Post Operative Nursing Care Post Operative- begins after the operation, the patient is transferred to the recovery

room. From recovery room transferred to ward until patient discharge at home. It is most critical one for the patient. he must be observed diligently and receive intensive care until the effects of the anesthetics have worn off and his condition stabilizes. Goals of Care 1. aintain ade!uate body system functions- "irculation and patent airway #. $estore homeostasis %. &lleviate pain and discomfort '. Prevent post op complications and in(ury ). *nsure ade!uate discharge planning and teaching Nursing care of clients during the immediate post operative recovery . 1. Ensure maintenance of patent airway - leave airway in place until gag refle+ has returned. ,urned the head to the side to prevent aspiration. -uction e+cess secretions. *ncourage coughing and deep breathing to promote chest e+pansion. #. Perform baseline assessment- level of consciousness, vital signs, color of s.in, inspect the surgical site for presence of bleeding, character of drainage is noted. *levation of temperature and leu.ocytes count should be e+pected because of the tissue damage. %. Maintain cardiovascular activity- onitor vital signs every 1) minutes until condition is stable. Observe signs and symptoms of shoc. and hemorrhage. "ool e+tremities, decreased urine output, slow capillary refill, tachycardia, narrowing pulse are often indication of decreased cardiac output. '. Maintain adequate fluid status- *valuate blood loss and measure urine output. &ssess amount and character of drainage on dressing. ). Maintain incision areas- &ssess amount and character of drainage on dressing. "hec. and record the status of the wound drains. /. Maintain psychological equilibrium- -pea. the client fre!uently in calm. In the anesthetized client, sense of hearing is the last to be lost and the first to return. 0. Clients meets criteria to return to room&ctivity- the client is able to obey commands $espiration- client can maintain a patent airway without assistance. 1oiseless breathing. "irculation- 2P is with in #3 mmhg of the preoperative. "onsciousness- client is awa.e, responsive and refle+es have returned. "olor- client has pin.ish s.in and mucous membrane. 4. Protect clients privacy

Nursing care of clients transfer from P C! to the surgical unit to day " post op# 1. Maintain cardiovascular functions- onitor vital signs, evaluate nail beds, and encourage early ambulation. #. Maintain $espiratory functions- client turn cough and breath deeply every two hours. 5se incentive spirometry to promote deep breathing. &dminister nebulizer treatment and bronchodilators. aintain ade!uate hydration to .eep mucus secretions thin and easily mobilized. %. Maintain adequate nutrition and elimination - &ssess for return of bowel sounds and normal peristalsis. 6o not allow oral inta.e of fluids until gastrointestinal function returns. '. Maintain fluid and electrolyte balance- aintain good inta.e and output. &ssess for ade!uate hydration li.e moist mucous membrane, good s.in turgor, and ade!uate urine output. Oliguria is caused by increased production of antidiuretic hormone. 7ater and sodium retention may increased production of adenocorticosteroids. ,he urine output decreases below normal levels for 1# to #' hours after operation. ). Promote comfort- &dminister analgesics and non pharmacological pain relief measures. Post operative %iscomfort "# Nausea and vomiting "ause8 anesthetic inhalation, which may irritate the stomach lining and stimulate the vomiting center in the brain. Preventive measure8 Insert 19, intra operatively for operations on gastrointestinal tract to prevent abdominal distention, which triggers vomiting. 6etermine whether the client is sensitive to morphine or meperidine : 6emerol; or other narcotic because they may induce vomiting in some patients.
Nursing Intervention: encourage client deep breathing to facilitate elimination of anesthetics, turned patient head side to prevent aspiration.

&# 'hirst "ause8 dehydration due to preoperative fluid restriction and fluid lost by way perspiration. 1ursing Intervention8 &dminister intravenous fluid and apply a moistened gauze over the lips occasionally. (# Constipation and gas cramps "ause8 trauma and manipulation of the bowel during surgery, as well as narcotic use, will retard peristalsis. Preventive measure8 encourage early ambulation to promote peristalsis, provide ade!uate fluid inta.e to promote soft stool and hydration. *ncourage early use of non- narcotic analgesia because many opiates increase chance of constipation. 1ursing Intervention8 perform manual e+traction for fecal impaction, if necessary. &dminister gastrointestinal stimulants, la+atives and suppositories.

