Post operative care

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  • I thought it was because it looks like 206 people have downloaded it but should def be downloadable now. Sorry for the delay.
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Post operative care

  1. 1. Post-Operative CarePost-Operative Care
  2. 2. ABCDE Assessment and Vital SignsABCDE Assessment and Vital Signs  Airway – clear & patent? May require an airway adjunct whileAirway – clear & patent? May require an airway adjunct while unconscious.unconscious.  Breathing – Monitor respirations for rate, character and symmetry. OBreathing – Monitor respirations for rate, character and symmetry. O22 therapy until fully conscious and target saturations reached.therapy until fully conscious and target saturations reached.  Circulation – Monitor pulse for rate, volume, character. Monitor bloodCirculation – Monitor pulse for rate, volume, character. Monitor blood pressure.pressure.  Disability – Level of Consciousness will initially be low but should riseDisability – Level of Consciousness will initially be low but should rise as anaesthetic dissipates. Monitor blood glucose in diabetic patients.as anaesthetic dissipates. Monitor blood glucose in diabetic patients.  Exposure – Monitor temperature for signs of infection. Monitor woundExposure – Monitor temperature for signs of infection. Monitor wound sites (usually not disturbed for first 24hrs) and drain sites. Regularsites (usually not disturbed for first 24hrs) and drain sites. Regular pain scoring and analgesia, may also require anti-emetics. Maintainpain scoring and analgesia, may also require anti-emetics. Maintain comfort.comfort.  COMMUNICATION WITH THE PATIENT IS KEY THROUGHOUT!COMMUNICATION WITH THE PATIENT IS KEY THROUGHOUT!
  3. 3. Oxygen TherapyOxygen Therapy ► Oxygen is considered a drug – it must beOxygen is considered a drug – it must be prescribed.prescribed. ► Oxygen is usually delivered around 4-6l byOxygen is usually delivered around 4-6l by Hudson mask post-op until anaesthetic hasHudson mask post-op until anaesthetic has dissipated and saturations recover.dissipated and saturations recover. ► Care must be taken to maintain moist mucousCare must be taken to maintain moist mucous membranes and avoid pressure around the maskmembranes and avoid pressure around the mask and elastic.and elastic. ► Fire precautions must be taken as Oxygen isFire precautions must be taken as Oxygen is flammable.flammable.
  4. 4. Specifics of SurgerySpecifics of Surgery ► Each surgery has its own considerations:Each surgery has its own considerations:  A range of drains may be used e.g. T-tube drains in gallA range of drains may be used e.g. T-tube drains in gall bladder surgery; multiple drains in head and neck orbladder surgery; multiple drains in head and neck or breast surgery.breast surgery.  Stoma care may be required after bowel surgery –Stoma care may be required after bowel surgery – colour, size, surrounding skin and activity must becolour, size, surrounding skin and activity must be considered.considered.  Orthopaedic surgery may require extensive physioOrthopaedic surgery may require extensive physio input.input.  Cardiac surgery involves transfer to ITU for 24 hours.Cardiac surgery involves transfer to ITU for 24 hours.  Body image may be affected esp in head and neck,Body image may be affected esp in head and neck, breast, genito-urinary or bowel surgery.breast, genito-urinary or bowel surgery.
  5. 5. IV InfusionsIV Infusions ►IV infusions may be used to replace fluidsIV infusions may be used to replace fluids while patient is NBM.while patient is NBM. ►Additional constituents may be GKI forAdditional constituents may be GKI for diabetics, Potassium or antibiotics.diabetics, Potassium or antibiotics. ►Fluids must be prescribed and charted andFluids must be prescribed and charted and care taken esp with patients with heartcare taken esp with patients with heart failure who may suffer overload.failure who may suffer overload.
  6. 6. Blood TransfusionsBlood Transfusions ► Student Nurses may not take part in bloodStudent Nurses may not take part in blood transfusions except for monitoring vital signs.transfusions except for monitoring vital signs. ► Blood transfusions are usually given when Hb < 8Blood transfusions are usually given when Hb < 8 or blood loss over 30% (approx 1500mls)or blood loss over 30% (approx 1500mls) ► Blood must be appropriate to the individual toBlood must be appropriate to the individual to avoid reactions and ‘group and save’ must beavoid reactions and ‘group and save’ must be within a week or redone.within a week or redone. ► Transfusion reactions usually take place within 15Transfusion reactions usually take place within 15 minutes of start.minutes of start.
  7. 7. Pain AssessmentPain Assessment ► Assessment of pain is fundamental to managing painAssessment of pain is fundamental to managing pain successfully. It is a crucial part of nursing care and shouldsuccessfully. It is a crucial part of nursing care and should be carried out at regular intervals following surgery.be carried out at regular intervals following surgery. ► Pain assessment can involve:Pain assessment can involve:  Observation- looking for non-verbal signs such as guarding,Observation- looking for non-verbal signs such as guarding, bracing or even lying perfectly still. Non-verbal clues are importantbracing or even lying perfectly still. Non-verbal clues are important when nursing unconscious patients.when nursing unconscious patients.  Communication- talking to the patient and asking them questionsCommunication- talking to the patient and asking them questions like where is your pain? What makes it worse? Describe the type oflike where is your pain? What makes it worse? Describe the type of pain- sharp, dull, stabbing etc.pain- sharp, dull, stabbing etc.  Assessment tools- Pain scales, Smiley faces etc.Assessment tools- Pain scales, Smiley faces etc.
  8. 8. Pain Assessment ToolsPain Assessment Tools Wong-Baker Visual Recognition Scale Numerical Recognition Scale
