Post operative Nursing care by Ms. Mini Jose, SI, MSW, SVBCH, Silvassa

Postoperative Nursing care, Role of Nurse after Surgery, Responsibility of nursing officers during Postoperative period

1. POSTOPERATIV
E NURSING
CARE
Mrs.MINI JOSE
SISTER IN-CHARGE,
M&SW, SVBCH,
SILVASSA

2. Thenursethoroughlydocuments the
assessmentincludingvitalsciences,level
consciousness,conditionofdressinganddrain,
comfort levelallfluidsstatus,andurinary
outputmeasurement
Clientdatacanbeenterflowsheetandcompute
raisedclientrecordandwrittenprogressnotes
POST OPERATIVE CARE

3. Thepostoperativeperiodbeginsfromthetimethe
patientleavestheoperatingroomandendswiththe
followupvisitbythesurgeon.
Careinimmediatepostoperativeperiod,includingthe
operatingroom,postanesthesiacareunit(PACU).
Extentdependsontheindividual'spre-surgicalhealthstatus,
typeofsurgery, day-surgerysettingorinthehospital.
Goal
.
preventcomplicationssuchasinfection
promotehealingofthesurgicalwound
returnthepatienttoastateofhealth.
INTRODUCTION

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

7. NURSINGMANAGEMENTINPOST
OPERATION Unit
To provide care until the patient has
recovered from the effect of anesthesia.
Assessing the patient
Monitorvitals-pulse
volumeandregularity,depth
andnatureofrespiration.
Assessmentofpatient’s
O2saturation.
Skincolour.

8. KEEPMONITORINGVITALS

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

10. MAINTAININTAKEANDOUTPUT

11. Byproper
positioning
ofpatient’shead
Byclearingairway
Oxygentherapy
Pharyngeal obstruction
can occur when the
patient lies on the back
as there are chances
for tongue to fall back
ProtectAirway

12. MaintainingIVStability
Hypovolemic shock can be avoided
by timely administration of IV Fluids,
blood and blood products and
medication
Replacementoffluids.[colloids, e.g.
albumin dextran, haemaccel and
crystalloids, e.g, RL.0.45% NaCl
hypotonic solution, 3% NaCl
hypertonic solution]
Keepthepatientwarm
Monitorintakeandoutput balance
Monitorthevitalscontinuously

13. ShockPosition
Keep the patient in shock position, flat on back,
legs elevated at 20 degree + knee kept
straight.

14. ASSESSMENTOFTHESURGICALSITE-Hemorrhage
It is a serious complication
of surgery that results in
death
Itcanoccurin immediate
post operatively or up to
several days after surgery
Ifleft untreated, cardiac
output decreases, blood
pressure and Hblevel will
fall rapidly

15. Blood transfusion if necessary
The surgical site + incision should
always be inspected
If bleeding, pressure dressing are
placed
If the bleeding is concealed, the
patient is taken in OR for
emergency exploration of
concealed hemorrhage in body
cavity.
In case of Excessive Bleeding

16. Usewarmlights
KEEPTHEPATIENTWARM

17. Relievingpain+Anxiety
Administer Opioids &
analgesia as per Doctor’s
order
NSAIDS (Non steroidal
anti-Inflammatory drugs)
Psychological support to
relieve fear
Epidural Analgesia catheter
should be removed after
informing anaesthetist and
before discharge

18. ControllingNausea+Vomitting
These are common
problem
In post operative period
medication can be
administered as per doctor’s
order
Example:Inj
MetaclopramideInj
Ondansetron(Emeset)

