This document discusses post-operative care in three phases: immediate recovery, intermediate hospital stay, and recovery at home. It focuses on maintaining homeostasis, treating pain, and preventing complications in the first two phases. Common complications include pulmonary, cardiovascular, and fluid issues. The document outlines monitoring, respiratory care, wound care, pain management, and other orders and treatments during post-operative recovery.

1. P0ST-OPERATIVE
CARE

2. PHASES
• IMMEDIATE ( POST-ANAESTHETIC )
PHASE (1)
• INTERMEDIATE ( HOSPITAL STAY )
PHASE (2)
• CONVALESCENT ( AFTER DISCHARGE
TO FULL RECOVERY )

3. AIM OF PHASES 1 &
2
• HOMEOSTASIS
• TREATMENT OF PAIN
• PREVENTION & EARLY
DETECTION OF COMPLICATIONS

4. IMMEDIATE
POST-OPERATIVE
PERIOD

5. CAUSES OF
COMPLICATIONS &
DEATH
• ACUTE PULMONARY PROBLEMS
• CARDIO-VASCULAR PROBLEMS
• FLUID DERANGEMENTS

6. PREVENTIONPREVENTION
• RECOVERY ROOM :
ANAESTHETIST RESPONSIBILITIES
TOWARDS CARDIO-PULMONARY
FUNCTIONS.
SURGEON’S RESPONSIBILITIES
TOWARDS THE OPERATION SITE.
• TRAINED NURSING STAFF :
T0 HANDLE INSTRUCTIONS.
• CONTINUOUS MONITORING OF
PATIENT (VITAL SIGNS etc.)

7. DISCHARGE FROM RECOVERYDISCHARGE FROM RECOVERY
SHOULD BE AFTER COMPLETESHOULD BE AFTER COMPLETE
STABILIZATION OF CARDIO-STABILIZATION OF CARDIO-
VASCULAR, PULMONARY ANDVASCULAR, PULMONARY AND
NEUROLOGICAL FUNCTIONSNEUROLOGICAL FUNCTIONS
WHICH USUALLY TAKES 2-4WHICH USUALLY TAKES 2-4
HOURS.HOURS.
IF NOT SPECIAL CARE INIF NOT SPECIAL CARE IN
ICU.ICU.

8. Post-Operative
Orders
A) Monitoring
• Vital sign (pulse, BP, R.R, Temp) every
15-30 min.
• C.V.P (? Swan – gins for pulmonary
artery wedge pressure) and arterial
line for continuous BP measurement.
• ECG
• Fluid balance ( intake and output) ?
Needs urinary catheter.
• Other types of monitoring :
• Arterial pulses after vascular surgery.
• Level of consciousness after
neurosurgery.

9. Post-Operative Orders
B) Respiratory Care:
• O2 mask.
• Ventilator.
• Tracheal suction.
• Chest physiotherapy.
C) Position in bed and mobilization:
• Turning in bed usually every 30 min. until full
mobilization.
• Special position required sometimes.
• DVT prevention mechanically ( intermittent calf
compression).

10. D) Diet:
• NPO
• Liquids.
• Soft diet.
• Normal or special diet.
E) Administration of I.V. fluids:
• Daily requirements.
• Losses from G.I.T and U.T.
• Losses from stomas and drains.
• Insensible losses.
• Care of renal patients.
• If care of drainage tubes.

11. G) Medication:
• Antibiotics.
• Pain killers.
• Sedatives.
• Pre-operative medication.
• Care of patients on Pre-Op. Steroids.
• H2 Blockers specially in ICU patients.
• Anti-Coagulants.
• Anti Diabetics.
• Anti Hypertensives.
H) Lab. Tests and Imaging:
• To detect or exclude Post-Op. complications.

12. The Intermediate
Post-Operative
period
Starts with complete recovery
from anaesthesia and lasts for
the rest of the hospital stay.

13. Care of the
wound• Epithelialisation takes 48 hs.
• Dressing can be removed 3-4 days after
operation.
• Wet dressing should be removed earlier and
changed.
• Symptoms and signs of infection should be
looked for, which if present compression,
removal of few stitches and daily dressing with
swab for C & S.
• R.O.S. usually 5-7 days Post-Op.
• Tensile strength of wound minimal during first 5
days, then rapid between 5th
20th
day then
slowly again (full strength takes 1-2 years).
• Good nutrition.

14. Management of drains
• To drain fluids accumulating after surgery,
blood or pus.
• Open or closed system.
• Other types (Suction, sump, under water etc.)
• Should be removed as long as no function.
• Should come out throw separate incision to
minimize risk of wound infection.
• Inspection of contents and its amount.
• Soft drains e.g. Penrose should not be left
more than 40 days because they form a tract
and acts as a plug.

