Hawler Medical University

College of Nursing
Academic Year 2020-2021
Second Semester/First Trial
Scientific Report

Title of the report: Postoperative Care Nursing

Student’s Name: Muhamad Musa Muhedin

Department: Nursing Department

Student’s year: Second Year

Subject’s Name: Adult Nursing I

Teacher’s Name: Berivan Star Hamad Ameen

Outlines:

I. Definition
II. Immediate Postanesthetic Assessment
III. Prevention of Postoperative Complications
IV. Ongoing Assessments
V. Client and Family Teaching and Discharge

Objectives:

At the end of this report, you will be able to:

 Describe Postoperative care.

 Identify the main nursing responsibilities after surgery.
 Discuss the right time for discharge.
 Know what are the preventions for Postoperative Complications.
Contents:

Definition
The postoperative period designates the time that the client spends recovering from the effects
of anesthesia (Timby et al, 2010). Inpatients remain in the PACU until their condition
stabilizes; they then return to the postoperative nursing unit.

Immediate postanesthetic assessment

During the immediate postanesthetic stage, an unconscious client is positioned on the side,
with the face slightly down. The nurse ensures maximum chest expansion by elevating the
client’s upper arm on a pillow. Vital signs should be checked every 30 minutes. An artificial
airway is maintained in place, and the client is suctioned as needed. The return of the client’s
reflexes, such as swallowing and gagging, indicates that anesthesia is ending. Nurses should
arouse clients by calling them by name, telling them that they are in the PACU.
The PACU nurse uses criteria developed by the anesthesia department to evaluate client
readiness for discharge from the PACU. The Aldrete score is the first introduce objective
scoring system that helps identify when patients are ready for discharge (Aldrete and Kroulik,
1970). A number of scoring systems have been developed and there is no consensus for which
specific system should be used (Phillips et al, 2011).

Clients are usually discharged from the PACU when they are conscious and oriented; they are
able to maintain a clear airway and deep breathe and cough freely; vital signs have been stable
with preoperative vital signs for at least 30 minutes; protective reflexes are active; they are
able to move all extremities; intake and urinary output is adequate; and dressings are dry.

Prevention of Postoperative Complications

Hemorrhage: The nurse inspects dressings frequently for signs of bleeding. If bleeding is
internal, the client may need to return to surgery for ligation of the bleeding vessels.

Shock: Treatment of shock varies and depends on the cause, which may include: Blood,
plasma expanders, parenteral fluids, oxygen, and medications.
Hypoxia: The nurse observes the client closely for signs of cyanosis, and dyspnea. The nurse
must position the patient correctly, if dyspnea is not relieved, mechanical ventilation is used.

Aspiration: The nurse closely observes the client for difficulty swallowing. Unless, the nurse
places the client in a side-lying position until the client can swallow oral secretions.

Ongoing Assessments
Respiration: Nursing management to prevent postoperative respiratory problems includes
early mobility, frequent position changes, deep breathing, and coughing exercises.

Circulation: The patient is at risk for cardiovascular complications resulting from actual or
potential blood loss from the surgical site, anesthesia, and electrolyte imbalances (Potter et al,
2013). The nurse must assess the client’s BP and circulatory status frequently.

Pain Management: Postoperative pain reaches its peak between 12 and 36 hours after
surgery. Clients must receive pain and discomfort relief. The goal is to enhance the efficacy of
pain control while minimizing side effects of each modality (Costantini et al., 2011).

Fluids and Nutrition: IV fluids usually are administered after surgery. The nurse monitors
the IV fluid flow rate and adjusts it as needed, also assesses for signs of fluid excess or deficit.

Skin Integrity/Wound Healing: When assessing the wound, the nurse inspects for
approximation of the wound edges, intactness of staples or sutures, and signs of infection.

Bowel Elimination: Constipation, diarrhea, abdominal distention may occur because of

postoperative diet or medications. The nurse notifies the physician of either problem.

Activity: The nurse must emphasize the importance of increasing activities. He or she assists
the client to a sitting position at the side of the bed.

Urinary Elimination: When clients cannot void within 8 hours, the surgeon is notified for an
order to catheterize. If the client has a Foley catheter, it should flow freely with urine
(Delaune and Ladner, 2011).
Psychosocial Status: Many clients experience anxiety and fear after surgery, as well as an
inability to cope with changes in body image, and lifestyle. The nurse acts as an effective
listener, works to assist the client and family to work through the problems.

Client and Family Teaching and Discharge

Before discharge, the client needs to receive instructions on how to carry out treatments at
home. The nurse conveys the discharge instructions verbally and in writing. The nurse
evaluates clients to determine their ability to carry out their care and to determine their
specific needs, such as the need for:
1. Supervised home care (e.g., visiting nurse, other healthcare agencies and personnel)
2. Supplies (e.g., dressings, tape, ostomy supplies, crutches)
3. Special dietary needs
4. Adjustments to the living environment (e.g., special bed, portable commode, wheelchair
access)

References:

 Aldrete JA (1970). Kroulik D: A post-anesthetic recovery score, Anesth Analg

49:924,1970.
 Costantini R, et al (2011). Controlling pain in the post-operative setting, MA Int J
Clin Pharmacol Ther 49(2):116.
 DeLaune SC, Ladner PK, (2011). Fundamentals of nursing: Standards & practice (4th
ed.). Delmar Cengage Learning. p.1325
 Phillips NM, Haesler E, Street M, Kent B, (2011). Post-anaesthetic discharge scoring
criteria: A systematic review. JBI Library of Systematic Reviews, 9(41), 1679–1713.
 Potter PA, Perry AG, Stockert P, Hall A, (2013). Fundamentals of nursing (8th ed.).
Mosby. p. 1277
 Timby, Barbara K, Smith, Nancy E (2010). Introductory medical-surgical
nursing (10th ed). Philadelphia: Lippincott Williams & Wilkins. p. 157.