POSTOPERATIVE CARE

-is the management of a patient after surgery. This includes care given during the immediate postoperative period, both in the operating room and the postanesthesia care unit (PACU), as well as during the days following the surgery.

PURPOSE
The goal of postoperative care is to prevent such complications as infection, to promote healing of the surgical incision, and to return the patient to a state of health.

GOAL
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 good health.

PRECAUTIONS
Thorough postoperative care is crucial to ensuring positive outcomes for patients who have had surgery. There are no contraindications to providing this care. However, skill and careful monitoring are needed to prevent complications and to restore the patient to health as soon as possible. Postoperative care involves assessment,     diagnosis, planning, intervention outcome evaluation.

POSTANESTHESIA CARE UNIT (PACU)
After the surgical procedure, and anesthesia reversal and extubation if necessary, the patient is transferred to the PACU. The length of time the patient spends there depends on:     length of surgery type of surgery the status of regional anesthesia (for example, spinal anesthesia) patient's level of consciousness

Rather than being sent to the PACU, some patients may be transferred directly to the critical care unit instead. For example, patients who have had coronary artery bypass grafting (CABG) are sent directly to the critical care unit.

and presence of adequate cough. Vital signs.         First 24 hours After the hospitalized patient transfers from the PACU. safety is a primary goal. An example is the Aldrete scale. the receiving nurse should assess the patient again. assessment of chest excursion.In the PACU. including any variations in hemodynamic stability. the type of surgery performed. .       If the patient reports "hearing" or feeling pain during surgery (under anesthesia) the observation should not be discounted. anesthesiologist or nurse anesthetist should discuss the possibility of an episode of awareness under anesthesia with the patient. since patients are often hypothermic after surgery and may need a warming blanket or warmed IV fluids. which scores the patient on mobility. Since the patient may still be sedated from anesthesia. and level of consciousness are the first priorities upon admission to the PACU. and tolerated a small amount of oral intake. estimated blood loss. and any drainage tubes should be monitored every one to two hours for at least the first eight hours. Patients in a day-surgery setting are either discharged from the PACU to the unit to their home. The patient's call light should be in their hand and all side rails should be up. respiratory status. vital signs. and pulse oximetry. including auscultation of lung sounds. the patient may be admitted to either a general surgical floor or the intensive care unit. ambulated. the type of anesthesia given. circulation. the anesthesiologist or the nurse anesthetist reports on the patient's condition. Assessment of the patient's airway patency. respiratory status. Depending on the type of surgery and the patient's condition. as determined by use of a scale. Fluid intake and urine output should be monitored every one to two hours. and total input and output during the surgery. pain status. or are directly discharged home after they have voided. The receiving nurse should also be made aware of any complications during the surgery. consciousness. The following is a list of other assessment categories: surgical site (check that dressings are intact and there are no signs of overt bleeding) patency of drainage tubes/drains body temperature (hypothermia/hyperthermia) patency/rate of IV fluids circulation/sensation in extremities after vascular or orthopedic surgery level of sensation after regional anesthesia pain status nausea/vomiting The patient is discharged from the PACU when: They meet established criteria for discharge. Body temperature must be monitored. using the same previously mentioned categories. the incision. Respiratory status should be assessed frequently.

After 24 hours After the initial 24 hours: vital signs can be monitored every four to eight hours if the patient is stable  The incision and dressing should be monitored for the amount of drainage and signs of infection. Respiratory exercises should continue to be performed every two hours and incentive spirometry values should improve. encouraging circulation to the extremities. and keeping the lungs clear. Patients should be kept NPO (nothing by mouth) if ordered by the surgeon. Understanding the need for movement and respiratory exercises also underscores the importance of keeping pain under control. and that movement is imperative for preventing blood clots. The hospitalized patient should be sitting up in a chair at the bedside and ambulating with assistance by this time period. Patients often have a dry mouth following surgery. as well as for pain. the surgeon may order the dressing to be changed during the first postoperative day. Postoperative dressing changes should be done using sterile technique. Respiratory exercises (coughing.    If the patient doesn't have a urinary catheter. post-hip replacement). If the patient had a vascular or neurological procedure performed. unless contraindicated (for example. If they have not voided six to eight hours after surgery. usually every one to two hours.   The patient should be encouraged to splint chest and abdominal incisions with a pillow to decrease the pain caused by coughing and moving. then they will be much more likely to perform these tasks. deep breathing and incentive spirometry) should be done every two hours. the bladder should be assessed for distension and the patient monitored for inability to void. If patients understand that they must perform respiratory exercises to prevent pneumonia. Bowel sounds should be monitored and the patient's diet gradually increased as tolerated. and should at least be sitting on the edge of the bed by eight hours after surgery. which can be relieved with oral sponges dipped in ice water or by applying lemon ginger in mouth swabs. The patient may require medication for nausea and/or vomiting. at least until their cough and gag reflexes have returned.     The patient should be monitored for any evidence of potential complication such as:  leg edema  redness  pain (deep vein thrombosis) . The patient should be turned every two hours. circulatory status or neurological status should be assessed as ordered by the surgeon. depending on the type of surgery and the physician's orders. Effective preoperative teaching has a positive impact on the first 24 hours postoperatively. the physician should be notified.

The patient and the family should be updated on the evaluation. .    assist the patient with respiratory exercises and regaining mobility provide postoperative teaching generally care for the patient Respiratory therapists also provide instruction and assistance with respiratory exercises and monitor the patient's respiratory status.  shortness of breath (pulmonary embolism) dehiscence (separation) of the incision or ileus. Radiology personnel take x-rays that are ordered by the physician Laboratory personnel draw blood samples and perform blood tests. The surgeon performs the surgery and manages the patient's postoperative care. HEALTH CARE TEAM ROLES Almost every member of the health care team has a role in postoperative care. The patient's primary care doctor often helps manage the care of hospitalized patients as well. Nurses are at the bedside 24 hours a day. so they monitor the patient for complica tions. If dehiscence occurs. If any of these occur. All team members must communicate with one another and with the patient to provide the best possible postoperative care. sterile saline-soaked dressing packs should be placed on the wound. the surgeon should be notified immediately.