Postoperative Observation of the Patient

The duration and type of postoperative observation and care

will vary according to the following:
Patients condition (e.g., alert and oriented vs.
unresponsive)
Need for physiologic support (e.g., ventilatordependent,vs. awake and extubated)
Complexity of the surgical procedure (e.g., open
laparotomy vs. laparoscopy)
Type of anesthesia administered (e.g., a general
inhalation agent vs. local infiltration)
Prescribed period for monitoring parameters to
evaluate physiologic status (e.g., stable vs. unstable
vital signs)

The Recovery Room Patient Care Personnel

Adequate personnel should be available to monitor patients
and to provide appropriate care as needed. The education and training of a recovery room
nurse should include
knowledge of the following:
Airway management techniques, including positioning,
chin lift, jaw thrust, suctioning, bagging, and
placement of an airway
Circulatory assessment,
Neurological condition
Anesthetic agents and their action
Medications and their actions
Most invasive and minimally invasive procedures

The nurses working in the recovery room should demonstrate

competence in the following:
Physical assessment (e.g., heart and lung sounds)
Recognition of physiologic complications (e.g., airway
obstruction, hypothermia, pain, nausea or vomiting,
and/or oropharyngeal aspiration)
Management of physiologic emergences (e.g., airway
obstruction, hemorrhage, cardiac arrest)
I n t e r p r e t a t i o n o f mo n i t o r i n g d a t a f r o m
electrocardiogram (ECG) and oximetry devices
Application of cardiopulmonary resuscitation (CPR)
Admission of the Postoperative Patient to the
Recovery Room

As the patient enters the recovery room (RR), his/her

immediate physiologic and psychologic status is reported to
the recovery room nurse by the accompanying personnel
(usually the circulating nurse, assistant surgeon, or
anesthesia provider). The recovery room nurse observes the
postoperative patients wound (for bleeding), catheter, drain
material, and intravenous infusions (whether they are in
place). Then, the nurse monitors the vital signs of the patient
as prescribed.

Documentation
Institutional policies and procedures should be followed in
documenting the care given in the recovery room.
Observations of respiratory and circulatory functions and level of consciousness are recorded at
frequent intervals.
Postoperative physiologic and psychologic status are
documented at the time of any significant event (e.g., the
administration of medication), as well as routinely at 5- to 7-
minutes interval for the first hour and at 15- to 30-minutes
intervals for the second hour and thereafter.

Equipment in the Recovery Room

The variety of equipment required in the recovery room are
listed below.
Equipment for airway management
Oropharyngeal and nasopharyngeal airways
Tracheal tubes (oral and nasal)
Laryngoscopes
Suction catheters and tubing.
Equipment for respiratory support
Ambubag or similar type of manual device for artificial
ventilation
Automatic ventilators
Equipment for oxygen therapy
Oxygen flow meters
Humidifier for oxygen

Equipment for monitoring

Electrocardiograph
Blood pressure apparatus
Central venous pressure
 Temperature
Urinary output
Equipment for intravenous infusion
Supply of intravenous (IV) fluids
Plasma substitutes
Refrigerator for storing blood for transfusion
Intravenous giving sets
Intravenous cannulae
Central venous catheters
Drip controllers or infusion pumps
Blood warmers
Pressure infusers (for pressurizing bags of intravenous
fluid for rapid transfusion)
Blood filters
General
Syringes and needles
Swabs
Preparations for cleaning skin prior to injections, etc.
Forms and appropriate sample tubes for biochemistry,
hematology, blood transfusion, bacteriology,
Requirements for general nursing care, e.g. wound
dressing materials, bed linen, pillows, bed pans, sick
bowels, etc.

Drugs for resuscitation trolley

There will be a small range of drugs required in acute cardiac
or respiratory emergences:
Sodium bicarbonate solution 8.4%
Adrenaline 1:1000
Calcium chloride 10%
Isoprenaline
Atropine
Lignocaine for intravenous use
Beta-blocking drugs e.g. propranolol
A cardiac glycoside, e.g. digoxin
An antihistamine, e.g. promethazine
A bronchodilator, e.g. aminophylline
Antinarcotics agents, e.g. naloxone
Hydrocortisone
Sterile water for injection when necessary