Postoperative Care

Main goals of the postop period

• managing pain

• Supporting O2 and cardiac stability

• Maintain fluid balance

• Wound care

• Monitor bowel function

• Assist with mobility

• Prevent complications

Initial recovery period in PACU

• SBAR report given to PACU RN from ACP

• Report includes procedure, anesthesia, meds, blood/fluid loss, VS trends

Why is the PACU next to the OR?

• limits transportation

• Gives ready access to anesthesia and OR staff

Focuses of PACU

• ABCs

• Maintain safety

• Patient airway

• Identifying actual and potential problems

• Request assessment and monitoring

What is the main goal the post period in the PACU?

To prepare the patient to go back to the floor for discharge

Neuropsychologic post op complications: what are they, what should you assess, what should you support

• delirium, delayed awakening, post op cognitive dysfunction (POCD)

• Assess: LOC, orientation, pupil response, motor/sensory function

• Support: reorient, ensure oxygenation, pain control, calm environment

Cardiovascular post op complications: what are they, what should you monitor, and what are some interventions

• dysrhythmias, hypo/hypertension, VTE, syncope

• Monitor: VS every 15 mins, ECG, skin color/temp, I&O

• Interventions: IV fluids, anticoagulants, early ambulation, slow position changes

Respiratory post op complications: what are they, what are some interventions, and what is the recovery position

• atelectasis, hypoxemia, bronchospasm, aspiration, hypoventilation, pulmonary edema

• Interventions: positioning lateral then supine, incentive spirometry, deep breathing, early ambulation, O2 therapy, pain control

• Recovery position: lateral, hand supporting head, knee up to prevent rolling over

GI post op complications: what are they and what are some interventions

• N/V, ileus, constipation, hiccups

• Interventions: early ambulation, hydration, NPO until bowel sounds return

GU post op complications: what are they and what are some interventions

• retention, oliguria, CAUTI

• Interventions: monitor output (>0.5mL/kg/hr), positioning, bladder scan, catheter

Surgical site and wound risks

• Surgical site infection (SSI)

• Dehiscence

• Evisceration

What should you do when evisceration occurs?

Cover with saline gauze and call for help

Interventions for SSI and wounds

• monitor COCA, glycemic control, notify surgeon

Gerontologic considerations post op

• decreased respiratory/cardiac reserve and drug metabolism

• Higher risk for delirium and cognitive changes

• Pain often underreported

• Emphasize mobility, hydration, and clear discharge instructions

Causes of pain post op

• incision

• Positioning

• Tubing

• Anxiety

• Shivering

Pain management post op

• multimodal (opioids, NSAIDS)

• PCA

• Epidural

• Non-pharmacological (positioning, distractions)

Temperature complications post op

• hypothermia (<96.8)

• Hyperthermia (>100.4)

• Infections (SSI, pneumonia, UTI)

PACU discharge criteria

• stable VS

• Awake baseline neuro

• No excessive bleeding

• Pain managed

Ambulatory discharge criteria

• no IV opioids in past 30 mins

• Voided

• Ambulated

• Tolerating fluids

• Ride home

• Understands post op instructions

Post op teaching criteria

• wound care

• Meds

• Restrictions

• Red flags

What indicates hypovolemic shock

hypotension with a rapid or weak pulse and cold, clammy, pale skin

When does delayed emergence refer to failure to regain consciousness?

30-60 minutes

What 24 hour urine output range is considered urinary retention?

800-1500 mL

What 24 urine output is considered oliguria?

Less than 400 mL

What medication treats malignant hyperthermia?

Dantrolene

What electrolyte imbalance may result from urinary and GI losses

Hypokalemia