Post Operative Care | PACU | Complications | Treatment Yashasvi Verma
Post operative period is the most crucial and
critical span of time after completion of surgery
In this period numerous complications occur and if not treated on time can prove fatal hence increasing the mortality rate .
The specialized care provided to the patient after completion of surgery till the patient is fully conscious
This specialized care is provided in a specialized area called PACU
SEVERAL POST OPERATIVE COMPLICATIONS LIKE
HYPOXIA , HYPERTENSION , HYPOTENTION , HYPO THERMIA , HYPERTHERMIA , MODIFIED ALDERT SCORE , PAIN ASSESMENT AND TREATMENT , POST OPERATIVE NAUSEA AND VOMITING , ETC. MIGHT OCCUR .
Post-Operative Managment
• The post operative period begins from the time
• The patients leaves the operating room and ends with the
follow up visit by the surgeon.
• The post operative care is provided by
-- PACU
-- SICU
at the end of this lecture, the learner will be able to Define the three phases of perioperative nursing.
Identify the members and functions of the surgical team.
Describe the principles of surgical asepsis.
Differentiate the three phases of post-anesthesia care.
Identify measures to manage postoperative complications.
Preoperative and postoperative Nursing care(ayoub ) for presentation Ayoub Abdul Majeed
Photo: Pre and post-operative care
During the perioperative period, specialised nursing care is needed during each phase of treatment. For nurses to give effective and competent care, they need to understand the full perioperative experience for the patient.
Perioperative refers to the three phases of surgery.
Preoperative stage
Intraoperative stage
Postoperative stage
Within these stages there are many different roles for nurses and different care needed for the patient dependent on which stage they are in.
As with any nursing care, the goal during these stages is to provide holistic and evidence-based care as well as support to the individual
To provide quick, painless & safe recovery from surgery as soon as possible.
Learning Objectives:
1.The need for immediate post-op care
2. Common post-operative problems
3. Anticipation & prevention of common complications
4. Identification & Treatment
5. Enhancement of recovery
6. Systematic discharge
Pre and post operative care for patients undergoing general anesthesiaJewel George Thomas
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*Statutory Declaration - The Slides are congested as they contain a number of animations. Please download it and play Slideshow for proper understanding. Thank You.
Post Operative Care | PACU | Complications | Treatment Yashasvi Verma
Post operative period is the most crucial and
critical span of time after completion of surgery
In this period numerous complications occur and if not treated on time can prove fatal hence increasing the mortality rate .
The specialized care provided to the patient after completion of surgery till the patient is fully conscious
This specialized care is provided in a specialized area called PACU
SEVERAL POST OPERATIVE COMPLICATIONS LIKE
HYPOXIA , HYPERTENSION , HYPOTENTION , HYPO THERMIA , HYPERTHERMIA , MODIFIED ALDERT SCORE , PAIN ASSESMENT AND TREATMENT , POST OPERATIVE NAUSEA AND VOMITING , ETC. MIGHT OCCUR .
Post-Operative Managment
• The post operative period begins from the time
• The patients leaves the operating room and ends with the
follow up visit by the surgeon.
• The post operative care is provided by
-- PACU
-- SICU
at the end of this lecture, the learner will be able to Define the three phases of perioperative nursing.
Identify the members and functions of the surgical team.
Describe the principles of surgical asepsis.
Differentiate the three phases of post-anesthesia care.
Identify measures to manage postoperative complications.
Preoperative and postoperative Nursing care(ayoub ) for presentation Ayoub Abdul Majeed
Photo: Pre and post-operative care
During the perioperative period, specialised nursing care is needed during each phase of treatment. For nurses to give effective and competent care, they need to understand the full perioperative experience for the patient.
Perioperative refers to the three phases of surgery.
Preoperative stage
Intraoperative stage
Postoperative stage
Within these stages there are many different roles for nurses and different care needed for the patient dependent on which stage they are in.
As with any nursing care, the goal during these stages is to provide holistic and evidence-based care as well as support to the individual
To provide quick, painless & safe recovery from surgery as soon as possible.
Learning Objectives:
1.The need for immediate post-op care
2. Common post-operative problems
3. Anticipation & prevention of common complications
4. Identification & Treatment
5. Enhancement of recovery
6. Systematic discharge
Pre and post operative care for patients undergoing general anesthesiaJewel George Thomas
Guys if you are desirous of a Personalized PowerPoint Presentation, then feel free to screen into my SlideShare profile and pick up the most suitable Contact method to get in touch with me.
