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post operative care for surgery patients
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- 4. The care ofpatient after surgery. This includes care given during the immediate post operative period, both in the operative room and post anaesthesia care unit
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- 6. The post anaesthesiacare unit also called the post anaesthesia recovery room, is located adjacent to the operating room. The PACU is kept clean and free of necessary equipment. The PACU involves assessing the patient and preventing the complications of anaesthesia or the surgical procedure.
- 7. CONT.. Patient stays inPACU vary depending upon type of surgery performed and individual response of the patients to surgery.
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- 9. TRANSFER Transfer of thepatient from operation theatre to PACU. After the operation, the patient is transported to recovery room on the stretcher. Care must be taken to prevent injury and exposure while transportation.
- 10. POSITION Position of thepatient after surgery depends upon the operation and the type of anaesthesia given unless contraindicated, the patient is kept in lateral position with the back, abdomen and extremities well supported. If the patient is kept in supine position, the head should be turned slightly to the side to have a free passage for breathing.
- 11. CARDIO VASCULAR SYSTEM Monitor thevital signs including ECG, blood pressure respiration, oxygen saturation and temperature. After 15 min for 1st hour 3min for next 2 hours Hourly for next 2 hours If the patient is stable, than 4 hourly.
- 12. RESPIRATORY SYSTEM Assess therespiratory status of the patient. It includes:- Assessing the patency of airway Administering the humidified oxygen Oxygen saturation Assessing the respiratory rate, rhythm and depth Auscultating the breath sounds Assessing the skin colour
- 13. CENTRAL NERVOUS SYSTEM Assessment isbased upon patients response to stimuli and orientation and ability to move the extremities. Not responding, arousable with verbal stimuli, fully awake, oriented to time.
- 14. FLUID VOLUME Assess thefluid status. It includes:- Skin turgor Fluid intake and urine output Wound drainage Maintain fluid balance chart Assess intravenous site for patency infusion for correct rate and solution
- 15. OPERATIVE SITE(SURGICAL SITE) Assessthe surgical site and wound drainage system Wound- colour, infection, bleeding, sutures Drains rate and volume of blood loss Urinary catheter- position, patency hourly urine/volume, colour and concentration.
- 16. PAIN MANAGEMENT Assess thelevel of pain, type, location and severity using verbal or numeric rating scale. Use non pharmacologic method decrease pain and improve comfort by positioning verbal assurance. Administer analgesics as prescribed and assess their effectiveness in relieving pain.
- 17. When the patientis received in the post operative ward, assess the following conditions:-
- 18. RESPIRATORY STATUS Patency ofairway depth, rate and character of respirations
- 19. CIRCULATORY STATUS Vital sigs,colour and temperature of the skin
- 20. LEVEL OF CONSCIOUSNESS Levelof consciousness and orientation to time, place and person.
- 21. WOUND Dressing is examinedclosely for signs of bleeding, redness and other drainage.
- 22. TUBES Presence of intravenous tubes, N.G.tube, indwelling catheters, type of patency of tubing, catheter and amount of infusion is checked
- 23. TREATEMENT Examine the patient’s chartfor the surgeon’s order and other information like type of surgery performed.
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- 25. PREPARATION OF POST ANESTHETIC BEDAND RECEPTION OF THE PATIENT
- 26. After sending thepatient to operating room prepare a bed to receive the patient under gone surgery and anaesthesia. There should be adequate surgery number of people to transfer the patient without distributing the functioning of the devices attached to the patient. Receive the patient without disturbing the devices attached to the patient.
- 27. CONT.. Ask the theatrestaff who has accomplished with the patient about any complications that has occurred in the operation room during surgery . Before the theatre staff return to operations theatre; check the vital signs blood pressure, pulse rate, respiratory rate, colour of the skin and nails for cyanosis. Check the operation site for bleeding, discharge etc. If the drainage tube are filtered.