19. ALDRETESCORE
Atotaldischargescoreof8-10isnecessary
Post-AnesthesiaScore
PRE-ANESTHESIAVITALSIGNS/SOURCE TIME AD
M
15"30"45"1'2'3'4'DISCHARGE
CIRCULATION SYSTOLICBP20%OFPRE-ANESTHETIC
LEVEL 2
20-50% 1
>50 0
CONCIOUSNESS
FULLYAWAKE 2
AROUSABLE ONCALLING 1
NOTRESPONDING 0
COLOR
WARM,DRYSKINWATCH FOR
PREPROCEDURAL COLORING 2
PALE,DUSKY,BLOTCHY,JAUNDICED,
OTHER 1
CYANOTIC 0
RESPIRATION ABLETODEEPBREATHE &COUGH
FREELY 2
DYSPNEAORLIMITED BREATHING 1
APNEIC 0
ACTIVITY ABLETOMOVE4EXTREMITIES 2
ABLETOMOVE2EXTREMITIES 1
ABLETOMOVE0EXTREMITIES 0
COMMENTS TOTAL

20. Expectedoutcomes
ImmediatePost-
Operativechanges
Writteninstructions
Like Woundcare
Activity+dietary
recommendation
MedicationsFollowup
Teaching,PatientSelfCare

21. Postoperativeunitneedtobepreparedwithsuction,Oxygen,
Monitors/Pulseoxymeters,Siderails&proppedupbeds,
Emergencytray&resuscitationTray&Crashcart
Immediatepostoperativepatienttobeplacedneartothe
nursingstationwhorequiresdirectsupervisionofnursing
officer
Comfortablebedding&Position
Ifpatientisconfinedtobedairmattresscanbegiven
Afterreceivingtheclientcheckthecasesheetsandmonitor
thevitalsigns&documentit.Abnormalfindingsneedtobe
informedimmediatelytosisterin-charge&ondutydoctor
Clienttobekeptwarminimmediatepostoperativecase
(controlenvironmentaltemperature)
Sanitarypadsneedtobecheckedfortheplacementincaseof
gynaecpatient
Role of Post operative Nurse

22. Contd . . .
Measure & Document Abdominal girth
Mention the post operative day in Temperature chart
Vascularity refilling need to be checked for client with any
vascular surgeries or POP
NBM need to be released as per the surgeon order and need to
be explained to the patients clearly
Surgical site should be checked for any oozing if there is
excessive bleeding over the dressing and need to be reported
immediately to the sister in-charge or Concerned Doctors on
duty
RT tube need to be checked for continuation
Urobag should be checked for the patency & should be placed
at the foot end side
Drain bag & Urobag to be on the same side and IV Fluids to
be in the opposite side

23. IncaseofNeurosurgeryProppedupat30’atheadendside
tobemaintainedtillfurtherorder.ButincaseofSpinal
anasthesiaheadendshouldnotberaised
Earlyambulationtobedone
Deepbreathingexercise&innecessarycasephysiotherapist
referencetobedone
In case of specimen or any biopsy postoperatively need to
be send it to Lab after explaining the relatives
Strict compliance to the Documentation and in special case
like DM & HT, Eclampsia, PIH, PPH need to monitor Vitals at
the specified time
While feeding need to be cautious to prevent aspiration
Drain need to be removed as per surgeon order
Hygiene of the client need to be ensured to prevent surgical
site infection
Dressing need to be changed as per surgeon order
Contd . . .

24. I/O chart to be maintained strictly
Bowel elimination need to be monitored
Strict compliance to all due medications as per time
Catheter need to be removed or replaced after 7 days
Contd . . .

25. DischargefromthePostOperativeUnit
A patient remains in the post op unit, until the patient has fully
recovered from anesthesia.
Following measures are used to determine the patient ready for
discharge from post operative unit.
Stable vital signs
Orientation to Person, Place, Time or events
Adequate oxygen saturation level.
Urine out put at least 30ml/hour
Minimal pain
Adequate respiratory function
Aldretescore more than ‘ 9 ‘ before shifting from
Post Operative AnaesthesiaCare Unit

26. THANK
YOU
SHRI VINOBA BHAVE CIVIL HOSPITAL,
SILVASSA