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Postoperative Care

Postoperative Care. PACU. Postanesthesia care unit (PACU) Allows for ongoing evaluation and stabilization of patients to anticipate, prevent, and treat complications after surgery Anesthesia Care Provider (ACP) gives PACU nurse a verbal report. PACU Nurses Functions Assessment. Airway

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Postoperative Care

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  1. Postoperative Care

  2. PACU • Postanesthesia care unit (PACU) • Allows for ongoing evaluation and stabilization of patients to anticipate, prevent, and treat complications after surgery • Anesthesia Care Provider (ACP) gives PACU nurse a verbal report

  3. PACU Nurses FunctionsAssessment • Airway • Breathing • Circulation • Neurologic • Genitourinary • Surgical site • Pain

  4. Impaired Gas Exchange Interventions include: • Airway maintenance • Positioning the patient in a side-lying position or turning his or her head to the side to prevent aspiration • Encouraging breathing exercises • Encouraging mobilization as soon as possible

  5. Patient Using Incentive Spirometer

  6. Potential Complication: Hypoxemia • Interventions include: • Maintenance of airway patency and breathing pattern • Prevention of hypothermia • Maintenance of oxygen therapy as prescribed

  7. Cardiovascular Assessment • Vital signs • Heart sounds • Cardiac monitoring • Peripheral vascular assessment

  8. Neurologic System • Cerebral functioning • Emergence Delirium • Delayed Emergence

  9. Discomfort/Pain Assessment • Pain and discomfort expected after surgery, however, can contribute to post-op complications so has to be controlled. • Consider type, extent, and length of the surgical procedure in assessing patient’s discomfort and need for medication.

  10. Physical and Emotional Signs of Acute Pain • Assess for: • Increased pulse and blood pressure • Increased respiratory rate • Profuse sweating • Restlessness • Confusion (in older adults) • Wincing, moaning, or crying

  11. Altered Temperature • Hypothermia • Hyperthermia

  12. Gastrointestinal System • Postoperative nausea and vomiting remain most common postoperative complications. • Peristalsis may be delayed for up to 24 hours. • Monitor for bowel sounds and passage of flatus.

  13. Nasogastric Tube Drainage • Tube inserted during surgery to: • Decompress and drain the stomach • Promote GI rest • Allow the lower GI tract to heal • Provide an enteral feeding route

  14. Nasogastric Tube Drainage (Cont’d) • Assess drained material every 8 hr. • Do not move or irrigate the tube after gastric surgery without an order from the physician/surgeon.

  15. Levin Tube and Salem Sump Tube

  16. Renal/Urinary System • Check for urine retention. • Consider other sources of output such as sweat, vomitus, or diarrhea stools. • Report a urine output of <0.5 mL/kg/hr.

  17. Skin Assessment • Assessment of the wound and dressing requires knowledge of the type of wound, the drains inserted, and expected drainage related to the specific type of surgery. • Dehiscence—a partial or complete separation of the outer wound layers • Evisceration—a total separation of all wound layers and protrusion of internal organs through the open wound

  18. Skin Assessment(Cont’d)

  19. Dressings and Drains

  20. Impaired Skin Integrity Interventions include: • Nursing assessment of the surgical area • Dressings • Drains—provide an exit route for air, blood, and bile as well as help prevent deep infections and abscess formation during healing

  21. Discharge from the PACU • Home care management • Health teaching • Health care resources

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