Goal of post-op care
- support healing and recovery
- Prevent complications
PACU RN verbal report to RN
General information, type of surgery, level of consciousness, equipment, any problems
First priority when pt arrives on unit…
take vital signs and compare to baseline
Post-op complications related to…
-pain -exhaustion - immobility -rxn to meds -loss of control -exposure
Assess when arrive from PACU
- respiratory
- circulatory (skin color, cap refill, BP, P,T)
- neurological systems (level of consciousness)
- dressings (drainage, bleeding)
- pain
- safety (side rails, call bell)
- equipment (IV fluids, drainage system, EPCs, PCA)
- comfort (positioning)
Alteration in respiratory functions (Assessment)
- Evaluate airway patency –tongue most common cause of obstruction
- position pt in sims or semi-prone with HOB 30 degrees
- evaluate chest symmetry
- evaluate depth, rate & character of resps
Often first sign of respiratory problem
Restfulness!
Atelectasis
- alveolar collapse causes airless condition of lung
- mucus blocks bronchioles>air beyond blocked>gradually absorbed> alveolus collapses
- Causes: hypoventilation, prolonged bedrest, ineffective cough
- S/S: pain, tachypnea, dyspnea, tachycardia, fever
Pneumonia
-inflammation/infection of lungs
-most common respiratory complications in the elderly, obese, malnourished, chronic respiratory disease
-S/S: fever, dyspnea, pain, cough (productive)
(progresses from atelectasis)
Aspiration Pneumonia
- inhalation of gastric contents
- gastric contents very acidic ph= 2-4 & toxic to lung tissue
- prevent w/ IS, OOB, deep breath -cough - HOB^ -turning)
Nurse management of respiratory complications
- deep breathing & coughing (begin as soon as pt is responsive)
- turn, cough, & deep breathe (4-6 deep breaths then forceful cough)
- splint incision
- change position every 1-2 hours
Deep breathing
- maximized lung expansion
- 10 deep breath/hour
- incentive spirometer
Post operative day #
POD #1 = first full day after surgery
-each subsequent day counted
Most important intervention to prevent post-op complications
EARLY AMBULATION
-increases vital capacity of lungs
Alterations in cardiovascular function
-fluid and electrolyte imbalance
-fluid status directly affects cardiac output
Assessment– freq. VS monitoring, skin color, temp, cardiac arrhythmias
Cardiac complications
DVT, thrombophlebitis, embolus
Deep vein thrombosis (DVT)
blood clot
(usually in the legs)
-risk due to increased platelet production as body reacts to stress of surgery
Thrombophlebitis
inflammation with a clot
Embolus
clot dislodges and travels
Interventions for cardiac complications
- early ambulation
- EPCs/SCDs and/or TEDs
- Leg exercises
If thrombus occurs…
- duplex scan in vascular lab to confirm clot
- bed rest to prevent dislodgement
- Do NOT massage legs
- anti-coagulant therapy (heparin, lovenox)
Pulmonary embolus
- clot lodged in pulmonary circulation
- blocks blood supply to lower lobe (anything below clot may die)
- S/S: restlessness, dyspnea, tachypnea, sudden sharp chest pain, crackles, change in mental status (hypoxia)
- size of emboli reflects results - death can result
- report any S/S to physician immediately
Syncope
- brief lapse in consciousness caused by transient cerebral hypoxia (not enough oxygen to the brain)
- postural hypotension
- vascular pooling
- sudden changes in position
Interventions for syncope
- change position slowly
- raise HOB, progress to sitting, dangle, stand
- monitor radial pulse
- safety for fall prevention
- -if pt faints, assist to floor to prevent injury
