POSTOPERATIFVE NURSING MANAGEMENT
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Serious orthostatic hypotension may occur when a patient is moved from one position to
another (eg, from a lithotomy position to a horizontal position or from a lateral to a supine
position), so the patient must be moved slowly and carefully.
The primary objective in the immediate postoperative period is to maintain pulmonary
ventilation and thus prevent hypoxemia (reduced oxygen in the blood) and hypercapnia (excess
carbon dioxide in the blood).
The treatment of hypopharyngeal obstruction involves tilting the head back and pushing
forward on the angle of the lower jaw, as if to push the lower teeth in front of the upper teeth.
The anesthesiologist or anesthetist may leave a hard rubber or plastic airway in the patient’s
mouth to maintain a patent airway. Such a device should not be removed until signs such as
gagging indicate that reflex action is returning.
Respiratory difficulty can also result from excessive secretion of mucus or aspiration of vomitus.
Turning the patient to one side allows the collected fluid to escape from the side of the mouth. If
the teeth are clenched, the mouth may be opened manually but cautiously with a padded
tongue depressor. The head of the bed is elevated 15 to 30 degrees unless contraindicated, and
the patient is closely observed to maintain the airway as well as to minimize the risk of
aspiration. If vomiting occurs, the patient is turned to the side to prevent aspiration and the
vomitus is collected in the emesis basin. Mucus or vomitus obstructing the pharynx or the
trachea is suctioned with a pharyngeal suction tip or a nasal catheter introduced into the
nasopharynx or oropharynx. The catheter can be passed into the nasopharynx or oropharynx
safely to a distance of 15 to 20 cm (6 to 8 inches). Caution is necessary in suctioning the throat of
a patient who has had a tonsillectomy or other oral or laryngeal surgery because of risk for
bleeding and discomfort.