Postoperative Nursing care, Role of Nurse after Surgery, Responsibility of nursing officers during Postoperative period

1. POSTOPERATIV
E NURSING
CARE
Mrs. MINI JOSE
SISTER IN-CHARGE,
M&SW, SVBCH,
SILVASSA

2.  The nurse thoroughly documents the
assessment including vital sciences, level
consciousness, condition of dressing and drain,
comfort level all fluids status, and urinary
output measurement
 Client data can be enter flow sheet and compute
raised client record and written progress notes
POST OPERATIVE CARE

3. The post operative period begins from the time the
patient leaves the operating room and ends with the
follow up visit by the surgeon.
 Care in immediate postoperative period, including the
operating room, postanesthesia care unit (PACU).
 Extent depends on the individual's pre-surgical health status,
type of surgery, day-surgery setting or in the hospital.
Goal
.
 prevent complications such as infection
 promote healing of the surgical wound
 return the patient to a state of health.
INTRODUCTION

5.  To enable a successful and faster recovery of
the patient post operatively.
 To reduce post operative mortality rate.
 To reduce the length of hospital stay of the
patient.
 To provide quality care service.
 To reduce hospital and patient cost during
post operative period.
PURPOSES

7. NURSING MANAGEMENT IN POST
OPERATION Unit
To provide care until the patient has
recovered from the effect of anesthesia.
Assessing the patient
 Monitor vitals-pulse
 volume and regularity, depth
and nature of respiration.
 Assessment of patient’s
 O2 saturation.
 Skin colour.

8. KEEP MONITORING VITALS

9. Check the level of consciousness
Ability to respond to commands

10. MAINTAIN INTAKE AND OUTPUT

11.  By proper
positioning
 of patient’s head
 By clearing airway
 Oxygen therapy
Pharyngeal obstruction
can occur when the
patient lies on the back
as there are chances
for tongue to fall back
Protect Airway

12. Maintaining IV Stability
 Hypovolemic shock can be avoided
by timely administration of IV Fluids,
blood and blood products and
medication
 Replacement of fluids.[colloids, e.g.
albumin dextran, haemaccel and
crystalloids, e.g, RL.0.45% NaCl
hypotonic solution, 3% NaCl
hypertonic solution]
 Keep the patient warm
 Monitor intake and output balance
 Monitor the vitals continuously

13. Shock Position
Keep the patient in shock position, flat on back,
legs elevated at 20 degree + knee kept
straight.

14. ASSESSMENT OF THE SURGICAL SITE -Hemorrhage
 It is a serious complication
of surgery that results in
death
 It can occur in immediate
post operatively or up to
several days after surgery
 If left untreated, cardiac
output decreases, blood
pressure and Hb level will
fall rapidly

15.  Blood transfusion if necessary
 The surgical site + incision should
always be inspected
 If bleeding, pressure dressing are
placed
 If the bleeding is concealed, the
patient is taken in OR for
emergency exploration of
concealed hemorrhage in body
cavity.
In case of Excessive Bleeding

16. Use warm lights
KEEP THE PATIENT WARM

17. Relieving pain +Anxiety
Administer Opioids &
analgesia as per Doctor’s
order
NSAIDS (Non steroidal
anti-Inflammatory drugs)
Psychological support to
relieve fear
Epidural Analgesia catheter
should be removed after
informing anaesthetist and
before discharge

18. Controlling Nausea+Vomitting
 These are common
problem
 In post operative period
medication can be
administered as per doctor’s
order
 Example:Inj
Metaclopramide Inj
Ondansetron(Emeset)

19. ALDRETE SCORE
Atotal discharge scoreof 8-10isnecessary
Post-Anesthesia Score
PRE-ANESTHESIA VITAL SIGNS/SOURCE TIME AD
M
15" 30" 45" 1' 2' 3' 4' DISCHARGE
CIRCULATION SYSTOLIC BP 20% OF PRE-ANESTHETIC
LEVEL 2
20-50% 1
> 50 0
CONCIOUSNESS FULLY AWAKE 2
AROUSABLE ON CALLING 1
NOT RESPONDING 0
COLOR WARM, DRY SKIN WATCH FOR
PREPROCEDURAL COLORING 2
PALE, DUSKY, BLOTCHY, JAUNDICED,
OTHER 1
CYANOTIC 0
RESPIRATION ABLE TO DEEP BREATHE & COUGH
FREELY 2
DYSPNEA OR LIMITED BREATHING 1
APNEIC 0
ACTIVITY ABLE TO MOVE 4 EXTREMITIES 2
ABLE TO MOVE 2 EXTREMITIES 1
ABLE TO MOVE 0 EXTREMITIES 0
COMMENTS TOTAL

20.  Expected out comes
 Immediate Post-
Operative changes
 Written instructions
 Like Wound care
Activity+dietary
recommendation
 Medications Follow up
Teaching, Patient Self Care

21.  Post operative unit need to be prepared with suction, Oxygen,
Monitors/Pulse oxymeters, Side rails & propped up beds,
Emergency tray & resuscitation Tray& Crash cart
 Immediate post operative patient to be placed near to the
nursing station who requires direct supervision of nursing
officer
 Comfortable bedding & Position
 If patient is confined to bed air mattress can be given
 After receiving the client check the case sheets and monitor
the vital signs & document it. Abnormal findings need to be
informed immediately to sister in-charge & on duty doctor
 Client to be kept warm in immediate post operative case
(control environmental temperature )
 Sanitary pads need to be checked for the placement in case of
gynaec patient
Role of Post operative Nurse

22. Contd . . .
 Measure & Document Abdominal girth
 Mention the post operative day in Temperature chart
 Vascularity refilling need to be checked for client with any
vascular surgeries or POP
 NBM need to be released as per the surgeon order and need to
be explained to the patients clearly
 Surgical site should be checked for any oozing if there is
excessive bleeding over the dressing and need to be reported
immediately to the sister in-charge or Concerned Doctors on
duty
 RT tube need to be checked for continuation
 Uro bag should be checked for the patency & should be placed
at the foot end side
 Drain bag & Uro bag to be on the same side and IV Fluids to
be in the opposite side

23.  In case of Neuro surgery Propped up at 30’ at head end side
to be maintained till further order. But in case of Spinal
anasthesia head end should not be raised
 Early ambulation to be done
 Deep breathing exercise & in necessary case physiotherapist
reference to be done
 In case of specimen or any biopsy postoperatively need to
be send it to Lab after explaining the relatives
 Strict compliance to the Documentation and in special case
like DM & HT, Eclampsia, PIH, PPH need to monitor Vitals at
the specified time
 While feeding need to be cautious to prevent aspiration
 Drain need to be removed as per surgeon order
 Hygiene of the client need to be ensured to prevent surgical
site infection
 Dressing need to be changed as per surgeon order
Contd . . .

24.  I/O chart to be maintained strictly
 Bowel elimination need to be monitored
 Strict compliance to all due medications as per time
 Catheter need to be removed or replaced after 7 days
Contd . . .

25. Discharge from the Post Operative Unit
A patient remains in the post op unit, until the patient has fully
recovered from anesthesia.
Following measures are used to determine the patient ready for
discharge from post operative unit.
 Stable vital signs
 Orientation to Person, Place, Time or events
 Adequate oxygen saturation level.
 Urine out put at least 30ml/hour
 Minimal pain
 Adequate respiratory function
 Aldrete score more than ‘ 9 ‘ before shifting from
 Post Operative Anaesthesia Care Unit

26. THANK
YOU
SHRI VINOBA BHAVE CIVIL HOSPITAL,
SILVASSA