POST OPERATIVE CARE

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.
The post operative
care is provided by
-
 PACU

 SICU
 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.
 POST OPERATIVE CARE
UNIT
 Patients still under anesthesia or
recovering from anesthesia are
placed in the unit for observation by
highly skilled nurses,anesthetist and
surgeon.
 PACU should be sound proof, painted
in soft colour, isolated and these
features will help the patient to
reduce anxiety and promote comfort.
 PHASES OF POST OP UNIT
Two phases-
 Phase I
 Phase II
 Phase I
It is the immediate recovery phase
• and requires intensive nursing care to detect


early signs of complication.

 Receive a complete patient record from
the operating room which to plan post
operative care.
 It is designated for care of surgical patient
immediately after surgery and patient
requiring close monitoring
 Phase II
 Care of the surgical patient who has
been transferred from the Phase I
post op unit.
 Patient requiring less observation
and less nursing care than Phase I
 This phase is also known as Step
down or progressive care unit.
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.
 Skin colour.
KEEP MONITORING VITALS
 Check the level of consciousness.
Ability to respond to commands.
MAINTAIN INTAKE AND OUTPUT
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.
MaintainingIV 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.
 Shock Position
Keep the patient in shock position, flat on back,
legs elevated at 20 degree+knee kept straight.
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.
• 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.
KEEP THE PATIENT WARM
 Use warmer(Bair
Hugger) blankets
 Use warm lights
Relieving pain +Anxiety
 Administer opioid
analgesia as per
Doctor’s order.
 Epidural analgesia.
 NSAIDS.
 Psychological support
to relieve fear+To
give support.
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 )
 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
 ALDRETESCORE
Post-Anesthesia Score
Atotal discharge score of 8-10 is necessary
Post-Anesthesia Score
PRE-ANESTHESIAVITAL SIGNS/SOURCE TIME ADM 15" 30" 45" 1' 2' 3' 4' DISCHARGE
SYSTOLIC BP 20% OF PRE-ANESTHETIC LEVEL
2
CIRCULATION 20-50% 1
> 50 0
FULLYAWAKE 2
CONCIOUSNES AROUSABLE ON CALLING 1
S
NOT RESPONDING 0
WARM, DRY SKIN W/ PREPROCEDURAL
COLORING 2
COLOR PALE, DUSKY, BLOTCHY, JAUNDICED, OTHER
1
CYANOTIC 0
ABLE TO DEEP BREATHE & COUGH FREELY
2
RESPIRATION DYSPNEA OR LIMITED BREATHING APKEIC
1
0
ABLE TO MOVE4 EXTREMITIES 2
ACTIVITY ABLE TO MOVE2 EXTREMITIES 1
ABLE TO MOVE0 EXTREMITIES 0
COMMENTS TOTAL
Teaching, Patient Self Care
• Expected out comes
• Immediate post
operative changes
• Written instructions
like
Wound care
Activity+dietary
recommendation
Medications
Follow up