chapter 16 postoperative

postanestheisa care

• PACU

• phase 1

  • immediate recovery

  • intensive nursing care

  • patient transitions to an inpatient nursing unit or phase 2 PACU

• phase 2

  • prepared for transfer to an inpatient nursing unit or an extended care unit setting or discharge

nursing management in post op care unit

provide care for patient until patient has recovered from effects of anesthesia

• return to cognitive baseline

• clear airway

• controlled nausea and vomiting

• stable vital sign

• vital to perform frequent skilled assessment of patient

responsibilities of the pacu nurse

• review pertinent information, baseline assessment upon admission to unit

• assess airway, LOC, cardiac, resp, wound, and pain

• chart 16-1, 16-3

• check drianage tubes, monitoring lines, IV fluids and medications

• assess vs at the time of arrival to PACU and repeated per institution protocol

• administration of postoperative analgesics

• transfer report to another unit or discharge patient home, continuing or transitional care

Hemovac drain

• A hemovac drain is placed into a vascular cavity where blood drainage is expected after surgery, such as with abdominal and orthopedic surgery

• suction is maintained by compressing the spring like device in the collection unit

• after a surgical procedure, the surgeon places one end of the drain in or near the area to be drained

• these drains are usually sutured in place

• the site may be treated as an additional surgical wound, but often these sites are left open to air 24 hrs after surgery

• as the drainage accumulates in the collection unit, it expands and suction is lost, requiring recompression

• typically the drain is emptied every 4-8 hours or after every shift when it is half full of drainage or air

• look at immediately upon assessment if its open it is not working when it is working its smushed down means it is positive pressure and is working as a suction unit empty after every shift into a specimen container document it in I/O as output and document what the drainage looks like

Jackson Pratt drain

• a Jackson- Pratt (JP) or grenade drain collects wound drainage in a bulblike device

• compressed to create low suction (negative) pressure

• sutured in place

• the site may be treated as an additional surgical wound, but often these sites are left open to air 24 hrs after surgery

• they are typically used with breast and abdominal surgery

• as the drainage accumulates in the bulb, the bulb expands and suction is lost, requiring recompression

• drains are emptied every 4-8 hrs and when they are half full of drainage or air

• based on nursing assessment and judgment, the drain could be emptied and recompressed more frequently

biliary tube (T tube)

• looks like a T shape

• placed in the common bile duct after removal of the gallbladder (cholecystectomy) or a portion of the bile duct (choledochotomy)

• the tube passively drains bile while the surgical site is healing

• a portion of the tube is inserted into the common bile duct and then attached to closed drainage system

• often a three-way valve is inserted between the drain tube and the drainage system to allow for clamping and flushing of the tube if necessary

• the drainage amount is measured every shift, recorded, and included in output totals

penrose drain

drains onto a dressing not a closed system

out patient surgery/direct dishcarge

• discharge planning, discharge assessment

• provide written, verbal instructions regarding follow up care, complications, wound care, activity, medications, diet

• give prescriptions, contact information

• discuss actions to take if complications occur

• give instructions to patient, responsible adult who will accompany patient

• patients are not to drive home or be discharged to home alone

• sedation, anesthesia may cloud memory, judgment, affect decision making ability

nursing management of hospitlalized post op patient

maintain patent airway

cardio stability

shock/hemmorhage

nV

gerontologic

wound healing

purpose of postoperative dressing

change the dressing

nursing care fo the ospitalized pt rocvering

collaborative problems

• pulmonary infection/hypoxia

• deep vein thrombosis/ pulmonary embolism

• hematoma/hemorrhage

• infection

• wound dehiscence or evisceration ***

managing potential complications

• VTE/PE

• hematoma

• infection

• wound dehiscence and evisceration

nursing process

• ADPIE

• assessment

• diagnosis

• planning and goals

• implementation

• evaluation