*Statutory Declaration - The Slides are congested as they contain a number of animations. Please download it and play Slideshow for proper understanding. Thank You.
Oral Surgery in Patients on Anticoagulant TherapyVarun Mittal
Management of patients on Anticoagulant Therapy in Surgical Practice with special emphasis on Oral Surgical Procedures; along with Guidelines drawn from various Text Books and Journals
Management Of Patient Undergoing Surgerykalyan kumar
Preoperative care refers to health care provided before a surgical operation. The aim of preoperative care is to do whatever is right to increase the success of the surgery.
At some point before the operation the health care provider will assess the fitness of the person to have surgery.
During the perioperative period, specialised nursing care is needed during each phase of treatment. For nurses to give effective and competent care, they need to understand the full perioperative experience for the patient.
Perioperative refers to the three phases of surgery.
Preoperative stage
Intraoperative stage
Postoperative stage
Within these stages there are many different roles for nurses and different care needed for the patient dependent on which stage they are in.
As with any nursing care, the goal during these stages is to provide holistic and evidence based care as well as support to the individual.
There are different nursing roles throughout the perioperative process including: admissions nurse, anaesthetic nurse, circulating nurse or scout nurse, instrument or scrub nurse, post anaesthesia care unit (PACU) nurse and the surgical ward nurse. Other nurses may be included in the perioperative process such as pain management specialist nurses, diabetes educators.
Peri-operative Nursing/Anesthesia/Pain ManagementWasim Ak
The care provide during surgical intervention (pre-operative, intra-operative and post-operative period) is known as Peri-operative Nursing Care.
Peri-operative Nursing Care includes :
Pre-operative Nursing Care
Intra-operative Nursing Care
Post-operative Nursing Care.
Anesthesia means “loss of sensation with or without loss of consciousness” .
Medications that cause anaesthesia, are called Anesthetics.
Anesthesia is defined as a temporary state consisting of unconsciousness, loss of memory, lack of pain, and muscle relaxation.
Anesthesia is defined as a loss of feeling or awareness caused by drugs or other substances which keeps patient free from feeling pain during surgery or other procedures.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. The long operation is finished,leaving you to
savour the sweet postoperative HIGH and
Elation.But soon ,when your serum level of
endorphins declines ,you start worrying about
the outcome.And worry you must,for the
cocksure,macho attitude is a recipe for disasters.
We do not intend here to have a detailed
discussion of postoperative care or to write a new
surgical intensive care manual.
We only wish to share with you some basic
precepts,which may be forgotten,drowned in a sea
of fancy technology and gimmicks.
3. The post operative
period begins from
the time the patient
leaves the operating
room and ends with
the follow up visit by
the surgeon.
The post operative
care is provided by -
PACU
SICU
4.
5.
6.
7.
8. Transferring of the patient from
the OR to the PACU is the
responsibility of the
anesthesiologist.
During transport the
anesthesiologist remains at the
head part of the patient and a
surgical team member remains
at the opposite side.
Transporting the patient
involves the special
consideration of the incision
site, potential vascular changes
and exposure.
9. Location:
◦ Close to Operating Rooms
◦ Easy access to Lab, X-ray, Blood bank
◦ Close to ICU
Size:
◦ Ideal 1.5 PACU bed for every OT
◦ 120 square foot per patient
◦ Minimum of 7 feet between beds
February 6, 2015 9
10. Facilities:
◦ Fowler’s cot with side rails
◦ Piped Oxygen, Vacuum and Air
◦ Multiple electrical outlets
◦ Large doors
◦ Good lighting
◦ Isolation for Immuno-compromised patients
February 6, 2015 10
11. Tray with labeled Emergency drugs
Airway maintenance kit:
◦ Laryngoscope with all size blades
◦ All sizes Endotracheal tubes
◦ Face masks, Airways, Ambu Bag, Venturi masks
◦ Tracheostomy set
◦ ICD set
◦ Transport ventilator
February 6, 2015 11
12. Personnel:
◦ Requirement varies
◦ 1 : 1 ratio good
◦ 1 : 3 ratio acceptable for busy OR’s
Monitors:
◦ ECG
◦ Pulse oximeter
◦ Non invasive BP
◦ EtCO2
◦ Invasive pressure monitor
◦ Temperature
February 6, 2015 12
13. Before receiving the patient, there should be proper functioning of
monitoring and suctioning devices, oxygen therapy equipment, and
all other equipment. The following initial assessment is made by the
nurse in the PACU.
