Post-operative Care

Post-operative Care

After the operation, post-operative care continues in the recovery area, in the hospital, and during the outpatient and inpatient stays. In addition to the days following surgery in the post-operative ward and surgical ward, postoperative care is offered during the immediate postoperative period in the operating room and postanesthesia care unit (PACU). The preservation of the airway, stopping bleeding, determining the vital signs, pain management, mental status, and wound healing are crucial immediate issues. Preventing urine retention, constipation, and deep venous thrombosis are additional significant issues (DVT). This time frame could be for only one week or several months. It entails a number of procedures carried out by qualified medical professionals in order to enhance the patient's welfare after surgery. Assessment, diagnosis, planning, action, and outcome evaluation are all part of postoperative care. The level of postoperative care needed varies on the patient's preoperative health, the type of surgery, and whether the procedure was done in a hospital or a day surgery facility. Patients who undergo treatments at a day surgery center typically only need a short period of medical attention before being released to return home.

Purposes

• To promote the healing of surgical incision.
• To help the patient to return to normal functioning as quickly, safely and comfortably.
• To provide comfort and maintain safety to the patient.
• To prevent post-operative complications.
• To detect and manage post-operative complications.
• To maintain fluid and electrolyte and nutritional status of the patient.

Articles needed for post-operative care

• Post-operative bed with a mackintosh
• Oxygen cylinder, connection tube, humidifier
• Suction apparatus
• Vital sign tray
• IV stand
• Mouth gag
• A covered container with bowel, gauze, cotton ball, air way, tongue depressor and torch light
• Bed elevator, side rails
• Emergency box with drugs
• Intake/output chart
• Kidney tray
• Dressing set

Care of Post-Operative Patient

Care in the Recovery Room

It is given in the recovery room which should be located inside the operating room and should be equipped with necessary articles needed to deal with post anesthesia or post-operative emergencies. Postoperative recovery starts in the post-anesthesia care unit (PACU). This unit is dedicated to meet the patient's needs; thereby minimizing post-operative complications. The patient is kept in the recovery room until he/she returns back to full consciousness from  anesthesia. 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. Assessment of the patient's airway patency, vital signs, and level of consciousness are the first priorities upon admission to the PACU.

Receive the patient gently lifting from the trolley to the bed. Avoid unnecessary exposure. The recovery nurses should assess the following area in immediate post-operative period.

Respiration

• Monitor respiratory rate and depth
• Check air way patency
• Inspect skin colour
• Observe symmetry of chest expansion

Cardiac/vascular function

• Monitor BP
• Monitor pulse rate and rhythms

Neurological assessment

• Check pupillary response
• Monitor muscle strength, sensory, motor ability
• Check the level of consciousness
• Reflexes

Dressing

• Monitor for drainage.
• Observe for hemorrhage or haematoma formation.
• Assess both subjective and objective manifestation of pain. 
• Place proper positioning of the patient on her side. Unless contraindicated, the patient is kept in the lateral position with the back, abdomen and extremities well supported. If the patient is in the supine position, the head should be turned slightly to the side to prevent tongue falling back into the throat and aspiration of saliva or vomiting. 
• Maintain an open airway. Suction secretions from the throat when necessary. Watch for any signs of respiratory distress.
• Attached of supportive equipment such as oxygen, suction, intravenous infusion and drainage tube etc.
• Assess and monitor the patient's following condition:
  • Level of consciousness every 15 minutes.
  • Vital signs every 15 minutes during first hour and then every hour until the patient's general condition normalizes.
  • Surgical site; the leakage from the operation site, patency of drainage tubes/drains
  • Skin colour and level of sensation after regional anesthesia
  • Pain status
  • Nausea/vomiting
  • Patency air way as needed to prevent tongue fall.
  • Bladder for retention and abdominal distention
  • Post-operative complication.
• Carryout the doctor's order immediately.
• Check intravenous infusion rate frequently. Plan intravenous fluids for 24 hours according to order.
• Prevent the patient from falling out of bed by the use of bed-side rails.
• Maintain accurate intake output record.
• Avoid noise and bright light. Light source should be behind the head of the patient.
• Post-operative analgesic, sedative should be given according to the doctor's order and the patient's need.
• Never leave the patient alone until fully conscious and side rails must be up.
• Transfer the patient to the post-operative ward after 1 to 2 hours; once her condition is stabilized, hand over to the post-operative ward sister.

Care in Post-Operative Ward

After the hospitalized patient transfers from the PACU, the nurse taking over his or her care should assess the patient again, using the same previously mentioned categories. General post- operative nursing care refers to the care after surgery to complete healing of would/incision of the patient. It includes mainly the following nursing cares:

• The sufferer should be welcomed into a warm bed.
• Place the patient in a supine position with their face turned to the side.
• Connect any necessary support devices, such as a catheter, oxygen, suction, or an IV infusion. Analyze the color, consistency, and volume of all the tubes and suction equipment's drainage. Bags for drainage must be hung correctly.
• Evaluate your level of awareness and your sense of place, time, and people. Evaluate your capacity to move your extremities.
• Check the patient's vital signs every 12 hour, then every 4 hours as long as their condition has improved throughout that time. Since patients are frequently hypothermic following surgery and may require a warming blanket or warmed IV fluids, it is important to keep an eye on their body temperatures. Frequent evaluations of respiratory status should be made, including checks for a sufficient cough, chest excursion, and lung sounds (auscultation).
• Verify the rate of intravenous infusion often. Every one to two hours, fluid intake and urine output should be noted. Keep an eye on your urine output. (30 ml minimum per hour). In the absence of a urinary catheter, the patient's bladder should be examined for distension and his or her incapacity to urinate should be kept track of.
• For at least the first eight hours, monitoring of the pain status, incision patency, and drainage function should be done every one to two hours.
• According to the doctor's instructions, administer the medication, and make a proper note. Along with pain medicine, the patient could also need something for nausea or vomiting.
• Keep the ward quiet and dim the lights.
• Keep an eye out for complications after surgery.
• If the surgeon so directs, the patient should be kept NPO, at the very least until their cough and gag reflexes have returned.
• Following surgery, patients frequently experience dry mouth, which can be treated with mouth swabs made of lemon and ginger or oral sponges dipped in ice water. If the patient is using oxygen or a nasogastric tube, provide oral care every two hours; otherwise, every four hours.
• As soon as you can, encourage deep breathing. Foot and leg exercises should be performed every two hours.
• Sequential compression devices will be placed on the legs of patients who are unable to sit up in bed after surgery until they are able to move around.
• To lessen the discomfort brought on by coughing and moving around, the patient should be urged to splint any chest and abdominal incisions with a pillow.
• To avoid respiratory complications, provide stem inhalation.
• Ambulation on the first day following surgery.
• impart health education The first 24 hours following surgery are positively impacted by effective preoperative instruction. Patients will be much more likely to carry out these chores if they are aware that they need to move in order to prevent blood clots, promote circulation to the extremities, and keep the lungs clear as well as that they must undertake respiratory exercises in order to prevent pneumonia. Maintaining pain under control also emphasizes the need of understanding the necessity for movement and breathing exercises.
• Keep track of the client's arrival time, evaluation results, intake output (including any oral fluid, IV fluid, and drainage, voiding, and emesis), and all of these.

Care in Surgical Ward

• Receive the patient in a warm comfortable bed.
• Intravenous fluids should be continued until she/he is taking liquid well and as per the doctor's order, check the IV site for swelling and redness.
• Administer analgesic, sedative, antibiotic according to the doctor's advice.
• Attach the drainage tubes and ensure that the tubes are not kink and drain properly.
• Encourage bladder and bowel movement.
• Ambulate the patient after 24 hours depending on type of surgery.
• Provide stem inhalation and encourage deep breathing and coughing exercises.
• Watch for wound soakage, if soaked change dressing using sterile technique.
• Provide routine care depending upon the patient's condition e.g. skin care, oral care, hair care.
• Remove the drainage tube according to the doctor's written order.
• Oral fluid could be allowed only when the peristalsis movement returns. Usually, a sip of water is given after returning peristalsis movement, followed by black tea, fruit juice and clear soup. Follow with soft and semi-solid when the patient is passing gas and abdomen is not distended.
• Remove the stitches according to the doctor's written order. Stitches are removed usually on the 7th day of surgery.
• Discharge the patient the day after if everything goes well.
• Advise the patient on the following at the time of discharge:
  •   Exercise to be performed
  •   Activities to be restricted
  •   Medication
  •   Follow up visit
  •   Diet
  •   Wound care
  •   Complication to be observed

Special Precautions

• After dressing changes, blood-soaked dressings should be properly disposed of in a bio- hazard container.
• Pain medication should be offered before any procedure that might cause discomfort. Patients should be given the opportunity to ask questions.
• In some cases, they may ask the nurse to demonstrate certain techniques so that they can perform them properly once they return home.
• Patients may receive educational materials such as handouts and video tapes, so that they will have a clear understanding of what to expect postoperatively.

Post-Operative Complications

Immediate complications

• Hemorrhage
• Shock
• Vomiting
• Asphyxia

Delayed Complications

• Hemorrhage
• Infection
• Respiratory complication
• Urinary retention
• Abdominal distension
• Deep vein thrombosis
• Incision hernia
• Thrombophlebilitis
• Pulmonary embolism

Post-Operative Checklist

Name of patient:

Hospital Number:

Date:

Risk factors: Diabetes/hypertension/cardiac disease/asthma/epilepsy 

Anesthesia: General/spinal/local

Surgery done:

Duration of surgery:

Time and name of antibiotic administration (in OR):

Time of arrival:

Name of analgesic given:

Skin integrity:

Level of consciousness:

Oxygen Therapy-Lit/Min:

Bleeding-Yes/No:

Type of I/V fluid on flow:

I/V Line-Patency:

Drip rate-Drops/min:

Types of drainage and functioning status:

Movement of Limbs:

Voiding time:

Time of starting feeds:

Vomiting Yes/No:

Abdominal Distension-Yes/No

Position

Vitals:

B.P.:

                                                   Pulse:                     Respiration:

                                                 Signature                Date and Time

Nursing students                     ---------------               ---------------

Staff nurse                               ---------------               ---------------

Ward sister/supervisor             ---------------               ---------------