Post operative care

Post Operative Care

1. POST OPERATIVE CARE

Mr. Leo Devasia
Leo Home Health Services
www.leohomehealth.com

2. INTRODUCTIONINTRODUCTION
The post operative The post operative
period begins from period begins from
the time the the time the
patient leaves the patient leaves the
operating room operating room
and ends with the and ends with the
follow up visit by follow up visit by
the surgeon.the surgeon.
The post operative The post operative
care is provided by care is provided by
--

PACUPACU

SICUSICU

3. PURPOSESPURPOSES
To enable a successful and faster To enable a successful and faster
recovery of the patient post recovery of the patient post
operatively.operatively.
To reduce post operative mortality To reduce post operative mortality
rate.rate.
To reduce the length of hospital stay To reduce the length of hospital stay
of the patient.of the patient.
To provide quality care service.To provide quality care service.
To reduce hospital and patient cost To reduce hospital and patient cost
during post operative period.during post operative period.

4. SCOPESCOPE
All the patients who undergoing surgery
Responsibility And Authority
Registered Nurse

5. POST OPERATIVE CARE UNIT POST OPERATIVE CARE UNIT
OROR POST ANESTHETIC CARE POST ANESTHETIC CARE
UNIT[PACU]UNIT[PACU]

Patients still under anesthesia or Patients still under anesthesia or
recovering from anesthesia are recovering from anesthesia are
placed in the unit for observation by placed in the unit for observation by
highly skilled nurses,anesthetist and highly skilled nurses,anesthetist and
surgeon.surgeon.

PACU should be sound proof, painted PACU should be sound proof, painted
in soft colour, isolated and these in soft colour, isolated and these
features will help the patient to features will help the patient to
reduce anxiety and promote comfort.reduce anxiety and promote comfort.

6. PHASES OF POST OP UNITPHASES OF POST OP UNIT
Two phases-Two phases-

Phase IPhase I

Phase IIPhase II

7. Phase IPhase I

It is the immediate recovery phase It is the immediate recovery phase
and requires intensive nursing care and requires intensive nursing care
to detect early signs of complication.to detect early signs of complication.

Receive a complete patient record Receive a complete patient record
from the operating room which to from the operating room which to
plan post operative care.plan post operative care.

It is designated for care of surgical It is designated for care of surgical
patient immediately after surgery patient immediately after surgery
and patient requiring close and patient requiring close
monitoringmonitoring

8. Phase IIPhase II

Care of the surgical patient who has Care of the surgical patient who has
been transferred from the Phase I been transferred from the Phase I
post op unit.post op unit.

Patient requiring less observation Patient requiring less observation
and less nursing care than Phase Iand less nursing care than Phase I

This phase is also known as Step This phase is also known as Step
down or progressive care unit.down or progressive care unit.

9. NURSING MANAGEMENT IN POST NURSING MANAGEMENT IN POST
OP UNITOP UNIT
To provide care until To provide care until
the patient has the patient has
recovered from the recovered from the
effect of anesthesia.effect of anesthesia.
Assessing the patient
Monitor vitals-pulse
volume and regularity,
depth and nature of
respiration.
Assessment of patient’s
O2 saturation.
Skin colour.

10. KEEP MONITORING VITALSKEEP MONITORING VITALS

11. Check the level of consciousness.
Ability to respond to commands.

12. MAINTAIN INTAKE AND OUTPUTMAINTAIN INTAKE AND OUTPUT

13. Protect airway
By proper positioning
of patient’s head.
By clearing airway.
Oxygen therapy.

Pharyngeal obstruction
can occur when the
patient lies on the
back as there are
chances for tongue to
fall back.

14. Maintaining IV StabilityMaintaining IV Stability
Hypovolemic shock: can be
avoided by timely
administration of IV Fluids,
blood and blood products and
medication.
Replacement of fluids.[colloids
and crystalloids]
Keep the patient warm.
Monitor intake and output
balance.
Monitor the vitals continuously
with the patient condition.

15. Shock PositionShock Position
Keep the patient in shock position, flat on back, Keep the patient in shock position, flat on back,
legs elevated at 20 degree+knee kept straightlegs elevated at 20 degree+knee kept straight..