- 28. CONT.. Keep the patientwell covered to prevent draught. Never leave the patient alone to prevent injury from falls. Observe the patient for swallowing reflexes. If not present keep the patient in a side lying position to prevent the tongue falling back and obstructing the airway.
- 29. CONT.. Quickly observe thefunctioning of all devices and make sure that they are in its functioning order. E.g. The drainage tubes connected with the drainage bottle the IV sets are patent.
- 30. CARE OF THEPATIENT WHO IS UNDER THE EFFECTS OF ANAESTHESIA
- 31. Patient needs closeand diligent observation until the patient fully recovers from anaesthesia. A noisy breathing is indicative of airway obstruction the can occur due to the tongue falling back and obstructing the pharynx or fluid collected in the circulatory passages or fluids aspirated into the lungs. Keep the patient in a suitable position that will be helpful to drain out he vomitus, blood and secretions collected in the mouth and will prevent them aspirating into the lungs.
- 32. CONT.. The oro-pharyngeal airwayleft in the mouth of the patient should be removed as soon as the patient has regained the cough and swallowing reflexes. Excessive secretions in the mouth or anywhere in the respiratory passage can lead to airway obstruction If the patient is cyanosed, administer oxygen inhalation. At the same time, find out the cause and remove the cause.
- 33. CONT.. A weakthready pulse with a significant fall in blood pressure may indicate circulatory future In order to prevent injury from bed put on the side rails on the bed. Till the patient recover from the effects of anaesthesia the nurse should not leave the patient alone. While awakening from anaesthesia, patients need frequent orientation as to where they are, what has been done to them and reassurance that they are safe in the hands of the medical team
- 34. CONT.. Although thesepatients, while they are under the anaesthesia, appear to be unconsciousness, the nurses should be careful, not to make any statement about the patient. When the patients under the effects of anaesthesia complaint pain in the operation site, the Narcotics/Sedatives may be ordered by the surgeon and it should be given with caution. Patient recovering from anaesthesia may for drinking water
- 35. CONT.. The firstpost operative dose of a Narcotic is usually reduced to half the dose of the patient will be receiving after fully recovered from anaesthesia. Unless the patient has fully regained the swallowing reflex, drinking water may the patient; it should not be given. As the patient is recovering from the effects of anaesthesia the patient may become restless due to discomfort caused by the presence of those those devices attached to the patient. such as:- IV sets, urinary catheters, drainage tubes etc.
- 36. CONT.. The nurse shouldhelp the patient by giving adequate explanations. Keep the family informed of the successful completion of surgery, transfer of the patient from the operating room to recovery room etc. It possible allow the relatives to meet surgeon to clear their doubts.
- 37. OBSERVATION OF THE PATIENTIN THE POST OPERATIVE PERIOD
- 38. Close the diligentobservation by the nurses are important to detect complications in the early stages and thus, save the patients. On the first post operative day the patient needs close and frequent observation; e.g. vital signs are cleared every 15 minutes or more frequently. Once the vital signs are stabilized, the observations may be made every 2nd hourly or 4th hourly according to the progress made by the patient.
- 39. CONT.. The main points thatshould be observed are vital signs-blood pressure, pulse rate, respiratory rate, skin colour, temperature.
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- 41. All patients, expectpatients who had abdominal surgery, may start the normal diet, if desired, so on the first day. Patients who had abdominal surgery but did not involved the intensive or stomach can have the clear fluids on the day after the surgery, may start the normal diet, if desired so on the first day.
- 42. CONT.. Gradually, it canchange into soft diet and then normal diet. Patients who are with specific diseases, for which they were taking special diets should be taken systematically.
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- 44. All the patientsneed health teaching according to the educational back ground of the patient. Teach the patient following points:- Maintenance of personal hygiene. Diet that is allowed for the patient; any control of the diet.
- 45. CONT.. Ambulation, activities thatare permitted, as well as restricted. Any adjustments to be made in the occupation of the patient.
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