Objective and Management of OT VIII

Care of post-anesthetic patients

To get patients ready for postoperative care, the following steps may be necessary: referral to postoperative physical therapy;

• Patient education on the value of regular, gentle leg exercises, deep breathing, and coughing, as well as early mobilization to lower the risk of problems such deep vein thrombosis, pulmonary embolism, and chest infections; Measure the patient for anti-embolism stockings, a foot impulse device, or an intermittent pneumatic compression device as part of VTE prevention.
• Describe to patients what they can anticipate having in place following surgery, such as intravenous lines or drains, and that pumps may beep;
• Talk about analgesia;
• Patients who will likely undergo surgery and then be moved to an intensive care or high dependency unit may want to visit the facility first;
• Patients should be informed that their bed may be relocated when they return to the ward so that nursing staff may monitor them more closely right after surgery.

Care of recovery room and ward

A patient receiving general nursing care in the recovery room

• Whenever possible, unnecessary strain, exposure, or potential harm should be avoided while the patient is transferred to the recovery room. In the recovery room, the anesthesiologist or anesthetist goes with the patient, reports his status, notes any specific instructions or postoperative orders, and keeps an eye on him until the nursing staff in the recovery room takes over. The recovery room nurse should confirm the doctor's instructions and follow them right away.
• In order for one nurse to provide careful attention to two or three patients at once, patients are gathered in a small space. A recovery bed with side rails, IV poles, and a chart rack is provided for each patient's unit. It is simple to move and modify the bed. Each unit features connections for blood pressure, suction, and piped oxygen equipment.
• Maintain the proper operation of the intravenous infusions, tubes, and drains. Avoid kinking or clogging that could obstruct a proper drainage flow through catheters and drainage tubes.
• Keep a close eye on all intravenous fluids and blood products, as well as any urine, vomit, nasogastric tube drainage, and wound drainage.
• Determine the patient's state of consciousness and record it. Consciousness, responsiveness to touch and sound, and states of drowsiness or alert but unfocused are used to gauge the central nervous system's restoration to normal function. The patients in the recovery area are typically categorized according to specific standards.
• Unconscious and unresponsive to stimuli is comatose.
• Stupor: unresponsive, drowsy, and ignorant of surroundings.
• Drowsy, lethargic, and half asleep; responsive to touch and noise.
• Alertness is the capacity to respond appropriately to stimuli.
• Put safety measures in place to safeguard the patients.
• Always keep the side lifted. Check to make sure the patient is not lying on, tangled up in, or lying on drainage or IV tubing.
• While the patient is unconscious or for eight hours if they underwent spinal anesthesia, avoid using a head pillow.
• In the supine position, tilt the patient's head to one side to allow the mouth to drain and prevent the tongue from falling into the throat and obstructing the airway.
• Place the call bell in a convenient location and demonstrate how to use it when the patient is awake.
• Whether the patients underwent spinal anesthesia
• Keep an eye out for any sentiments or impulsive behavior and report it.
• Spinal anesthesia subsides gradually.
• To avoid a spinal headache, keep the patient in a supine position for six to eight hours.
• For a few minutes, turn the patient on one side and support them with pillows to ease strain on their back, but only if the doctor approves.
• Keep nosocomial diseases at bay
• Prior to and after working with each patient, wash your hands.
• Maintain aseptic procedure for wounds caused by incisions.
• To reduce the risk of respiratory infections, frequently turn the patient.
• Encourage and help the patient to cough and take deep breaths many times an hour when he is awake.
• If at all feasible, converse with the patient to gauge how oriented he is. Be mindful of each patient's typical reactions caused by diverse physical circumstances.
• Support the patient and his family emotionally.
• Encourage the patient to engage in conversation to reduce anxiety and improve lung understanding.

Use this chance to patiently instruct by using short, straightforward sentences to describe what you are about to do.

Stay with them while they visit if family members are allowed in the recovery room. They can be alarmed by the surroundings and the way their loved one looks.

The surgeon gives the all-clear to transfer the patient to his room once the patient's physical condition and degree of consciousness are stabilized. Give the nursing unit a verbal report that includes the following when you call.

• Name of the patient.
• Surgical kind.
• Mental clarity
• In the recovery room, care is provided.
• Vital signs, including the moment at which they were recorded and any signs of problems.
• Intravenous fluids, including their type, status, and presence, as well as any suction or drainage devices.
• If a catheter is not in place, regardless of whether the patient has urinated.
• Medication is administered in the recovery area.
• In accordance with regional standard operating procedures, transfer the patient to the unit after recording all pertinent information in the nurse's notes (SOP).

Post-operative analgesics and other relevant drugs 

• Opioids
  • This family comprises the partial agonists buprenorphine and pentazocine as well as the agonists morphine, pethidine, fentanyl, and methadone. If taken after morphine or pethidine, pentazocine has certain antagonist qualities that can counteract the analgesia of the agonist medicines and exacerbate pain. There is no discernible antagonist activity for buprenorphine. The negative effects of these medications include urine retention, nausea and vomiting, sleepiness, ventilatory depression, and depression of respiratory guarding reflexes. Dysphoria is a common side effect of pentazocine. Fentanyl is the opioid of choice in renal failure. All other opioids may take longer to work than expected.
•  Paracetamol and NSAIDs
  • After small to moderate surgery, non-steroidal anti-inflammatory medications (NSAIDs) and paracetamol are sufficient, and they may lessen the need for opioids after major surgery. GI disturbances, peptic ulcers, platelet dysfunction, renal impairment, and asthma can all be brought on by or made worse by NSAIDs. The majority of these medications are only available orally or as suppositories, but side effects might happen regardless of the route of administration. It is no longer employed as a perioperative analgesic as a result.This class of analgesics includes ketorolac, which can be administered orally as well as parenterally. However, like all NSAIDs, it has the potential to cause renal impairment, particularly in older patients and those who already have renal disease. Inflammation of the gastrointestinal tract, platelet dysfunction, renal issues, or asthma do not appear to be brought on by paracetamol.
• Nitrous oxide
  • The traditional "laughing gas" is still available in pre-mixed cylinders containing 50% oxygen. It is a strong analgesic and is probably better than opioids at controlling acute somatic pain, like that experienced when bandages or drain tubes are removed. Of course, it needs to be inhaled for a long enough period of time (at least five minutes) to produce analgesia. Typically, self-administration is used.
• Local anaesthetics
  • Despite the fact that there are other local anesthetics available, lignocaine and bupivacaine offer a choice between extended duration and slower onset (bupivacaine) or rapid onset and short duration (lignocaine).
• 5. Other routes
  • Sublingual
    • Effective analgesics include sublingual pills of buprenorphine. It's unclear if the action of buprenorphine results through sublingual absorption or from being ingested through the saliva.
  • Transdermal
    • Trials are being conducted with fentanyl patches for transdermal delivery. Although gradual, absorption seems to be working. Patches may be helpful in pediatrics, but they will likely be utilized more to alleviate chronic pain in adults.