BAKERSFIELD COLLEGE
LICENSED VOCATIONAL NURSING PROGRAM
1ST SEMESTER FUNDAMENTALS
CLIENTS WITH SPECIAL NEEDS
CHAPTER 50 - POSTOPERATIVE CARE
INTRODUCTION
Postoperatively, a client’s care can become complex as a result of physiological changes
that may occur. To assess a client’s postoperative condition, the nurse relies on
information from the preoperative nursing assessment and on knowledge regarding the
surgical procedure performed and events occurring intraoperatively.
OBJECTIVES
Upon completion of this unit, the student will be able to:
A.
Theory
1.
List three major causes of airway obstruction in the postoperative client.
2.
Describe how to assess the respiratory status of the postoperative client.
3.
Describe the assessment steps to be performed by the PAR nurse.
4.
Describe the nurse’s role in phase I ad II recovery.
5.
Describe the signs of hemorrhage and shock.
6.
Describe how often assessment of the postoperative client is made.
7.
List some of the ways to prevent circulatory stasis.
8.
List ways to prevent infection of the surgical wound.
ASSIGNMENT
A.
B.
Read Chapter 50 of Potter & Perry, pgs. 1393 – 1408, and Review Questions
Study guide for Chapter 50
Chapter 50 - Postoperative Care
Postoperatively a client’s care can become complex as a result of physiological
changes that may occur
To assess a client's postoperative condition the nurse relies on:
information from the preoperative nursing assessment and
on knowledge regarding the surgical procedure performed
events occurring intraoperatively
The anesthesiologist or surgeon usually accompanies the client to the:
Recovery room – RR
Or the post anesthesia room – PAR
Or the Post Anesthesia Care Unit – PACU
Assessment includes:
Admission time
Airway
Measurement of vital signs
Color of skin
Condition of dressing
Measurement of body temperature
Assessment includes:
Level of consciousness
Condition of the skin
Genitourinary function
Monitor IV’s or blood transfusions
Perception of pain
Assess for hemorrhage and shock
Recovery in Ambulatory Surgery
Phase I Recovery
Needs close monitoring
Average time is 1 hour
Phase II Recovery
May be in medical recliner chair
For clients who have undergone minor surgery
Environment is designed to promote comfort and well-being
Discharge from the Recovery Room
When the client is stable he is discharged from the recovery room
To home
To the ambulatory/outpatient unit
To the hospital room
If client’s condition is poor, may be transferred to the ICU
Postoperative Assessment
In the hospital room
Same physical measurements and observations performed in the recovery
room
Vital signs and assessments are made:
every 15 min X 4
Every 30 min for 1-2 hours
Every hour X 4
Then q4h x 24
Nursing Diagnoses
For the surgical client
Ineffective airway clearance
High risk for injury
Due to bleeding, falling
Impaired tissue integrity
Pain
High risk for infection
Implementation
Maintain respiratory function
Position, suction, diaphragmatic breathing, incentive spirometry, early
ambulation, turn in bed, keep client comfortable
Preventing circulatory stasis
Antiembolic stockings
Pneumatic antiembolic stockings – SCD
Avoid positions that put pressure or interrupts blood flow to the extremities
Implementation
Promote normal elimination and adequate nutrition
NPO then progress to liquids
Gradually progress diet
Monitor for bowel sounds
Assess for N/V
Promote urinary elimination
Check for first voiding (> 30cc/hr)
Bladder distention
Monitor I&O
Implementation
Preventing infection
Strain on sutures disrupts wound layers
Critical time is 24 - 72 hours post-op
Infections usually occur 3 – 6 days post-op
Takes 15 – 20 days to regain wound strength
Achieving rest and comfort
Irritations from tubes, dressings, casts
Muscular strain from positioning on OR table
Determine character of pain
Maintaining Self-Concept
Provide privacy
Maintain client hygiene
Prevent drain overflow
Maintain pleasant environment
Allow opportunities for client discussion
Provide opportunities for family discussion