  9. 9. Pain Assessment ToolsPain Assessment Tools Abbey Pain Scale (Dementia) WHO Pain Ladder
  10. 10. Pain ManagementPain Management ► Effective pain management rely’s on a good nurse/ patient relationship.Effective pain management rely’s on a good nurse/ patient relationship. ► Pain can be managed with the use of medication e.g. Weak/ StrongPain can be managed with the use of medication e.g. Weak/ Strong Opioids, paracetamol etc. It very much depends on the type of surgery.Opioids, paracetamol etc. It very much depends on the type of surgery. The route of administration needs to be considered, as you cannot giveThe route of administration needs to be considered, as you cannot give oral meds to an unconscious patient.oral meds to an unconscious patient. ► Certain surgeries use PCA, which allows the patient to have moreCertain surgeries use PCA, which allows the patient to have more control. This is not suitable for all surgeries and needs to be monitoredcontrol. This is not suitable for all surgeries and needs to be monitored very closely.very closely. ► Patient’s pain may be managed with positional changes; getting themPatient’s pain may be managed with positional changes; getting them up to sit when appropriate may help.up to sit when appropriate may help. ► There is a specialised pain services team which can offer advice aboutThere is a specialised pain services team which can offer advice about the best way to manage a patients’ pain. They also offer educationalthe best way to manage a patients’ pain. They also offer educational services to health professionals and audit and evaluate the care that isservices to health professionals and audit and evaluate the care that is given.given.
  11. 11. Pain ManagementPain Management ► There are alternative methods regarding pain managementThere are alternative methods regarding pain management that may be used after discharge-that may be used after discharge- ► * Relaxation (in/out patient)* Relaxation (in/out patient) ► * Massage* Massage ► * Heat/ cold packs* Heat/ cold packs ► * Hypnosis* Hypnosis ► * Acupuncture* Acupuncture ► Post-operative pain is managed by nurses, surgeons,Post-operative pain is managed by nurses, surgeons, anaesthetists and physio’s, it is very much a team effort. Itanaesthetists and physio’s, it is very much a team effort. It should also be noted that treatment must be tailored to theshould also be noted that treatment must be tailored to the individual and preventing pain should be the main goal.individual and preventing pain should be the main goal.
  12. 12. MobilityMobility ► If the patient is on bed rest as first you would be looking atIf the patient is on bed rest as first you would be looking at positional changes and pressure relieving devices, with the usepositional changes and pressure relieving devices, with the use of passive exercise ie. lifting and bending patients legs.of passive exercise ie. lifting and bending patients legs. ► Encourage early mobilisation as this prevents complicationsEncourage early mobilisation as this prevents complications such as pressure damage and deep vein thrombosis, alsosuch as pressure damage and deep vein thrombosis, also promoting the patient’s independence again as well.promoting the patient’s independence again as well. HoweverHowever only if their overall medical condition allows.only if their overall medical condition allows. ► Mobilisation and multi-disciplinary team rehab should beginMobilisation and multi-disciplinary team rehab should begin within 24 hours.within 24 hours. ► Initial emphasis should be on walking and the activities of dailyInitial emphasis should be on walking and the activities of daily living such as transferring, washing, dressing and toileting.living such as transferring, washing, dressing and toileting. ► You should be assessing a patient’s balance and gait and if anyYou should be assessing a patient’s balance and gait and if any pain on movement.pain on movement.
  13. 13. MobilityMobility ► Since the patient’s condition has changed you would needSince the patient’s condition has changed you would need to update appropriate risk assessments.to update appropriate risk assessments. ► You should bear in mind a patient’s previous mobilityYou should bear in mind a patient’s previous mobility before the operation. Such as the use of walking aids andbefore the operation. Such as the use of walking aids and make them available for use.make them available for use. ► The physiotherapist would be involved with active dailyThe physiotherapist would be involved with active daily exercises, strengthening muscles and joints and canexercises, strengthening muscles and joints and can devise a patient rehab plan - giving advice and patientdevise a patient rehab plan - giving advice and patient education.education. ► The occupational therapist could also be involved toThe occupational therapist could also be involved to provide aids and prepare the patient for discharge home.provide aids and prepare the patient for discharge home.
  14. 14. Psychological IssuesPsychological Issues ► Easily tiredEasily tired ► Inability to concentrate e.g. unable to concentrate effectively whilstInability to concentrate e.g. unable to concentrate effectively whilst reading a book or newspaper.reading a book or newspaper. ► Memory dysfunction e.g. reduced ability to remember things recentlyMemory dysfunction e.g. reduced ability to remember things recently said or done.said or done. ► Reduced ability to perform arithmeticReduced ability to perform arithmetic ► Highly confused e.g. hallucinations due to medication on for painHighly confused e.g. hallucinations due to medication on for pain management.management. ► Behavioural problems- more aggression due to increased confusionBehavioural problems- more aggression due to increased confusion after surgery.after surgery. ► Self-esteem issuesSelf-esteem issues ► Body image issuesBody image issues ► DepressionDepression ► Sexuality issuesSexuality issues

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