis, resumption of oral intake too peristalsis, resumption of oral intake too
soon after surgerysoon after surgery
•Abdominal distention from decreased Abdominal distention from decreased
peristalsis caused by handling of bowel peristalsis caused by handling of bowel
during surgeryduring surgery

36. 36
Potential AlterationsPotential Alterations
in Gastrointestinal Functionin Gastrointestinal Function
•Swallowed air and GI secretions may Swallowed air and GI secretions may
accumulate in colon, producing accumulate in colon, producing
distention and gas painsdistention and gas pains
•Hiccoughs from irritation of phrenic Hiccoughs from irritation of phrenic
nervenerve

37. 37
Nursing ManagementNursing Management
Gastrointestinal ComplicationsGastrointestinal Complications
•Nursing AssessmentNursing Assessment
•Auscultate abdomen in all four Auscultate abdomen in all four
quadrants for presence, frequency, quadrants for presence, frequency,
and characteristics of bowel soundsand characteristics of bowel sounds
•Can be absent or diminished in Can be absent or diminished in
immediate postoperative periodimmediate postoperative period
•Return of bowel motility Return of bowel motility
accompanied by flatusaccompanied by flatus

38. 38
Potential AlterationsPotential Alterations
in Gastrointestinal Functionin Gastrointestinal Function
•Nursing DiagnosesNursing Diagnoses
•NauseaNausea
•Imbalanced nutrition: less than body Imbalanced nutrition: less than body
requirementsrequirements
•Potential complication: paralytic ileusPotential complication: paralytic ileus
•Potential complication: hiccoughsPotential complication: hiccoughs

39. 39
Potential AlterationsPotential Alterations
in Gastrointestinal Functionin Gastrointestinal Function
•Nursing ImplementationNursing Implementation
•May resume intake upon return of gag May resume intake upon return of gag
reflexreflex
•NPO until return of bowel sounds for NPO until return of bowel sounds for
patient with abdominal surgerypatient with abdominal surgery
•IVF, NG for decompressionIVF, NG for decompression
•Clear liquids, advance as toleratedClear liquids, advance as tolerated

40. 40
Potential AlterationsPotential Alterations
in Gastrointestinal Functionin Gastrointestinal Function
•Nursing ImplementationNursing Implementation
•Regular mouth care when NPORegular mouth care when NPO
•Antiemetics administered for nauseaAntiemetics administered for nausea
•NG tube if symptoms persistNG tube if symptoms persist
•Early and frequent ambulation to prevent Early and frequent ambulation to prevent
abdominal distentionabdominal distention
•Assess patient regularly for resumption of Assess patient regularly for resumption of
normal peristalsisnormal peristalsis

41. 41
Potential AlterationsPotential Alterations
in Gastrointestinal Functionin Gastrointestinal Function
•Nursing Implementation Nursing Implementation
•Encourage patient to expel flatus and Encourage patient to expel flatus and
explain expulsion is necessary and explain expulsion is necessary and
desirabledesirable
•Relief of gas pains by frequent Relief of gas pains by frequent
ambulation and repositioningambulation and repositioning
•Suppositories prnSuppositories prn
•Determine cause of hiccoughsDetermine cause of hiccoughs

42. 42
Potential AlterationsPotential Alterations
of the Integumentof the Integument
•Incision disrupts skin barrier and Incision disrupts skin barrier and
healing is major concern during healing is major concern during
postoperative periodpostoperative period
•Adequate nutritionAdequate nutrition
•Impaired wound healing with chronic Impaired wound healing with chronic
disease and elderlydisease and elderly
•Wound infectionWound infection

43. 43
Potential AlterationsPotential Alterations
of the Integumentof the Integument
•Evidence of wound infection usually Evidence of wound infection usually
not apparent until 3not apparent until 3
rdrd
to 5 to 5
thth

postoperative daypostoperative day
•Local manifestations of redness, Local manifestations of redness,
edema, pain, and tendernessedema, pain, and tenderness
•Systemic manifestations of leukocytosis Systemic manifestations of leukocytosis
and feverand fever

44. 44
Potential AlterationsPotential Alterations
of the Integumentof the Integument
•Accumulation of fluid in wound may Accumulation of fluid in wound may
impair healing and predispose to impair healing and predispose to
infectioninfection
•Drain may be placedDrain may be placed

45. 45
Nursing ManagementNursing Management
Surgical WoundsSurgical Wounds
•Nursing AssessmentNursing Assessment
•Knowledge of type of wound, drains, Knowledge of type of wound, drains,
and expected drainageand expected drainage
•Drainage should change from Drainage should change from
sanguineous to serosanguineous to sanguineous to serosanguineous to
serous with decreasing output serous with decreasing output
•Wound dehiscence may be preceded by Wound dehiscence may be preceded by
sudden brown, pink, or clear discharge sudden brown, pink, or clear discharge

46. 46
Potential AlterationsPotential Alterations
of the Integumentof the Integument
•Nursing DiagnosesNursing Diagnoses
•Risk for infectionRisk for infection
•Potential complication: impaired Potential complication: impaired
wound healingwound healing