15. Post-Operative
pulmonary Care
• Functional residual capacity ( FRC) and vital
capacity (VC) decrease after major intra-
abdominal surgery down to 40% of the Pre-
Op. Level.
• They go up slowly to 60-70% by 6th
-7th
day and
to normal Pre-Op. Level after that.
• FRC, VC, and Post-Op. pulmonary oedema
(Post anaesthesia) Contribute to the changes
in pulmonary functions Post-Op.
• The above changes are accentuated by
obesity, heavy smoking or Pre-existing lung

16. • Post-Op. atelectasis is enhanced by
shallow breathing, pain, obesity and
abdominal distension (restriction of
diaphragmatic movements)
• Post-Op. physiotherapy especially deep
inspiration helps to decrease
atelectasis. Also O2 mask and periodic
hyperinflation using spirometer.
• Early mobilization helps a lot.
• Antibiotics and treatment of heart
failure Post-Op. by adequate
management of fluids will help to

17. Respiratory
failure
• Early :
• Occurs minutes to 1-2 hs. Post-Op.
• No definite cause.
• Occurs suddenly.
• Late :
• Occurs 48 hs. Post-Op.
• Due to pulmonary embolism, abdominal
distension or opioid overdose.
Manifestation :
• Tachypnea > 25-30/min.
• Low tidal volume < 4ml /kg
• High Pco2 > 45mmHg.
• Low Po2 < 60mmHg.

18. • Treatment :
• Immediate intubation and mechanical ventilation.
• Treatment of atelectasis, pneumonia or
pneumothorax if any.
• Prevention:
• Physiotherapy (Pre. & Post-OP.) to prevent
atelectasis.
• Treatment of any Pre-existing pulmonary diseases.
• Hydration of patient to avoid hypovolaemia and later
on atelectasis and infection.
• May be hyperventilation to compensate for
insufficiency of lungs.
• Use of epidural block or local analgesia in patients
with COPD to relieve pain and permits effective
respiratory muscle functions

19. Post-Operative fluid &
Electrolytes management
• Considerations:
• Maintenance requirements.
• Extra needs resulting from systemic factors e.g.
fever, burn diarrhea and vomiting etc.
• Losses from drains and fistulas.
• Tissue oedema (3rd
space losses)
• The daily maintenance requirements in adult for
sensible and insensible losses are 1500-2500mls.
depending on age, sex, weight and body surface area.
• Rough estimation of need is by body weight x 30/day.
e.g. 60 KG x 30 = 1800ml/day.
• Requirements is increased with fever, hyperventilation
and increased catabolic states.

20. • Estimation of electrolytes daily is only
necessary in critical patients.
• Potassium should not be added to IV fluid
during first 24hs. Post-Op. (because
Potassium enters circulation during this time
and causes increased aldosterone activity).
• Other electrolytes are corrected according to
deficits.
• 5% dextrose in normal saline or in lactated
Ringer’s solution is suitable for most patients.
• Usual daily requirements of fluids is between
2000-2500ml/day.

21. Post-Operative Care of
GIT
• NPO until peristalsis returns.
• Paralytic ileus usually takes about 24hs.
• NGT is necessary after esophageal and gastric
surgery.
• NGT is NOT necessary after cholecystectomy,
pelvic operation or colonic resections.
• Gastrostomy and jujenostomy tubes feeding can
start on 2nd
Post-Op. day because absorption from
small bowel is not affected by laparotomy.
• Enteral feeding is better than parenteral feeding.
• Gradual return of oral feeding from liquids to normal
diet.

22. Post-Operative Pain
• Factors affecting severity :
• Duration of surgery.
• Degree of Operative trauma (intra-thoracic, intra-
abdominal or superficial surgery).
• Type of incision.
• Magnitude of intra-operative retraction.
• Factors related to the patient :
• Anxiety.
• Fear.
• Physical and cultural characteristics.
• Pain transmission:
• Splanchnic nerves to spinal cord.
• Brain stem due to alteration in ventilation, BP and
endocrine functions.
• Cortical response from voluntary movements and
emotions.

23. • Complications of Pain:
• Causes vasospasm.
• Hypertension.
• May cause CVA, MI or bleeding.
• Management of Post-Op. pain:
• Physician – patient communication (reassurance).
• Parenteral opioids.
• Analgesics (NSAIDS).
• Anxiolytic agents (Hydroxyzine) potentiates action
of opioids and has also an anti-emetic effects.
• Oral analgesics or suppositories e.g. Tylenol.
• Epidural analgesia (for pelvic surgery).
• Nerve block (Post-thoracotomy and hernia repair).