lecture about postoperative care

1. Postoperative
care
One of Chain care components
Dr. Sayed A.A .(GS Resident)
KFSHT

2. Chain care
components :
• Perioperative Care :
• Preoperative Care
• Intraoperative care
• Postoperative
care .

3. Preoperative care : decision for surgery to
transfer the patient to operating room table .
Intraoperative care : Table to admission to
post anesthesia care unit .
Postoperative care : Period of time that
begins with admissions of the patient to post
anesthesia care unit and ends after follow up
- evaluation in the clinical setting or home .

4. Preoperative care :
Psychological care
: forgotten , missed
or unsuccessful
Psychological
preparation :
Understand patients
concern (relax ,
reassure , support )
Answer patient
honestly
Allow patient to be
with their close ones
to cope better with
fear
Postponed the
surgery till the
patient feels secured
and prepared.
Arrange the room
with light colours
and minimal objects.
Take patients
feedback and
preferences.

5. Psychologically
prepared patient
• Low fear and anxiety
• Positive long term coping skills and
adjustments to future medical needs.
• Significant greater satisfaction with his
experience
• Benefits :
• low stress , trusting relationships , increase
confidence and cooperation

6. Post-
operative
care
Purpose :
The goal is to prevent complications such as infection ,
to promote healing of the surgical incision , and to
return the patient to the state of health !
In some cases this will not always be achieved : cancer
patients who got disabilities following surgery : more
postoperative care which include education how to
deal with the new state for ex (colostomy).

7. Description :
P.O.C involve assessment , diagnosis , planning ,
intervention and outcome evaluation
Length of the P.O.C : Pre- surgical heath status ,
: Type of surgery : day surgery ( hours ) during which
may require admission which will affect length of POC ,
(post anesthesia or postoperative complications )
: admitted patients POC length may be days or weeks
accordingly .

8. Postanesthesia care unit (PACU)
• The patient is transferred to the PACU after the surgical procedure,
anesthesia reversal, and extubation (if it was necessary). The amount
of time the patient spends in the PACU depends on the length of
surgery, type of surgery, status of regional anesthesia (e.g., spinal
anesthesia), and the patient's level of consciousness. Rather than
being sent to the PACU, some patients may be transferred directly to
the critical care unit. For example, patients who have had coronary
artery bypass grafting are sent directly to the critical care unit.
• In the PACU, the anesthesiologist or the nurse anesthetist reports on
the patient's condition, type of surgery performed, type of anesthesia
given, estimated blood loss, and total input of fluids and output of
urine during surgery. The PACU nurse should also be made aware of
any complications during surgery, including variations in
hemodynamic (blood circulation) stability.

9. D/C from PACU :
• Depending on the type of surgery and the patient's
condition, the patient may be admitted to either a general
surgical floor or the intensive care unit . Since the patient
may still be sedated from anesthesia, safety is a primary
goal. The patient's call light should be in the hand and side
rails up. Patients in a day surgery setting are either
discharged from the PACU to the unit, or are directly
discharged home after they have urinated, gotten out of
bed, and tolerated a small amount of oral intake.

10. First 24 hrs postoperative :
• Effective preoperative teaching has a positive impact on the first 24 hours
after surgery. pain under control. Respiratory exercises (coughing, deep
breathing, and incentive spirometry) should be done every two hours. The
patient should be turned every two hours, and should at least be sitting on
the edge of the bed by eight hours after surgery, unless contraindicated
(e.g., after hip replacement ). Patients who are not able to sit up in bed due to
their surgery will have sequential compression devices on their legs until
they are able to move about. These are stockings that inflate with air in
order to simulate the effect of walking on the calf muscles, and return blood
to the heart. The patient should be encouraged to splint any chest and
abdominal incisions with a pillow to decrease the pain caused by coughing
and moving. NPO (nothing by mouth) if ordered by the surgeon, at least
until their cough and gag reflexes have returned. Patients often have a dry
mouth following surgery, which can be relieved with oral sponges dipped in
ice water or lemon ginger mouth swabs.

12. Postoperative Management
If the patient is restless, something is wrong.
Look out for the following in recovery:
• Airway obstruction
• Hypoxia
• Hemorrhage: internal or external
• Hypotension and/or hypertension
• Postoperative pain
• Shivering, hypothermia • Vomiting, aspiration
• Falling on the floor
• Residual narcosis

13. Continue
management
The recovering patient is fit for the ward when:
• Awake, opens eyes
• Extubated
• Blood pressure and pulse are satisfactory
• Can lift head on command
• Not hypoxic
• Breathing quietly and comfortably
• Appropriate analgesia has been prescribed and is safely established

14. Post-
operative
note and
orders :
The patient should be discharged to the ward with comprehensive orders for the following: •
Vital signs
Pain control
• Rate and type of intravenous fluid
• Urine and gastrointestinal fluid output
• Other medications
• Laboratory investigations
The patient’s progress should be monitored and should include at least:
• A comment on medical and nursing observations
• A specific comment on the wound or operation site
• Any complications • Any changes made in treatment

15. Post-operative pain relief
• • Pain is often the patient’s presenting symptom. It can provide useful clinical
information and it is your responsibility to use this information to help the patient and
alleviate suffering. • Manage pain wherever you see patients (emergency, operating
room and on the ward) and anticipate their needs for pain management after surgery
and discharge. • Do not unnecessarily delay the treatment of pain; for example, do not
transport a patient without analgesia .

16. Pain
management
opiate analgesics.Preoperatively o Intraoperatively Postoperatively•
(NSAIDs), (1 mg/kg) , paracetamol (15 mg/kg).
• Premedication is rarely indicated,
• Opiates given pre- or intraoperatively have important effects in the postoperative
period since there may be delayed recovery and respiratory depression, even necessitating
mechanical ventilation. • Short acting opiate fentanyl is used intra-operatively to avoid this
prolonged effect. • Naloxone antagonizes (reverses) all opiates, but its effect quickly wears
off. •
Commonly available opiates are pethidine and morphine. •

17. Anaesthesia &
Pain Control in
Children
Ketamine
Local anesthetics (bupivacaine 0.25%, not to exceed 1
ml/kg)
• o Paracetamol (10–15 mg/kg every 4–6 hours)
• intravenous narcotics (morphine sulfate 0.05–0.1
mg/kg IV) every 2–4 hours
• o Ibuprofen 10 mg/kg can be administered by
mouth every 6–8 hours
• o Codeine suspension 0.5–1 mg/kg can be
administered by mouth every 6 hours, as needed.

18. Aftercare:
Prevention of
complications
• Encourage early mobilization:
Deep breathing and coughing ,
Active daily exercise
Joint range of motion
Muscular strengthening
Make walking aids such as canes, crutches and walkers available and provide instructions for their use
• Ensure adequate nutrition
• Prevent skin breakdown and pressure sores: o
Turn the patient frequently o
Keep urine and faeces off skin
• Provide adequate pain control

19. Discharge note
• • Diagnosis on admission and discharge
• • Summary of course in hospital
• • Instructions about further management, including
drugs prescribed. Ensure that a copy of this
information is given
• to the patient, together with details of any follow-
up appointment

20. Normal outcome :
• The goal of postoperative care is to ensure that patients
have good outcomes after surgical procedures. A good
outcome includes recovery without complications and
adequate pain management . Another objective of
postoperative care is to assist patients in taking
responsibility for regaining optimum health.