16. ASSESSMENT OF THE SURGICAL SITEASSESSMENT OF THE SURGICAL SITE
Haemorrhage
It is a serious
complication of
surgery that
resulting death.
It can occur in
immediate post
operatively or upto
several days after
surgery.
If left
untreated,cardiac
output decreases and
blood pressure and
Hb level will fall
rapidly.

17. •Blood transfusion if Blood transfusion if
necessary.necessary.
•The surgical The surgical
site+incision should site+incision should
always be inspected.always be inspected.
•If bleeding,If bleeding,pressurepressure
dressing are placed.dressing are placed.
•If the bleeding is If the bleeding is
concealed,the patient is concealed,the patient is
taken in OR for taken in OR for
emergency exploration emergency exploration
of concealed of concealed
haemorrhage in body haemorrhage in body
cavity.cavity.

18. KEEP THE PATIENT WARMKEEP THE PATIENT WARM

Use warmer(Use warmer(Bair Bair
HuggerHugger) blankets) blankets

Use warm lightsUse warm lights

19. Relieving pain +AnxietyRelieving pain +Anxiety
Administer opioid Administer opioid
analgesia as per analgesia as per
Doctor’s order.Doctor’s order.
Epidural analgesia.Epidural analgesia.
NSAIDS.NSAIDS.
Psychological support Psychological support
to relieve fear+To to relieve fear+To
give support.give support.

20. Controlling Nausea+VomittingControlling Nausea+Vomitting
These are common These are common
problem in post problem in post
operative period.operative period.
Medication can be Medication can be
administered as per administered as per
doctor’s order.doctor’s order.
Example:Example:
Inj MetaclopramideInj Metaclopramide
Inj OndansetronInj Ondansetron
( Emeset ) ( Emeset )

21. Discharge from the Post Operative UnitDischarge from the Post Operative Unit
A patient remains in the post op unit, untill the patient A patient remains in the post op unit, untill the patient
has fully recoverd from anesthesia.has fully recoverd from anesthesia.
Following measures are used to determine the Following measures are used to determine the
patient ready for disharge from post operative unit.patient ready for disharge from post operative unit.
Stable vital signsStable vital signs
Orientation to PersonOrientation to Person
PlacePlace
Time or eventsTime or events
Adequate oxygen saturation level.Adequate oxygen saturation level.
Urine out put at least 30ml/hourUrine out put at least 30ml/hour
Minimal pain.Minimal pain.
Adequate respiratory function.Adequate respiratory function.
Aldrete score more than ‘ 9 ‘ before shifting fromAldrete score more than ‘ 9 ‘ before shifting from
Post Operative Anaesthesia Care Unit Post Operative Anaesthesia Care Unit

22. ALDRETE SCORE
Post-Anesthesia Score
A total discharge score of 8-10 is necessary

Post-Anesthesia Score
PRE-ANESTHESIA VITAL SIGNS/SOURCE
TIME ADM 15" 30" 45" 1' 2' 3' 4' DISCHARGE
SYSTOLIC BP 20% OF PRE -ANESTHETIC LEVEL
2

CIRCULATION 20-50% 1
> 50 0
FULLY AWAKE 2
CONCIOUSNES
S
AROUSABLE ON CALLING 1
NOT RESPONDING 0
WARM, DRY SKIN W/ PREPROCEDURAL
COLORING 2

COLOR PALE, DUSKY, BLO TCHY, JAUNDICED, OTHER
1

CYANOTIC 0
ABLE TO DEEP BREATHE & COUGH FREELY
2

RESPIRATION DYSPNEA OR LIMITED BREATHING APKEIC
1

0
ABLE TO MOVE 4 EXTREMITIES 2
ACTIVITY ABLE TO MOVE 2 EXTREMI TIES 1
ABLE TO MOVE 0 EXTREMITIES 0
COMMENTS TOTAL

23. Teaching, Patient Self CareTeaching, Patient Self Care
•Expected out comesExpected out comes
•Immediate post Immediate post
operative changesoperative changes
•Written instructions Written instructions
likelike
Wound careWound care
Activity+dietary Activity+dietary
recommendationrecommendation
MedicationsMedications
Follow upFollow up

24. THANK YOU