The document discusses postoperative care in the post-anesthesia care unit (PACU). It outlines assessments and potential complications to monitor for various body systems, including respiratory (atelectasis, hypoxemia), cardiovascular (hypotension, arrhythmias), neurological, pain, hypothermia, nausea and vomiting. Nursing diagnoses and interventions are provided to manage complications and optimize recovery, such as deep breathing exercises to prevent atelectasis, monitoring vital signs and urine output, providing pain relief, and addressing psychological needs before discharge.

1. Postoperative Care

2. Care in the PACU- post anaesthetic care unit or recovery room ACP gives report to admitting PACU nurse What information would you want to know? Initial Assessment What should be included? What is the priority?

3. Care in the PACU What should be included in the following assessments? Respiratory Assessment Cardiovascular Assessment Neurological Assessment

4. Initial Assessments cont’d in PACU Urinary assessment Wound assessment

5. Potential Alterations in Respiratory Function Airway obstruction Hypoxemia Atelectasis Pulmonary edema Aspiration of gastric secretions Bronchospasm Hypoventilation

6. Etiology and relief of airway obstruction caused by patient’s tongue Fig. 19-2

7. Nursing Management Respiratory Complications Nursing Diagnoses Ineffective airway clearance Ineffective breathing pattern Impaired gas exchange Risk for aspiration Potential complication: hypoxemia

8. Nursing Management Respiratory Complications Nursing Implementation What are some nursing actions that the nurse can implement for a client exhibiting respiratory complications?

9. Potential Complications in Cardiovascular Function Most common complications: hypotension hypertension arrhythmia Greatest risk: Cardiac history Elderly Debilitated or critically ill

10. Nursing Management Cardiovascular Complications Nursing Assessment What assessments need to be done to monitor the cardiovascular system?

11. Nursing Management Cardiovascular Complications Nursing Diagnoses Decreased cardiac output Deficient fluid volume Ineffective tissue perfusion Excess fluid volume Potential complication: hypovolemic shock

12. Nursing Management Cardiovascular Complications Nursing Implementation What interventions can the nurse expect to be done for someone exhibiting cardiovascular complications?

13. Nursing Management Neurologic Complications Nursing Assessments for neurological system?

14. Nursing Management Neurologic Complications Nursing Diagnoses Disturbed sensory perception Risk for injury Disturbed thought processes Impaired verbal communication Nursing Implementation?

15. Pain and Discomfort What nursing assessments can be done to assess for pain and discomfort? Nursing Diagnoses Acute pain Anxiety Nursing Implementation for pain management?

16. Hypothermia Nursing Assessment? Nursing Diagnoses Hypothermia Risk for imbalanced body temperature Nursing Implementation?

17. Nausea and Vomiting Significant problems in postoperative period Responsible for unanticipated admission, increased discomfort, delays in discharge, and dissatisfaction with surgical experience

18. Nausea and Vomiting Nursing Assessment? Nursing Diagnoses Nausea Risk for aspiration Risk for deficient fluid volume Nursing Implementation

19. Care of Postoperative Patient on Clinical Unit PACU nurse gives report to receiving nurse summarizing operative and postoperative periods Receiving nurse assists with transfer onto bed Vital signs obtained and compared to report

20. Potential Complications in Respiratory Function Atelectasis and pneumonia commonly occur after abdominal and thoracic surgery

21. Postoperative Atelectasis Fig. 19-4 Normal bronchiole and alveolus B. Mucous plug in bronchiole C. Collapse of alveoli due to absorption of air

22. Potential Complications in Respiratory Function Nursing Diagnoses Ineffective airway clearance Ineffective breathing pattern Impaired gas exchange Potential complication: pneumonia Potential complication: atelectasis

23. Potential Complications in Respiratory Function Nursing Implementation Deep breathing and cough helps prevent alveolar collapse Incentive spirometer Splinting Diaphragmatic breathing Change position q2h

24. Techniques for Splinting Wound When Coughing Fig. 19-5

25. Potential Alterations in Cardiovascular Function Fluid and electrolyte imbalances contribute to alterations Hypokalemia can result from urinary or GI losses DVT and pulmonary embolism Syncope

26. Nursing Management Cardiovascular Complications Nursing Assessment Regular monitoring of BP, HR, pulse, and skin temperature and color Compare with preoperative status and postoperative findings

27. Nursing Management Cardiovascular Complications Nursing Diagnoses Decreased cardiac output Deficient fluid volume Excess fluid volume Ineffective tissue perfusion Activity intolerance Potential complication: thromboembolism

28. Nursing Management Cardiovascular Complications Nursing Implementation Accurate I&Os Monitor laboratory findings Assessment of infusion rate of fluid replacement and infusion site Adequate mouth care Leg exercises

29. Postoperative Leg Exercises Fig. 19-6

30. Nursing Management Cardiovascular Complications Elastic stockings or compressive devices Unfractionated or low-molecular-weight heparin Ambulation Slowly progress Monitor pulse Assess for feelings of faintness

31. Potential Alterations in Urinary Function Low urinary output may be expected in the first 24 hours, regardless of intake

32. Nursing Management Urinary Complications Nursing Assessment Urine examined for quantity and quality Note color, amount, consistency, and odor Assess indwelling catheters for patency Urine output should be at least 0.5 ml/kg per hour or 30cc/hr.