1. Verify the patient’s identity, the operative procedures, and the
surgeon who performed the procedures.
2. Evaluate the following signs & verify their level of stability with the
anesthesiologist.
Respiratory Status
Circulatory Status
Pulses
Temperature
Hemodynamics Values
14. A) All vitals 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.
15.
16.
17. Diet:
◦ NPO
◦ Liquids.
◦ Soft diet.
◦ Normal or special diet.
Extreme care in 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.
18. Maintain airway
By proper positioning of patient’s head.
By clearing airway.
◦ O2 mask.
◦ Ventilator.
◦ Tracheal suction.
◦ Chest physiotherapy.
Position in Bed and mobilization:
◦ Turning in bed usually every 30 min. until full mobilizatio
◦ Special position required sometimes.
◦ DVT prevention mechanically ( intermittent calf
compression).
19. 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.
20. 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.
21. Blood transfusion only absolutely
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 haemorrhage in body
cavity.
23. 1. Monitor temperature hourly to be alert from malignant
hyperthermia or to detect hypothermia.
2. A temperature over 37.7 c (100F) or under 36.1 c (97F) is
reportable.
3. Monitor for post anesthesia shivering (PAS) it is most significant
in hypothermic patients 30 to 45 minutes after admission to the
PACU. It represents a heat gain mechanism and relates to
regaining thermal balance.
4. Provide a therapeutic environment with proper temperature and
humidity, when cold, provide the patients with warm blanket.
24. Perhaps the most useful factor in trying to establish the cause of a
patient's fever is THE RELATIONSHIP BETWEEN THE
TIME OF ONSET OF THE FEVER AND THE
PROCEDURE.
Fever within the first 24 hours of an operation is common and may
reflect little more than the body's metabolic response to injury.
Atelectasis is common during this time and may produce a self-
limiting low-grade fever.
A fever that is evident between 5 and 7 days after an operation is
usually due to infection.
While pulmonary infections tend to occur in the first few days after
surgery, fever at this later stage is more likely to reflect infection of
the wound, operative site or urinary tract.
Cannula problems and deep vein thrombosis (DVT) should also
be considered.
A fever occurring more than 7 days after a surgical procedure may
be due to abscess formation.
Apart from infection as a cause of fever, it is important to
remember that drugs, transfusion and brainstem problems can
also produce an increase in the body's temperature.
25. Administer opioid
analgesia as per
Doctor’s order.
Epidural analgesia.
NSAIDS.
Psychological support to
relieve fear+To give
support.
26. These are common
problem in post operative
period.
Medication can be
administered as per
doctor’s order.
Example:
Inj Metaclopramide
Inj Ondansetron
( Emeset )
27. General and specific 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.
Lab. Tests and Imaging:
◦ To detect or exclude Post-Op. complications.
28.
29. 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.)
30. The major goals include:
Restoration of optimal respiratory function
Relief of pain
Optimal cardiovascular function
Increased activity tolerance
Unimpaired wound healing
Maintenance of body temperature
Maintenance of nutritional balance
Resumption of usual bowel and bladder elimination
Acquisition of sufficient knowledge to manage self-care after
discharge
Absence of complications
31. 1. Keep side rails up until the patient is fully awake.
2. Protect the extremity to which IV fluids are running so
the needle will not become accidentally dislodged.
3. Avoid nerve damage and muscles train by properly
supporting and padding pressure areas.
4. Recognize that the patient may not be able to complain
of injury such as the pricking of an open safety pin or
clamp that is exerting pressure.
5. Check dressing for constriction.
6. Determine return of motor control following anesthesia
indicated by how the patient responds to a pinprick or a
request to move a part.
32. Complications:
a. Urinary retention- inability to urinate as a result of the
recumbent position, effects of anesthesia and narcotics,
inactivity, altered fluid balance, nervous tension or surgical
manipulation of the pelvic area.