47. 47
Potential AlterationsPotential Alterations
of the Integumentof the Integument
•Nursing ImplementationNursing Implementation
•Note type, amount, color, and Note type, amount, color, and
consistency of drainageconsistency of drainage
•Assess affect of position changes on Assess affect of position changes on
drainagedrainage

48. 48
Potential AlterationsPotential Alterations
of the Integumentof the Integument
•Notify surgeon of excessive or Notify surgeon of excessive or
abnormal drainage and significant abnormal drainage and significant
changes in vitalschanges in vitals
•Note number and type of drains when Note number and type of drains when
changing dressingchanging dressing
•Examine incision siteExamine incision site
•Clean gloves and sterile techniqueClean gloves and sterile technique

49. 49
Pain and DiscomfortPain and Discomfort
•Postoperative pain caused by a Postoperative pain caused by a
number of physiologic and number of physiologic and
psychologic interactions psychologic interactions
•Traumatization of skin and tissuesTraumatization of skin and tissues
•Reflex muscle spasmsReflex muscle spasms
•Anxiety/fear increase muscle tone and Anxiety/fear increase muscle tone and
spasmspasm

50. 50
Nursing ManagementNursing Management
PainPain
•Nursing AssessmentNursing Assessment
•Nursing DiagnosesNursing Diagnoses
•Acute painAcute pain
•Disturbed sensory perceptionDisturbed sensory perception
•Nursing ImplementationNursing Implementation

51. 51
Potential AlterationsPotential Alterations
in Temperaturein Temperature
•Hypothermia may be present in Hypothermia may be present in
immediate postoperative periodimmediate postoperative period
•Fever may occur at any timeFever may occur at any time
•Mild elevation (up to 38 degrees C) Mild elevation (up to 38 degrees C)
may result from stress responsemay result from stress response
•Moderate elevation (>38Moderate elevation (>38°°

C) usually C) usually
caused by respiratory congestion or caused by respiratory congestion or
atelectasis and rarely by dehydrationatelectasis and rarely by dehydration

52. 52
Potential AlterationsPotential Alterations
in Temperaturein Temperature
•Wound infection often accompanied by Wound infection often accompanied by
fever spiking in afternoon and near-fever spiking in afternoon and near-
normal in morningnormal in morning
•Can signal Can signal C. difficileC. difficile when accompanied when accompanied
by diarrhea and abdominal painby diarrhea and abdominal pain
•Intermittent high with shaking chills and Intermittent high with shaking chills and
diaphoresis indicates septicemiadiaphoresis indicates septicemia

53. 53
Nursing ManagementNursing Management
Altered TemperatureAltered Temperature
•Nursing AssessmentNursing Assessment
•Nursing DiagnosesNursing Diagnoses
•Risk for imbalanced body temperatureRisk for imbalanced body temperature
•HyperthermiaHyperthermia
•HypothermiaHypothermia

54. 54
Nursing ManagementNursing Management
Altered TemperatureAltered Temperature
•Nursing ImplementationNursing Implementation
•Measure temperature q4h for first 48 Measure temperature q4h for first 48
hours postoperativelyhours postoperatively
•Asepsis with wound and IV sitesAsepsis with wound and IV sites
•Encourage airway clearanceEncourage airway clearance
•Chest x-rays and cultures if infection Chest x-rays and cultures if infection
suspectedsuspected
•Antipyretics and body-cooling >39.4Antipyretics and body-cooling >39.4° °
CC

55. 55
Potential AlterationsPotential Alterations
in Psychologic Functionin Psychologic Function
•Anxiety and depression may be more Anxiety and depression may be more
pronounced with radical surgery or pronounced with radical surgery or
with poor prognosiswith poor prognosis
•Confusion and delirium may result Confusion and delirium may result
from psychological and physiologic from psychological and physiologic
sourcessources

56. 56
Nursing Management Nursing Management
Psychologic FunctionPsychologic Function
•Nursing DiagnosesNursing Diagnoses
•AnxietyAnxiety
•Ineffective copingIneffective coping
•Disturbed body imageDisturbed body image
•Decisional conflictDecisional conflict

57. 57
Nursing Management Nursing Management
Psychologic FunctionPsychologic Function
•Nursing ImplementationNursing Implementation
•Provide adequate supportProvide adequate support
•Listen and talk with patient, offer Listen and talk with patient, offer
explanations, reassure, and explanations, reassure, and
encourage involvement of significant encourage involvement of significant
otherother
•Discuss expectation of activity and Discuss expectation of activity and
assistance needed after dischargeassistance needed after discharge

58. 58
Nursing Management Nursing Management
Psychologic FunctionPsychologic Function
•Patient must be included in discharge Patient must be included in discharge
planning and provided with planning and provided with
information and support to make information and support to make
informed decisions about continuing informed decisions about continuing
carecare
•Recognition of alcohol withdrawal Recognition of alcohol withdrawal
syndromesyndrome
•Report any unusual behavior for Report any unusual behavior for
immediate diagnosis and treatmentimmediate diagnosis and treatment

59. 59
Planning for Discharge and Planning for Discharge and
Follow-up CareFollow-up Care
•Planning for discharge begins in Planning for discharge begins in
preoperative periodpreoperative period
•Provide information to patient and Provide information to patient and
caregiverscaregivers
What information is needed?What information is needed?