33. Nursing Management Urinary Complications Nursing Diagnoses Impaired urinary elimination Potential complication: acute urinary retention

34. Nursing Management Urinary Complications Nursing Implementation Position patient for normal voiding Reassure patient of ability to void Use techniques such as running water, drinking water, pouring water over perineum, ambulation, or use of bedside commode

35. Potential Alterations in Gastrointestinal Function Nausea and vomiting may be caused from anesthetic agents or narcotics, delayed gastric emptying, slowed peristalsis, resumption of oral intake too soon after surgery Abdominal distention from decreased peristalsis caused by handling of bowel during surgery

36. Potential Alterations in Gastrointestinal Function Swallowed air and GI secretions may accumulate in colon, producing distention and gas pains Hiccoughs from irritation of phrenic nerve

37. Nursing Management Gastrointestinal Complications Nursing Assessment Auscultate abdomen in all four quadrants for presence, frequency, and characteristics of bowel sounds Can be absent or diminished in immediate postoperative period Return of bowel motility accompanied by flatus

38. Potential Alterations in Gastrointestinal Function Nursing Diagnoses Nausea Imbalanced nutrition: less than body requirements Potential complication: paralytic ileus Potential complication: hiccoughs

39. Potential Alterations in Gastrointestinal Function Nursing Implementation May resume intake upon return of gag reflex NPO until return of bowel sounds for patient with abdominal surgery IVF, NG for decompression Clear liquids, advance as tolerated

40. Potential Alterations in Gastrointestinal Function Nursing Implementation Regular mouth care when NPO Antiemetics administered for nausea NG tube if symptoms persist Early and frequent ambulation to prevent abdominal distention Assess patient regularly for resumption of normal peristalsis

41. Potential Alterations in Gastrointestinal Function Nursing Implementation Encourage patient to expel flatus and explain expulsion is necessary and desirable Relief of gas pains by frequent ambulation and repositioning Suppositories prn Determine cause of hiccoughs

42. Potential Alterations of the Integument Incision disrupts skin barrier and healing is major concern during postoperative period Adequate nutrition Impaired wound healing with chronic disease and elderly Wound infection

43. Potential Alterations of the Integument Evidence of wound infection usually not apparent until 3 rd to 5 th postoperative day Local manifestations of redness, edema, pain, and tenderness Systemic manifestations of leukocytosis and fever

44. Potential Alterations of the Integument Accumulation of fluid in wound may impair healing and predispose to infection Drain may be placed

45. Nursing Management Surgical Wounds Nursing Assessment Knowledge of type of wound, drains, and expected drainage Drainage should change from sanguineous to serosanguineous to serous with decreasing output Wound dehiscence may be preceded by sudden brown, pink, or clear discharge

46. Potential Alterations of the Integument Nursing Diagnoses Risk for infection Potential complication: impaired wound healing

47. Potential Alterations of the Integument Nursing Implementation Note type, amount, color, and consistency of drainage Assess affect of position changes on drainage

48. Potential Alterations of the Integument Notify surgeon of excessive or abnormal drainage and significant changes in vitals Note number and type of drains when changing dressing Examine incision site Clean gloves and sterile technique

49. Pain and Discomfort Postoperative pain caused by a number of physiologic and psychologic interactions Traumatization of skin and tissues Reflex muscle spasms Anxiety/fear increase muscle tone and spasm

50. Nursing Management Pain Nursing Assessment Nursing Diagnoses Acute pain Disturbed sensory perception Nursing Implementation

51. Potential Alterations in Temperature Hypothermia may be present in immediate postoperative period Fever may occur at any time Mild elevation (up to 38 degrees C) may result from stress response Moderate elevation (>38 ° C) usually caused by respiratory congestion or atelectasis and rarely by dehydration

52. Potential Alterations in Temperature Wound infection often accompanied by fever spiking in afternoon and near-normal in morning Can signal C. difficile when accompanied by diarrhea and abdominal pain Intermittent high with shaking chills and diaphoresis indicates septicemia

53. Nursing Management Altered Temperature Nursing Assessment Nursing Diagnoses Risk for imbalanced body temperature Hyperthermia Hypothermia

54. Nursing Management Altered Temperature Nursing Implementation Measure temperature q4h for first 48 hours postoperatively Asepsis with wound and IV sites Encourage airway clearance Chest x-rays and cultures if infection suspected Antipyretics and body-cooling >39.4 ° C

55. Potential Alterations in Psychologic Function Anxiety and depression may be more pronounced with radical surgery or with poor prognosis Confusion and delirium may result from psychological and physiologic sources

56. Nursing Management Psychologic Function Nursing Diagnoses Anxiety Ineffective coping Disturbed body image Decisional conflict

57. Nursing Management Psychologic Function Nursing Implementation Provide adequate support Listen and talk with patient, offer explanations, reassure, and encourage involvement of significant other Discuss expectation of activity and assistance needed after discharge

58. Nursing Management Psychologic Function Patient must be included in discharge planning and provided with information and support to make informed decisions about continuing care Recognition of alcohol withdrawal syndrome Report any unusual behavior for immediate diagnosis and treatment

59. Planning for Discharge and Follow-up Care Planning for discharge begins in preoperative period Provide information to patient and caregivers What information is needed?