Interventions for Postoperative Clients Care

PACU Recovery Room Purpose is to provide ongoing evaluation and stabilization of clients to anticipate, prevent, and treat complications after surgery. Purpose is to provide ongoing evaluation and stabilization of clients to anticipate, prevent, and treat complications after surgery. PACU is usually located close to the surgical suite. PACU is usually located close to the surgical suite. The PACU nurse is skilled in the care of clients with multiple medical and surgical problems that can occur following a surgical procedure. The PACU nurse is skilled in the care of clients with multiple medical and surgical problems that can occur following a surgical procedure.

Collaborative Management Assessment Assessment Physical assessment and clinical manifestations Physical assessment and clinical manifestations – Assess respiration. – Examine surgical area for bleeding – Monitor vital signs. – Assess for readiness to discharge once criteria have been met.

POST OPERATIVE COMPLICATIONS

Potential Alterations in Respiratory Function Potential Alterations in Respiratory Function Airway obstruction (tongue!, laryngospasm, laryngeal edema) Airway obstruction (tongue!, laryngospasm, laryngeal edema) Hypoxemia (SaO2 < 90%; agitation → somnolence) Hypoxemia (SaO2 < 90%; agitation → somnolence) Atelectasis (alveolar collapse) Atelectasis (alveolar collapse) Pulmonary edema (fluid-filled alveoli) Pulmonary edema (fluid-filled alveoli) Aspiration of gastric secretions Aspiration of gastric secretions Bronchospasm Bronchospasm Hypoventilation Hypoventilation Airway obstruction (tongue!, laryngospasm, laryngeal edema) Airway obstruction (tongue!, laryngospasm, laryngeal edema) Hypoxemia (SaO2 < 90%; agitation → somnolence) Hypoxemia (SaO2 < 90%; agitation → somnolence) Atelectasis (alveolar collapse) Atelectasis (alveolar collapse) Pulmonary edema (fluid-filled alveoli) Pulmonary edema (fluid-filled alveoli) Aspiration of gastric secretions Aspiration of gastric secretions Bronchospasm Bronchospasm Hypoventilation Hypoventilation

Etiology and relief of airway obstruction caused by patient’s tongue Fig. 19-2

Resp complications

Postoperative Atelectasis Fig A.Normal bronchiole and bronchiole and alveolus alveolus B. Mucous plug in bronchiole bronchiole C. Collapse of alveoli due to absorption of air due to absorption of air

Pulmonary Embolus

ARDS

ILEUS

SBO

Techniques for Splinting Wound When Coughing Fig. 19-5

Nursing Management Cardiovascular Complications DVT prophylaxis DVT prophylaxis –Leg exercise (10-12/Q 1-2 hr) –Elastic stockings –Sequential compression devices –Anticoagulants (Heparin, LMWH) –Early ambulation Slowly progress Slowly progress Monitor pulse Monitor pulse Assess for feelings of faintness Assess for feelings of faintness

Postoperative Leg Exercises Fig. 19-6

Skin Assessment Normal wound healing Normal wound healing Ineffective wound healing: can be seen most often between the 5th and 10th days after surgery Ineffective wound healing: can be seen most often between the 5th and 10th days after surgery –Dehiscence: a partial or complete separation of the outer wound layers, sometimes described as a “splitting open of the wound.” (Continued )

Skin Assessment –Evisceration: a total separation of all wound layers and protrusion of internal organs through the open wound. Dressings and drains, including casts and plastic bandages, must be assessed for bleeding or other drainage on admission to the PACU and hourly thereafter. Dressings and drains, including casts and plastic bandages, must be assessed for bleeding or other drainage on admission to the PACU and hourly thereafter.

TYPES OF INCISIONS

Surgical Drainage systems Jackson Pratt

Postoperative Care A. Dehiscence B. Evisceration Fig 14-5 pg 162

Evisceration

Dressings and Drains

Acute Pain Interventions include: Drug therapy Drug therapy Complementary and alternative therapies such as: Complementary and alternative therapies such as: –Positioning –Massage –Relaxation and diversion techniques

Epidural Anatomy

Gottschalk A.,& Smith DS (2001) AM Fam Physician Acute Pain Transmission

Physiology of pain

Systemiccirculation Epidural veins Epidural Opioid Spinal Arteries Dorsal Horn dural transfer CSF Non specific binding Brain Epidural Veins (Arachnoid Granulations ) Epidural Fat Brain Epidural Pharmacodynamics

Potential for Hypoxemia Interventions include: Maintenance of airway patency and breathing pattern Maintenance of airway patency and breathing pattern Prevention of hypothermia Prevention of hypothermia Maintenance of oxygen therapy as prescribed Maintenance of oxygen therapy as prescribed

Health Teaching Prevention of infection Prevention of infection Dressing care Dressing care Nutrition Nutrition Pain medication management Pain medication management Progressive increase in activity level Progressive increase in activity level Use of proper body mechanics Use of proper body mechanics