Postoperativ

e
Care

By: Kristen Glavin, Katherine

Baumes

What is Postoperative Care?

Postoperative care refers to the care a patient
receives following a surgical procedure. It begins
immediately after surgery, continues through the
duration of the patients stay until discharge, and
may continue past discharge from the hospital.

Purpose of Postoperative Care

The purpose of postoperative care is
to:
Promote healing to return the
patient to a functional level of
wellness
Prevent complications
Facilitate quicker recovery for
earlier discharge

Postoperative complications include:

Airway Obstruction
Atelectasis
Pneumonia
PE
Hemorrhage-Internal or External
Thrombophlebitis-DVT
Infection
Pain
Muscle Atrophy
Hypothermia
Hypotension and Hypertension
Residual narcosis
Restlessness

Can you name 3 postoperative

complications?

What is Involved in Postoperative

Care
Postoperative care involves:

Assessing VS and LOC

Assessing ABCs
Surgical wound assessment
Pain Management
Intake and Output (know EBL)
Fluid Management
Nutrition/Diet
Post-operative medications
Assessing Labs
DVT prophylaxis
Position and safety
Post-operative exercises/teaching

You are the RN Receiving a

Postoperative Patient On Your Unit
Here is What You Do

When a patient is ready to be discharged from the PACU, the PACU RN will call
the receiving unit with report.

The patient coming to your floor will have orders for post-op care based on the
procedure, facilities policies, and providing surgeon/doctor.
- For example, vital signs, IV fluids and rate, medications, dressings, etc.

Immediately upon arrival on the unit, the PACU RN and receiving RN will perform
a handoff. This includes identification of patient, review of VS, type of surgery
and anesthesia performed, blood loss, LOC, general physical condition, IV lines,
drainage tubes, and dressings.

The PACU RN will review the surgeons orders, recovery room record, the
patients condition, and the course of care as well.

The Receiving RN MUST assess the patient's VS with the PACU RN,
comparing them to the last set taken in the PACU to check for patient
stability.

After all of this is completed the PACU RN can leave. The receiving RN will
continue with her assessments of the patient.

 Once the patient is admitted to the unit, VS should generally be taken

every 15 minutes twice, every 30 minutes twice, hourly for 2 hours,
and then every 4 hours OR per MD orders. (Perry and Potter pg 1276)
The receiving RN will continue to monitor the post-op patients VS,
I&O, surgical wounds/dressings, pain, and labs throughout the
patients stay on the unit until discharge.
Accurate recording of I&O is needed to assess renal and circulatory
function. Urinary output can be impaired following surgical procedures
due to anesthesia. Part of the I&O assessment would also include EBL
from surgery and output from surgical drains.
Controlling the postoperative patients pain level is crucial. Not only
will it provide comfort, but it will also help to facilitate participation in
postoperative exercises.

True or False:
Since report was given to the receiving unit
and RN over the phone, the PACU RN can
leave once the post-op patient is on the
unit.

This is FALSE
The PACU RN must stay with the patient and the
receiving RN until the receiving RN takes a
complete set of vitals and compares it to the PACU
findings, or the patients baseline. During this time,
the PACU RN will also review the surgeons orders,
recovery room record, the patients condition, and
the course of care.

Postoperative
Exercises/Teaching
Part of postoperative care includes teaching post-op
exercises to promote recovery and prevent
complications.
Exercises that you should teach and encourage
during the postoperative period include:
- Incentive spirometer
- TCDB
- Splinting
- Ambulation
- ROM

Get Your Patient

Moving

Encouraging early mobilization of your postoperative patient will help to prevent

complications that develop when there is a decrease in activity such as DVT,
pneumonia, and paralytic ileus.

Ambulation should be implemented as soon as the patient is able to do so, unless

otherwise ordered.

Ambulation promotes recovery, mobilization of secretions in the airways,

promotes peristalsis, and facilitates venous return.

If the post-op patient is unable to ambulate, other forms of activity should be

implemented every 1-2 hours when awake. These include:
- ROM exercises, heel pumps, SCDs, TEDs, frequent turning and positioning

Preventing Respiratory
Complications
Anesthesia and pain both play a role in preventing adequate ventilation and
perfusion of oxygen throughout the body during the postoperative period.
Exercises to prevent respiratory complications include encouraging the use of
the incentive spirometer (IS), and TCDB.
Coughing and deep breathing work together to clear mucus from the airways
and allow for better oxygenation. If the patient experiences pain with TCDB
exercises, you can implement splinting to support the patients incision and
decrease discomfort. These exercises should be performed 3-5 times every
hour while awake.
Encouraging use of the incentive spirometer prevents alveolar collapse and
facilitates removal of secretions. The IS should be used 10 times every hour
while the patient is awake.

Evidence Based Practice

Postoperative patients are at risk of clinical deterioration and it is vital that
this is minimised. Knowledge and understanding of the key areas of risk and
local policies will help to reduce potential postoperative problems.
Evidence based practice has shown that, A combined effort in preoperative
optimization and information, stress-reduced surgery, efficient postoperative
pain treatment, adjustment of perioperative care principles to existing
evidence, and nursing care focusing on early mobilization and oral nutrition
enhance recovery, decrease morbidity, and shorten hospital stays.

Can you state 3 reasons for

providing post-operative care?

Does anyone have any experience with

postoperative care? Either as a patient or
as the individual caring for the patient.

Video
From Simple Nursing.com on YouTube
https://www.youtube.com/watch?v=sdnM5ZuP
fl0
https://www.youtube.com/watch?v=FVH80V0s
ExY&spfreload=10

References
Kehlet, H., & Wilmore, D. (2008). Evidence-Based Surgical Care and the Evolution of Fast-Track Surgery. Lippincott Williams & Wilkins:
Annals of Surgery, 248(2), 189-198. Retrieved April 6, 2015, from http://www.stolav.no/StOlav/Avdelinger/Ortopedi/Fast-track seminar 2011/Kehlet
2008 Evidence-Based Surgical Care and the Evolution of Fast-track surgery.pdf
Liddle, C. (2013). Principles of Monitoring Postoperative Patients. Nursing Times, 109(22), 24-26. Retrieved April 6, 2015, from
http://www.nursingtimes.net/Journals/2013/05/31/g/l/a/050613-Principles-of-monitoring-postoperative-patients.pdf
Postoperative Care. (2003). Retrieved April 6, 2015, from http://www.who.int/surgery/publications/Postoperativecare.pdf
Potter, P., & Perry, A. (2009). Care of Surgical Patients. In Fundamentals of nursing (8th ed., pp. 1274-1292). St. Louis, Mo.: Mosby Elsevier.
SECTION IV. POSTOPERATIVE PATIENT CARE. Retrieved April 6, 2015 from
http://www.brooksidepress.org/Products/Nursing_Fundamentals_II/lesson_8_Section_4.htm