Mosby items and derived items © 2005 by Mosby, Inc. Postoperative care Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Postoperative Phase Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Postoperative Care Immediate care: PACU Post Anesthesia Care Unit Surgical information Nursing assessments Interventions Discharge criteria: ambulatory and acute care surgical settings Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Examination Observations & trend Cardio-respiratory examinations Abdominal examination Abdominal signs Wounds Drains Calf tenderness Vascular access sites Blood transfusion Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Overall assessment Vital signs Condition of dressings and drains Comfort level IV fluid status Urinary output Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Assessment Respiration Circulation Temperature control Fluid and electrolyte balance Neurological function Skin integrity and wound condition Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Assessment Genitourinary function Gastrointestinal function Comfort Client expectations Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Respiratory complications Atelectasis Pneumonia Hypoxemia Pulmonary embolism Mosby items and derived items © 2005 by Mosby, Inc.

Maintaining a Patent Airway Maintain ventilation and oxygenation! Supplemental oxygen as indicated. Keep head of bed elevated 15-30o unless contraindicated. Use of Oral Airway May require suctioning. If vomiting occurs, turn patient to the side Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Circulatory complications Hemorrhage Hypovolemic shock Thrombophlebitis Thrombus formation Embolus Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Gastrointestinal & Urinary complications; Abdominal distention Paralytic ileus Nausea and vomiting Urinary retention Urinary tract infection Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Integumentary complications Wound infection Dehiscence Evisceration Skin breakdown Pain Mosby items and derived items © 2005 by Mosby, Inc.

TREATMENT OF POSTOPERATIVE PAIN Routes; Oral/Transdermal Rectal Parenteral (IV, SC) Spinal/ Epidural/ Regional techniques Non pharmacological methods Analgesic Drug Therapy Opioids Local anaesthetic agents Paracetamol NSAIDS Volatile/Gaseous agents Fentanyl Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Paraceramol N S A I D Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc.

Patient Controlled Analgesia (PCA) Advantages Safe Effective good analgesia reduces delay saves nursing time high patient satisfaction, few complications Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Maintaining respiratory function Positioning and turning Suctioning Deep breathing (incentive spirometer), coughing Comfort Early ambulation Oral hygiene Oxygen Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Preventing circulatory stasis Leg exercises TED stockings (Thrombo Embolic Deterrent) Early ambulation Positioning Anticoagulants Fluid intake Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Achieving rest and comfort Analgesics PCA Pain assessment Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Temperature regulation Warmed blankets Monitoring for hypothermia and malignant hyperthermia Assessment for signs of infection Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Time since surgery 3-7 days Urinary tract infection Chest infection Wound infection Intra-abdominal sepsis Anastomotic leak Thromobophlebitis Cl. Diff colitis 7-10 days DVT/PE Prosthetic infection First 24 hours Systemic response to trauma Pre-existing infection 24-72 hours Atelectasis Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Fever Common after surgery 27-58% in first 24 hours Incidence of infection Underlying cause dependent on: Time since surgery Type of surgery Associated clinical features Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Non infectious causes Medications (drug fever, malignant hyperthermia) Blood transfusion reactions Haematoma Adrenal insufficiency AMI (acute myocardial infarction) Thyrotoxicosis Alcohol withdrawal Pancreatitis/acalculous cholecystitis Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Treatment options Urine & blood culture CXR Iv A/B Call surgical registrar Give paracetamol Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Neurologic function Orientation to the environment Level of consciousness Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Maintaining fluid and electrolyte balance IV therapy Oral intake when appropriate Urin output Mosby items and derived items © 2005 by Mosby, Inc.

Fluid & electrolyte balance Fluid replacement Maintenance requirement Replacement of losses Ongoing losses Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Replacement of losses Actual losses Bleeding Vomiting/diarrhoea Ongoing losses Stoma Drains Fistulae NGT U/O Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. IV fluids Crystalloids N/S Hartmann’s/Ringer’s lactate Dex N/5 5% Dex Colloids Blood products Albumin Gelofusin Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Crystalloids Compos. Hartman N/S 4% Dex N/S Na 131 150 30 Cl 111 K 5 nil HCO3 29 Ca 2 Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Promoting normal elimination and adequate nutrition Gradual progression of dietary intake Ambulation and exercise Adequate fluid and food intake Elimination aids: fiber, medications Control of nausea and pain Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Promoting urinary elimination Normal positioning Frequent assessment Assess bladder distention Input & Output Mosby items and derived items © 2005 by Mosby, Inc.

Post operative oliguria Pre-renal: Hypovolaemia Blood loss Under resuscitation Shock Sepsis Cardiogenic Post-renal: Calculi Blood clot Ureteric injury BPH Blocked catheter Renal: ATN- Hypovolaemia -Contrast Nephrotoxic drugs - Acute pyelonephritis Acute glomerulonephritis Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Management Treat underlying cause Volume resuscitation Aim U/O ≥ 0.5ml/kg/hr (adult) Monitor vital signs ICU ? Inotropic support Invasive monitoring Art line CVL Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Promoting wound healing Protect surgical site Prevent strain Observe healing Provide wound care Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Maintaining/enhancing self-concept Provide privacy Maintain client’s hygiene Maintain a pleasant environment Offer opportunities for client and family to express feelings and participate in care Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc. Discharge written and verbal instructions; regarding follow-up care, complics., wound care, activity, medications and diet. Give prescriptions and phone numbers. Discuss actions if complications occur. Mosby items and derived items © 2005 by Mosby, Inc.

Mosby items and derived items © 2005 by Mosby, Inc.