Nsg Mgt:
a.1 assess for bladder distension
a.2 monitor I & O
a.3 maintain IVF as prescribed
a.4 increase daily oral intake 2500-3000L
a.5 insert straight or IFC
a.6 promote normal urinary elimination
33. b. Bowel elimination- frequently altered after pelvic or abdominal surgery
and sometimes after other surgery. Return to normal GI function may
be delayed by general anesthesia, narcotic analgesia, decreased
mobility or altered fluid and food intake during perioperative period.
Nsg Care:
1. Assess for return or normal peristalsis:
a. auscultate bowel sounds every 4 hours while the client is awake
b. assess the abdomen for distention
c. determine whether the client is passing flatus
d. monitor for passage of stool including consistency
2. Encourage ambulation within prescribed limits
3. Facilitate a daily intake of fluids 2.5-3L
4. Provide privacy when the patient is using the bedpan, commode or
bathroom
5. If no BM has occurred for 3-4 days post op, a suppository or an
enema may be ordered.
34. A patient remains in the post op unit, untill the patient has fully
recoverd from anesthesia.
Following measures are used to determine the patient
ready for disharge 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.
Aldrete score more than ‘ 9 ‘ before shifting from
Post Operative Anaesthesia Care Unit
35. “ Neither an arbitrary time
limit nor a discharge score
can be used to define a
medically appropriate length
stay in the recovery room
accurately ”
February 6, 2015 35
36. DISCHARGE FROM RECOVERY SHOULD BEDISCHARGE FROM RECOVERY SHOULD BE
AFTER COMPLETE STABILIZATION OFAFTER COMPLETE STABILIZATION OF
CARDIO-VASCULAR, PULMONARY ANDCARDIO-VASCULAR, PULMONARY AND
NEUROLOGICAL FUNCTIONS WHICHNEUROLOGICAL FUNCTIONS WHICH
USUALLY TAKES 2-4 HOURS.USUALLY TAKES 2-4 HOURS.
IF NOT SPECIAL CARE IN ICU.IF NOT SPECIAL CARE IN ICU.
37. Starts with complete recovery from
anaesthesia and lasts for the rest of
the hospital stay.
38. 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.
39. Drains- are tubes that exit the peri-incisional area,
either into a portable suction devise(close) or into the
dressing(open)
To drain fluids accumulating after surgery, blood or pus.
Open or closed system.
Other types (Suction, sump, under water etc.)
Should come out throw separate incision to minimize risk of wound infection.
Inspection of contents and its amount.
Drains are not highly reliable.we should always have a confirmation by inv
(usg) etc when in doubt, bcoz sometimes drain may get blocked by omentum
or intestine or may get displaced as in cholecystectomy
Should not be left long periods because they form a tract and acts as a plug.
Drain should be kept till it drains.
40. 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 diseases specially in elderly.
41. 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
reduce pulmonary oedema.
42. 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.
43. 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
44. 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.
45. 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.
46. NPO until peristalsis returns.
Paralytic ileus usually takes about 24hs.
NGT is necessary after esophageal and gastric surgery.
NGT is NOT necessary after cholecystectomy and pelvic operation.
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.
47. Complications of Pain:
◦ Causes vasospasm.
◦ Hypertension.
◦ May cause CVA, MI or bleeding.
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.
48. 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).
49. Expected outcomes:
1. Indicates that pain is decreased .
2. Maintains optimal respiratory function
a. performs DBE
b. displays clear breath sounds
c. uses incentive spirometry as prescribed
d. splints incisional site when coughing
3. Does not develop DVT
4. Exercises and ambulates as prescribed
a. alternates periods of rest and activity
b. progressively increases ambulation
c. resumes normal activities with prescribed time frame
d. performs activities r/t self care
5. Wounds heal without complications
50. 6. Resumes oral intake and normal bowel function
◦ takes at least 75% of usual diet
◦ is free of abdominal distress and gas pains
◦ exhibits normal bowel elimination pattern
7. Acquires knowledge and skills necessary to manage
therapeutic regimen
8. Experiences no complications and has normal Vs
51. Expected out comes
Immediate post
operative changes
Written instructions like
Wound care
Activity+dietary
recommendation
Medications
Follow up
52. ‘Seek consultation even if it is not sure to
help;never be a lone wolf’
It is much better in this modern surgical age to
form a close working relationship with colleagues
who share your philosophy of care and who have
expertise in areas beyond your own.
Because once you operate on a patient he or she
is all yours!