POST OPERATIVE CARE – Surgery, Postoperative Care (General), Care of Patient (anesthesia), Observation of Patient, Diet and Postoperative Health Teaching
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The success of every surgery depends on the type of nursing care given to the patient before (preoperative), during (infraoperative) and after (postoperative) period of surgery.
The preparation of patient for surgery depends on the type of surgery, age of the patient, general health of the patient and the organs involved
TYPE OF SURGERY
- Emergency surgery: preoperative period is very short, because of the life threatening situation, e.g. acute appendicitis
- Planned surgery: time for surgery is fixed with the method consent of the surgeon and the patient
- Major surgery: the operation involving a large surface area of the body
- Minor surgery: operation involving a small area of the body
- Diagnosis surgery: there is an operative in which the diagnosis is unknown, e.g. exploratory laparotomy in which the abdomen is opened to seek the cause of symptoms
- Curative surgery: this is an operative in which discussed part or organ is removed to relieve symptoms, e.g. cholecystectomy
- Reconstructive surgery: this is an operative involving strengthening of a weakened area, e.g. herniorrhaphy
- Corrective therapy: this is an operation in which deformities are corrected, e.g. replacement of the metal valve
- Quickly observe the functioning of all devices and make sure they are in its functioning order
- Palliative surgery: this is an operation in which symptoms are relieved but the basic cause remains, e.g. gastrojejunostomy
- Cosmetic surgery: this is an operation done to improve the appearance, e.g. repair of the left up and left palate
POSTOPERATIVE CARE (GENERAL)
Preparation of Postanesthetics and Reception of the Patient
- After sending the patient to operating room, prepare a bed to receive the patient undergone surgery and anesthesia
- There should be adequate number of people to transfer the patient without disturbing the functioning of the devices attached with the patient
- Receive the patient, without disturbing the devices attached to the patient
- Ask the theater staff who has accompanied with the patient about any complication that has occurred in the operation room during surgery
- Before the theater staff (including anesthetist) return to operation theater, check the vital sign
- Check the operation site for bleeding, discharge, etc. if drainage tubes are filled
- Keep the patient well covered to prevent draught
- Never leave the patient alone to prevent injury from fall
- Observe the patient for swallowing reflexes
- Quickly observe the functioning of all devices and make sure they are in its functioning order
- Check the doctor’s order for other instruction and treatment
CARE OF PATIENT WHO IS UNDER THE EFFECTS OF ANESTHESIA
- Patient needs close and diligent observation, until the patient fully recovers from anesthesia
- A noisy breathing is indicative of airway observation that can occur due to the tongue falling lick and obstructing the pharynx apply suction immediately
- Keep the patient in a suitable position that will be helpful to drain out the vomits, blood, secretions collected
- The oropharyngeal airway left in the mouth of the patient should be removed as soon as the patient has required cough and swallowing reflexes
- If the patient is cyanosed administer oxygen inhalation
- In order to prevent injury from falls from bed, put a side rails on the bed
- Keep the family informed about the successful completion of surgery, transfer of the patient from the operating room to recovery room, etc
OBSERVATION OF THE PATIENT IN THE POSTOPERATIVE PERIOD
- Close and diligent observation by the nurses is important to prevent complication in the early stages, and thus, save the patient
- On the first day (postoperative) the patient close and frequent observation is needed
The main points that should be observed are:
- Vital signs – BP, pulse rate, respiratory rate
- Intake and output – IV fluids, oral fluids
- Urinary concept – time and amount
- Bowel movement
- Sign of hypo/hypervolemia
- Any breathing difficulties
- Pain over the half muscles
POSTOPERATIVE ASSESSMENT
- Airway – patency, presence/adequacy of artificial airway
- Vital signs – respiratory rate; depth, character, heart rate (pulse, pulse oximeter or cardiac monitor), blood presence (cuff or arterial line)
- Pressure reading – pulmonary artery wedge pressure, central venous pressure (CVP), intracranial pressure
- Level of consciousness – ability to follow commands, sensation and ability to move extremities following regional anesthesia
- Patient position – position to facilitate breathing, to prevent pressure on body parts or invasive lines and to promote comfort
- Tissue oxygenation – skin: color, temperature, moisture. Nail beds: color, capillary refill. Lips/oral mucosa: color pulse oximetry peripheral pulses: presence strength
- Dressing/suture lines – dressing: dry or minimal drainage, suture lines (if visible): color approximation of wound edges
- Fluid lines/tubes – intravenous fluids; rare, amount in bottle/beg/infusion rate
Other lines (example: CVP line arterial lines); patency, connection, character and amount of drainage, Ryle’s tube drainage, urine output, quality and color. Note and record fluids coming out of dressing
DIET OF THE PATIENT
- All patients, except patients, who had abdominal surgery, may start the normal diet, if desired so, on the first day
- Patient who had abdominal surgery, but did not involve the intestine or stomach, can have the clear fluids on the day after the surgery
- Gradually, if can change into soft diet and then normal diet
- The patient who had undergone any type of surgery need a diet such in vitamin and minerals
POSTOPERATIVE HEALTH TEACHING
All patients need health teaching according to the educational background of the patient. Teach the patient following points:
- Maintain of personal hygiene
- Diet that is allowed for the patient, any control on the diet
- Ambulation; activities that are permitted as well as restricted
- Any drugs to be taken postoperatively; the side effects and precautions
- Date on which the patient may resume duty
- Further treatment that may be needed
