Post-operative care - Definition, Purposes and Complications

Post-operative care - Definition, Purposes and Complications

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Definition:-

Post-operative care is the care that the patient receives after a surgical procedure. The type of post-operative care that the patient need depends on the type of surgery as well as the patient’s history. It often depends upon pain management and wound care.

Phases:-

1. Immediate ( Post-anesthetic ) Phase (1) 
2. Intermediate ( Hospital Stay ) Phase (2) 
3. Convalescent ( After Discharge To Full Recovery )

Purposes:-

1. To enable a successful and faster recovery of the patient post operatively.
2. To reduce post-operative mortality rate.
3. To reduce the length of hospital stay of the patient.
4. To provide quality care service.
5. To reduce hospital and patent cost during postoperative period.

Post - Operative Care Unit OR PACU

PACU should be:-

1. Sound proof 
2. Painted in soft color
3. Isolated

These features will help the patient to reduce anxiety and promote comfort.

Phase 1 Immediate (post-anesthetic)

Phase 1

1. It is the immediate recovery phase and requires intensive nursing care to detect early signs of complications.
2. Receive a complete patient record from the operating room which to plan post operative care.
3. It is designed for care of surgical patients immediately after surgery and patient requiring close monitoring.

Nursing management in post operative care unit 

1. Assessing the patient: Frequent assessment of the patient for:- oxygen saturation, pulse volume and regularity, depth and nature of respiration, skin color ,depth of consciousness.
2. Maintaining a patent airway:− a) The primary objectives are to maintain pulmonary ventilation and prevent hypoxia and hypercapenia.b) Provide oxygen, and assesses respiratory rate and depth, oxygen saturation.
3. Maintaining cardiovascular stability: a) − Assess the patient’s mental status, vital signs, cardiac rhythm, skin temperature, color and urine output , Central venous pressure, arterial lines and pulmonary artery pressure. b) − The primary cardiovascular complications include hypotension, shock, hemorrhage, hypertension and dysarrythmias.
4. Relieving pain and anxiety: − Opioid analgesic.
5. Assessing and managing the surgical site: − The surgical site is observed for bleeding, type and integrity of dressing and drains.
6. Assessing and managing gastrointestinal function: − Nausea and vomiting are common after anesthesia. − Check of peristalsis movement.
7. Assessing and managing voluntary voiding: − Urine retention after surgery can occur for a verity of reasons. Opioids and anesthesia interfere with the perception of bladder fullness.
8. Encourage activity: − Most surgical are encouraged to be out of bed as soon as possible. -- Early ambulation reduces the incidence of post operative complication as ,atelectasis ,pneumonia, gastrointestinal discomfort and circulatory problem.

Complications

1. Shock:- Is the response of the body to a decrease in the circulating volume of blood, tissue perfusion impaired, cellular hypoxia and death.
2. Hemorrhage:- Is the escape of blood from a blood vessel.
3. Deep vein thrombosis. (DVT):- Occur in pelvic vein or in lower extremities, and it’s common after hip surgery.
4. Pulmonary embolism:- It’s the obstruction of one or more pulmonary arterioles by an embolus originating some where in the venous system or in the right side of heart.
5. Urinary Retention.
6. Intestinal obstruction:- Result in partial or complete impairment to the forward flow of intestinal content.

Causes Of Complications & Death

1. Acute pulmonary problems
2. Cardio-vascular problems
3. Fluid derangements

Preventions

Recovery room: a) anesthetist responsibilities towards cardio-pulmonary functions.

b) Surgeon’s responsibilities towards the operation site.

Trained nursing staff:-

a) To handle instructions. b) Continuous monitoring of patient (vital signs etc.)

Note:- Discharge from recovery should be after complete stabilization of cardio-vascular, pulmonary and neurological functions which usually takes 2-4 hours.