Peri-Operative Nursing and Post-Operative Care

Post-Op Focused Assessment

• Compare vital signs to pre-op baseline: RR (rate, depth, effort), pulse (rate, rhythm, quality), BP.
• Neuro: LOC, pupils (size, equality, light response), sensation, movement, response to commands.
• Skin & Incision: color, temp, dressing integrity, drainage amount/appearance, IV site.
• Thorax & Heart: chest expansion, breath sounds, apical pulse.
• Abdomen: contour, bowel sounds, bladder distention.
• Extremities: color, pulses, capillary refill, edema, warmth, redness.

Expected Tube / Catheter Output

• Indwelling urine: 800–1500 mL800\text{–}1500\,\text{mL}/24 h24\,\text{h} (minimum 0.5 mL / kg / h0.5\,\text{mL}\,/\,\text{kg}\,/\,\text{h}), clear yellow.
• NG/Gastrostomy: variable <1500 mL<1500\,\text{mL}, color depends on surgery. • Open drains (Penrose): volume decreases over time, sanguineous → serous. • Closed suction (Hemovac/Jackson-Pratt): output decreases; >100 mL / h100\,\text{mL}\,/\,\text{h} is excessive.
• T-tube bile: bright yellow ≈500 mL\approx500\,\text{mL}, should decline.
• Mediastinal / Pleural chest tubes: sanguineous → serous; 100 mL / h100\,\text{mL}\,/\,\text{h} excessive.

Key Post-Op Complications & Nursing Actions

• Fluid volume deficit (shock): tachycardia, hypotension, low urine; stop bleeding, give IV fluids/blood.
• Injury/Falls: assess LOC & motor; fall precautions, dangle, gait belt.
• Constipation: early ambulation, fluids, laxatives/suppository.
• Paralytic ileus: NG tube decompression, NPO.
• DVT/Thrombophlebitis: SCDs, stockings, assess warmth/redness; bedrest, anticoagulants.
• Pneumonia/poor oxygenation: q1h resp check 24 h24\,\text{h}, TCDB, incentive spirometer; O$_2$, antibiotics if needed.
• Urinary retention: expect void 6–8 h6\text{–}8\,\text{h}; bladder scan, straight cath → Foley.
• Wound infection (day 3–53\text{–}5): culture, antibiotics, strict hand hygiene.

Pre-Op Assessment

• Health history: procedure, diagnosis, allergies, meds (incl. herbs, anticoags), comorbidities, support system.
• Physical exam: ht/wt, vitals, lungs/heart, abdomen, skin, extremities, prostheses.

Pre-Op Preparations

• Circulation: compression hose/SCD applied.
• Meds in holding: opioids, anxiolytics, antiemetics, anticholinergics; void first, rails up.
• Digestive prep: laxative/enema if GI surgery.
• NPO: nothing after midnight or per order; give critical meds with sip of water.
• Skin prep: CHG shower.
• Dress/Groom: gown only; remove jewelry, dentures, nail polish; keep ID & alert bands.
• Prostheses: remove or clearly document non-removable (e.g., pacemaker).

Intra-Op Safety

• Holding room: ID, IV, skin prep.
• Final "Time-Out": right patient, procedure, site; whole team participates.

Surgery Classifications

• Diagnostic, Ablative, Palliative, Reconstructive/Restorative, Constructive, Cosmetic.

Variables Affecting Outcomes

• Age extremes.
• Nutrition: malnourished → poor healing; obesity → resp & wound risk.
• Fluid/Electrolyte balance – correct before OR.
• Comorbidities: cardiac, resp, anticoag use.
• Drugs/herbals: interactions; garlic ↑ bleeding.
• Habits: smoking, alcohol, recreational drugs.

Electrolyte Corrections

• Hyperkalemia: Kayexalate pulls K$^+$ into gut; watch for hypokalemia (cramps, weakness, palpitations).
• Hypomagnesemia: give Mg PO/IV; monitor vitals, deep tendon reflexes; caution in renal pts.