)# Post operative pain "ause8 stimulation or trauma to certain nerve ending. 9eneral Principles8 pain occurs between 1# and %/ hours after surgery and usually diminished significantly by '4 hours. Older people seems to have a higher tolerance for pain than younger or middle aged people. "linical manifestation8 elevate 2P, increase P$, increase $$, increase perspiration, increase muscle tension, Increase irritability, increase an+iety. Preventive measure8 teach patient about the pain management, reduce an+iety and establish a trusting relationship. 1ursing Intervention8 use basic comfort measures li.e8 provide therapeutic environment, massage the patient bac., and offer diversional activities. onitor possible side effect of analgesic therapy such as 8 respiratory depression, hypotension, nausea and s.in rashes. Post Operative Complications 1. -hoc. #. <emorrhage %. 6eep =ein ,hrombosis '. Pulmonary "omplications- atelectasis, aspiration, pneumonia ). Pulmonary *mbolism /. 5rinary $etention 0. Intestinal Obstruction 4. <iccups >. 7ound Infection 13. 7ound 6ehiscence *hoc+ ? is a response of the body to a decrease in the circulating blood volume8 tissue perfusion is impaired culminating eventually in cellular hypo+ia and death. Preventive easures8 have blood available if there is any indication that it may need. easure accurately any blood loss and monitor all fluid inta.e and output. ,emorrhage8 is a copious escape of blood from the blood vessel. &ccording to the blood vessel8 &rteries- bright red, venous- dar. and bubble out, capillary- general oozing from the capillaries "linical manifestation8 apprehension- restlessness, thirst, cold, moist, pale s.in. Pulse increase, rapid respiration, temperature drops. 7ith progression of hemorrhage@ decrease in cardiac output and narrowed pulse pressure, rapid decrease 2P, as well as hematocrit and hemoglobin. 1ursing Interventions8 1. Inspect the wound as a possible site of bleeding, apply pressure dressing over e+ternal bleeding site. #. Increase I=F infusion rate and administer blood if necessary. %. Aigation of bleeders by the surgeon as necessary.

%eep -ein 'hrombosis8 occurs in pelvic veins or in deep veins of the lower e+tremities in post operative patients. ore common in hip surgery, prostatectomy. &nd general thoracic or abdominal surgery. "ause8 in(ury to the vein wall, high ris.s include obesity, prolonged immobility, cancer, smo.ing, estrogen use, varicose vein dehydration, splenectomy and orthopedic procedure. "linical anifestations8 Pain or cramps in the calf Fever "hills and perspiration -welling 1ursing intervention8 1. <ydrate client ade!uately #. *ncourage leg e+ercise and ambulate as soon as possible %. &void any restricting devices '. &void rubbing or massaging ). Instruct patient to avoid standing or sitting in one place for a long period. Pulmonary Complication8 1. &telectasis- incomplete e+pansion of the lungs. -ymptoms8 mild or severe tachypnea, tachycardia, cough, fever, hypotension. #. &spiration- inhalation of food, gastric contents, water or blood into the tracheobronchial system. -ymptoms8 tachypnea, cough, dyspnea, bronchospasm, wheezing, rhonchi, crac.les, hypo+ia, and frothy sputum. %. Pneumonia- inflammatory response in which cellular material replaces alveolar gas. -ymptoms8 tachypnea, dyspnea, chest pain, fever, chills, hemoptysis, cough and decrease breath sounds. 1ursing intervention8 1. ,urn patient from side to side #. *ncourage deep breathing e+ercise %. 5se spirometry '. &ssist patient to ambulate ). 1ebulized patient /. *ncourage patient to increase fluid inta.e 0. Placed patient on semi or high fowler position 4. &dminister prescribed antibiotics Pulmonary Embolim "ause8 obstruction of one or more pulmonary arterioles by an embolus originating somewhere in the venous system or in the right side of the heart. It develop in the pelvic or iliofemoral veins before becoming dislodged and traveling to the lungs.

"linical anifestations8 -harp stabbing pain in the chest, an+iousness and cyanosis, papillary dilation, profuse perspiration, rapid irregular pulse, dyspnea, tachypnea, hypo+emia. 1ursing intervention8 1. &dminister o+ygen #. onitor vital signs, *"9, &29 %. 9ive analgesic !rinary $etention- rela+ation of detrusor muscles. "ause8 spasm of the bladder sphincter "linical anifestations8 Inability to void 1ursing intervention8 Provide privacy, use warm water for perineal care, run tap water fre!uently, catheterize only when all other measures are unsuccessful. .ntestinal Obstruction- decrease or absence peristalsis causing accumulation of gas and feces in the intestines. "linical anifestations8 intermittent sharp, colic.y abdominal pain, nausea , vomiting, high pitched bowel sounds. 1ursing intervention8 onitor for ade!uate bowel sounds, use of la+ative, replace fluid and electrolytes. Outcome criteria for the patient who has had surgery 1. 1o in(ury '. *limination patterns are reestablished #. ,he incision heals normally ). Patient can able to do daily activities %. 1o avoidable complications /est practice8 1. $espiratory status is a priority concern on the admission to operating room and throughout the post operative recovery period. #. &ntidiuretic hormone secretion is increased in the immediate post operative period. &dminister fluid with caution. It is easy to cause fluid overload in the client. %. ,he client who remains sedated due to analgesia is at ris. for complications such as aspiration, respiratory depression, atelectasis, hypotension, falls and poor post operative course. '. Promotion of clientBs safety should be given priority.