The postoperative phase of the surgical experience extends from the time the client is transferred to the recovery room or postanesthesia care unit (PACU) to the moment he or she is transported back to the surgical unit, discharged from the hospital until the follow-up care. GoalsDuring the postoperative period, reestablishing the patient’s physiologic balance, pain management and prevention of complications should be the focus of the nursing care. To do these it is crucial that the nurse perform careful assessment and immediate intervention in assisting the patient to optimal function quickly, safely and comfortably as possible.
The mnemonic “POSTOPERATIVE” may also be helpful:
To PACUPatient Care during Immediate Postoperative Phase: Transferring the Patient to RR or PACU Patient AssessmentSpecial consideration to the patient’s incision site, vascular status and exposure should be implemented by the nurse when transferring the patient from the operating room to the postanethesia care unit (PACU) or postanesthesia recovery room (PARR). Every time the patient is moved, the nurse should first consider the location of the surgical incision to prevent further strain on the sutures. If the patient comes out of the operating room with drainage tubes, position should be adjusted in order to prevent obstruction on the drains.
PositioningMoving a patient from one position to another may result to serious arterial hypotension. This occurs when a patient is moved from a lithotomy to a horizontal position, from a lateral to a supine position, prone to supine position and even when a patient is transferred to the stretcher. Hence, it is very important that patients are moved slowly and carefully during the immediate postoperative phase. Promoting Patient SafetyWhen transferred to the stretcher, the patient should be covered with blankets and secured with straps above the knees and elbows. These straps anchor the blankets at the same time restrain the patient should he or she pass through a stage of excitement while recovering from anesthesia. To protect the patient from falls, side rails should be raised. Safety checks when transferring the patient from OR to RR:
Postoperative Nursing CareAirway
Breathing
Circulation
Thermoregulation
Fluid Volume
Safety
GI Function and Nutrition
Comfort
Drainage
Skin Integrity
Assessing and Managing Voluntary Voiding
Encouraging Activity
Gerontologic ConsiderationsElderly patients continue to be at increased risk for postoperative complications. Age-related physiologic changes in respi-ratory, cardiovascular, and renal function and the increased incidence of comorbid conditions demand skilled assessment to detect early signs of deterioration. Anesthetics and opioids can cause confusion in the older adult, and altered pharmacokinetics results in delayed excretion and prolonged respiratory depressive effects. Careful monitoring of electrolyte, hemoglo-bin, and hematocrit levels and urine output is essential because the older adult is less able to correct and compensate for fluid and electrolyte imbalances. Elderly patients may need frequent reminders and demonstrations to participate in care effectively.
EvaluationPatients in PACU are evaluated to determine the client’s discharge from the unit. The following are the expected outcomes in PACU:
To Surgical UnitPatient Care during Immediate Postoperative Phase: Transferring the Patient from RR to the Surgical Unit To determine the patient’s readiness for discharge from the PACU or RR certain criteria must be met. The parameters used for discharge from RR are the following:
Most hospitals use a scoring system to assess the general condition of patient in RR or PACU. Observation and evaluation of the patient’s physical signs is based on a set of objective criteria. The evaluation guide used is a modification of the APGAR scoring system used for newborns. Through this, a more objective assessment of the patient’s physical condition is guaranteed while recovering the RR or PACU. The perfect possible score in this modified APGAR scoring system is 10. To be discharge from RR or PACU the patient is required to have at least 7 to 8 points. Patients with score less than 7 must remain in RR or PACU until their condition improves. Areas of assessment in PACU or RR evaluation guide are:
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