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Post-operative Nursing care
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This document describes nursing responsibilities regarding patients who have undergone surgery.
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Post Operative care: Students Notes• Post-operative care starts right after a patient has undergone surgery or recovering from
trauma. The focus of post operative care is to prevent further complications in a patient’s
health.
• Post operative care starts in Post-Anesthesia care Unit (PACU) and continues after the
patient is transferred to a unit.
There are three phases of Post Anesthesia care:
1. Phase I: which focuses on providing care immediately after anesthesia period and
bringing patient’s vital signs to baseline. In this period nurses need to constantly monitor
the patient. The goal of this phase is to transfer the patient to Phase II or into inpatient
Unit.
2. Phase II: In this phase patient is transferred to surgery Unit. The patient is encouraged to
walk around as tolerable. The main goal is to start discharge planning.
3. Extended observation: In this phase patient’s require ongoing care and need further
observations. The goal is prepare patient for self-care.
Potential Alterations in Respiratory Function
• There are two main respiratory complications that occur post-operative (after surgery). These
are Atelectasis and Pneumonia (which is explained in the next few slides).
• Most common causes of airway compromise include: some sort of obstruction, Hypoxemia
(low level of oxygen in blood) and Hypoventilation.
• Obstruction is commonly caused by the patient’s tongue. It usually occurs due to patient being
in the supine position and in patients who are extremely sleepy after surgery. The base of the
tongue falls backward against the soft palate, and it occludes the pharynx.
• Hypoventilation: Post-op patients breathing occurs at an abnormally slow rate, usually caused
by effects of opioids (Pain meds). and that further causes hypoxemia: decreased oxygen in
blood. (SPO2 levels usually drop) that’s why Nursing interventions like Deep breathing exercises
helps increase the SPO2 levels and prevent further complications.
• Atelectasis: complete or partial collapse of a lung or segment of a lung that occurs when the
alveoli become deflated. It could be a total collapse of the lung or partial collapse. Surgeries that
require Anesthesia is a common cause of Atelectasis. Normally, what happens in our lungs is
During inspiration Lungs fills up with air. The air travels to alveoli where oxygen moves into
your blood and Then blood delivers the oxygen to organs and tissues throughout body. But what
happens when the patient is on a lot of Pain medications Post-Op is the patterns of breathing
change, lots of secretions build up could cause an obstruction in the airway which results in
alveoli never getting the air and it causes it to deflate and causes that part of the lungs to
collapse. Pain medications causes shallow slow breathing which means not enough air is
reaching the alveoli for it to inflate resulting in that part of the lung to collapse known as partial
lung collapse. That’s why nursing interventions such as deep breathing, mobilizing patient,
sitting them up helps prevent this complication.
• Pneumonia: considered hospital-acquired Pneumonia. It is the 3rd most common complication
for all surgical procedures and is associated with increased patient morbidity and mortality.
Although rest is important Post-op: Immobilization/Pain medications can again prevent patients
, from fully ventilating their lungs which can cause pooling of secretions leading to bacterial
infection. Therefore early mobilization again is vital to prevent Pneumonia.
• Pathophysiology: Bronchial secretions increase when the respiratory passages have been
irritated by heavy smoking acute or chronic pulmonary infection and the drying of mucous
membranes which occurs with intubation, anesthesia (temporarily changes the way you
breathe resulting in mucous build up and dehydration. Subsequent post-operative development
of “mucous plugs” that blocks small bronchi and decreased surfactant production are directly
caused by hypoventilation (slow breathing due to pain meds), constant recumbent position,
ineffective coughing and history of smoking. Without any interventions, the affected lung
segment can collapse, become infected and progress to pneumonia within 2-3 days post-
operatively.
Risk Factors: Patients who had general anesthesia, age particularly Elderly, History of Smoking,
Lung disease, Obesity, Airway, thoracic or abdominal surgery.
Nursing Assessment:
1. Respiratory Assessment: Access for presence of cough, Chest symmetry, depth rate and
character of respirations. The chest wall should be observed for symmetry of movement
with a hand placed over the xiphoid process. Slow breathing or diminished chest and
abdominal movement during the respiratory cycle may indicate impaired ventilation. The
Nurse should determine if the patient is using accessory muscles for breathing as that
means that they are in respiratory distress and acknowledging and reporting that to HCP
is extremely important.
2. Assess for breath Sounds: SOB, Lung sounds should be auscultated anteriorly, laterally
and posteriorly. Decreased or absent breath sounds are detected when airflow is
diminished or obstructed. Crackles or wheezes heard upon auscultation should be
reported to HCP!
3. Airway Patency
4. Vital Signs: Checking for SPO2 levels, Fever, Pain, Chest Pain.
5. Sputum Color: The characteristics of sputum should be noted and recorded. Mucus from
trachea and throat is colorless and thin in consistency. Sputum from lungs and bronchi
can be thick with a slight yellow or pink tinge.
Nursing Interventions:
1. Proper Patient Positioning.
2. Unconscious patients should be positioned in lateral recovery position.
3. Once conscious, the patient is returned to a supine position with the head of bed elevated.
4. Encouraging and educating patient to do deep breathing and coughing to clear secretions
and to prevent the development of respiratory complications.
5. Educating the patient on using Incentive Spirometer. (Every patient has this on their
bedside table, but sometimes patients doesn’t know the importance of it or how to use it
so very important to do patient education.
6. Changing patient position every 2 hours, sitting them up for meals Unless
contraindicated.
7. Adequate hydration
8. Early mobilization: Sitting patients out of bed, standing on the first post-operative day,
walking a short distance in the room on the second post-op day as instructed by PT.
9. Oral care: Clears out excess secretions and keeps airway patent.
Potential Alterations in Cardiovascular Function
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