2. POST OPERATIVE CARE
The nurse thoroughly documents
the assessment including vital
sciences, level consciousness,
condition of dressing and drain,
comfort level all fluids status,
and urinary output measurement
Client data can be enter flow
sheet and compute raised client
record and written progress notes
3. INTRODUCTION
• The post operative period begins from the time the
patient leaves the operating room and ends with
the follow up visit by the surgeon.
• Care in immediate postoperative period, including the
operating room, postanesthesia care unit (PACU).
• Extent depends on the individual's pre-surgical health status,
type of surgery, day-surgery setting or in the hospital.
• Goal
- prevent complications such as infection
.- promote healing of the surgical wound
- return the patient to a state of health.
4.
5. PURPOSES
To enable a successful and faster
recovery of the patient post
operatively.
To reduce post operative mortality
rate.
To reduce the length of hospital stay
of the patient.
To provide quality care service.
To reduce hospital and patient cost
during post operative period.
6.
7. NURSING MANAGEMENT IN POST
OP UNIT
To provide care until the
patient has recovered from
the effect of anesthesia.
Assessing the patient
Monitor vitals-pulse
volume and regularity,
depth and nature of
respiration.
Assessment of patient’s
O2 saturation.
11. Protect airway
By proper positioning
of patient’s head.
By clearing airway.
Oxygen therapy.
Pharyngeal obstruction
can occur when the
patient lies on the
back as there are
chances for tongue to
fall back.
12. Maintaining IV Stability
Hypovolemic shock:
can be avoided by
timely administration
of IV Fluids, blood
and blood products
and medication.
Replacement of fluids.[colloids
and crystalloids]
Keep the patient warm.
Monitor intake and output
balance.
Monitor the vitals continuously
with the patient condition.
13. Shock Position
Keep the patient in shock position, flat on back,
legs elevated at 20 degree+knee kept straight.
14. ASSESSMENT OF THE SURGICAL SITE
Haemorrhage
It is a serious
complication of
surgery that
resulting death.
It can occur in
immediate post
operatively or upto
several days after
surgery.
If left
untreated,cardiac
output decreases and
blood pressure and
Hb level will fall
rapidly.
15. • Blood transfusion if
necessary.
• The surgical
site+incision should
always be inspected.
• If bleeding,pressure
dressing are placed.
• If the bleeding is
concealed,the patient is
taken in OR for
emergency exploration
of concealed
haemorrhage in body
cavity.
16. KEEP THE PATIENT WARM
Use warmer(Bair
Hugger) blankets
Use warm lights
17. Relieving pain +Anxiety
Administer opioid
analgesia as per
Doctor’s order.
Epidural analgesia.
NSAIDS.
Psychological support
to relieve fear+To
give support.
18. Controlling Nausea+Vomitting
These are common
problem in post
operative period.
Medication can be
administered as per
doctor’s order.
Example:
Inj Metaclopramide
Inj Ondansetron
( Emeset )
19. Discharge from the Post Operative Unit
A patient remains in the post op unit, untill the patient
has fully recoverd from anesthesia.
Following measures are used to determine the patient
ready for disharge from post operative unit.
✓Stable vital signs
✓Orientation to Person, Place, Time or events
✓Adequate oxygen saturation level.
✓Urine out put at least 30ml/hour
✓Minimal pain.
✓Adequate respiratory function.
✓Aldrete score more than ‘ 9 ‘ before shifting from Post
Operative Anaesthesia Care Unit
20. ALDRETESCORE
Post-Anesthesia Score
Atotal discharge scoreof 8-10isnecessary
Post-Anesthesia Score
PRE-ANESTHESIA VITAL SIGNS/SOURCE TIME AD
M
15"30" 45" 1' 2' 3' 4' DISCHARG
E
CIRCULATION SYSTOLIC BP 20% OF PRE-ANESTHETIC
LEVEL
2
20-50% 1
> 50 0
CONCIOUSNE
S S
FULLY AWAKE 2
AROUSABLE ON CALLING 1
NOT RESPONDING 0
COLOR WARM, DRY SKIN W/
PREPROCEDURAL COLORING
2
PALE, DUSKY, BLOTCHY, JAUNDICED,
OTHER
1
CYANOTIC 0
RESPIRATION ABLE TO DEEP BREATHE & COUGH
FREELY
2
DYSPNEA OR LIMITED BREATHING
APKEIC
1
0
ACTIVITY ABLE TO MOVE 4 EXTREMITIES2
21. Teaching, Patient Self Care
• Expected out comes
• Immediate post
operative changes
• Written instructions
Like Wound care
Activity+dietary
recommendation
Medications Follow
up
22. Role of Post operative Nurse
Post operative unit need to be prepared with suction, Oxygen,
Monitors/Pulse oxymeters, Side rails & propped up beds,
Emergency tray & resuscitation Tray& Crash cart
Immediate post operative patient to be placed near to the
nursing station who requires direct supervision of nursing officer
Comfortable bedding & Position
If patient is confined to bed air mattress can be given
After receiving the client check the case sheets and monitor the
vital signs & document it. Abnormal findings need to be informed
immediately to sister in-charge & on duty doctor
Client to be kept warm in immediate post operative case (control
environmental temperature )
Sanitary pads need to be checked for the placement in case of
gynaec patient
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SHRI VINOBA BHAVE CIVIL HOSPITAL,
SILVASSA
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23. Cont . . .
Surgical site should be checked for any oozing if
there is excessive bleeding over the dressing and
need to be reported immediately to the sister in-
charge or Concerned Doctors on duty
Measure & Document Abdominal girth
Mention the post operative day in Temperature chart
Vascularity refilling need to be checked for client with
any vascular surgeries or POP
NBM need to be released as per the surgeon order
and need to be explained to the patients clearly
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SHRI VINOBA BHAVE CIVIL HOSPITAL,
SILVASSA
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24. Cont. .
RT tube need to be checked for continuation
Uro bag should be checked for the patency &
should be placed at the foot end side
Drain bag & Uro bag to be on the same side and IV
Fluids to be in the opposite side
In case of Neuro surgery Propped up at 30’ at head
end side to be maintained till further order. But in
case of Spinal anasthesia head end should not
be raised
Early ambulation to be done
Deep breathing exercise & in necessary case
physiotherapist reference to be done
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SHRI VINOBA BHAVE CIVIL HOSPITAL,
SILVASSA
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25. Cont . .
In case of specimen or any biopsy postoperatively
need to be send it to Lab after explaining the
relatives
Strict compliance to the Documentation and in
special case like DM & HT, Eclampsia, PIH, PPH
need to monitor Vitals at the specified time
While feeding need to be cautious to prevent
aspiration
Drain need to be removed as per surgeon order
Hygiene of the client need to be ensured to prevent
surgical site infection
Dressing need to be changed as per surgeon order
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SHRI VINOBA BHAVE CIVIL HOSPITAL,
SILVASSA
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26. I/O chart to be maintained strictly
Bowel elimination need to be monitored
Strict compliance to all due medications as
per time
Catheter need to be removed or replaced
after 7 days
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SHRI VINOBA BHAVE CIVIL HOSPITAL,
SILVASSA
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