Postoperative care Mosby items and derived items 2005
![Postoperative care Mosby items and derived items © 2005 by Mosby, Inc. Postoperative care Mosby items and derived items © 2005 by Mosby, Inc.](https://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-1.jpg)
Postoperative care Mosby items and derived items © 2005 by Mosby, Inc.
![Postoperative Phase Mosby items and derived items © 2005 by Mosby, Inc. Postoperative Phase Mosby items and derived items © 2005 by Mosby, Inc.](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-2.jpg)
Postoperative Phase Mosby items and derived items © 2005 by Mosby, Inc.
![Postoperative Care • Immediate care: PACU Post Anesthesia Care Unit – Surgical information – Postoperative Care • Immediate care: PACU Post Anesthesia Care Unit – Surgical information –](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-3.jpg)
Postoperative Care • Immediate care: PACU Post Anesthesia Care Unit – Surgical information – Nursing assessments – Interventions – Discharge criteria: ambulatory and acute care surgical settings Mosby items and derived items © 2005 by Mosby, Inc.
![Examination • Observations & trend • Cardio-respiratory examinations • Abdominal examination – Abdominal signs Examination • Observations & trend • Cardio-respiratory examinations • Abdominal examination – Abdominal signs](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-4.jpg)
Examination • Observations & trend • Cardio-respiratory examinations • Abdominal examination – Abdominal signs – Wounds – Drains • Calf tenderness • Vascular access sites • Blood transfusion Mosby items and derived items © 2005 by Mosby, Inc.
![• Overall assessment –Vital signs –Condition of dressings and drains –Comfort level –IV • Overall assessment –Vital signs –Condition of dressings and drains –Comfort level –IV](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-5.jpg)
• Overall assessment –Vital signs –Condition of dressings and drains –Comfort level –IV fluid status –Urinary output Mosby items and derived items © 2005 by Mosby, Inc.
![• Assessment –Respiration –Circulation –Temperature control –Fluid and electrolyte balance –Neurological function –Skin • Assessment –Respiration –Circulation –Temperature control –Fluid and electrolyte balance –Neurological function –Skin](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-6.jpg)
• Assessment –Respiration –Circulation –Temperature control –Fluid and electrolyte balance –Neurological function –Skin integrity and wound condition Mosby items and derived items © 2005 by Mosby, Inc.
![• Assessment –Genitourinary function –Gastrointestinal function –Comfort –Client expectations Mosby items and derived • Assessment –Genitourinary function –Gastrointestinal function –Comfort –Client expectations Mosby items and derived](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-7.jpg)
• Assessment –Genitourinary function –Gastrointestinal function –Comfort –Client expectations Mosby items and derived items © 2005 by Mosby, Inc.
![• Respiratory complications –Atelectasis –Pneumonia –Hypoxemia –Pulmonary embolism Mosby items and derived items • Respiratory complications –Atelectasis –Pneumonia –Hypoxemia –Pulmonary embolism Mosby items and derived items](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-8.jpg)
• Respiratory complications –Atelectasis –Pneumonia –Hypoxemia –Pulmonary embolism Mosby items and derived items © 2005 by Mosby, Inc.
![Maintaining a Patent Airway • Maintain ventilation and oxygenation! • Supplemental oxygen as indicated. Maintaining a Patent Airway • Maintain ventilation and oxygenation! • Supplemental oxygen as indicated.](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-9.jpg)
Maintaining a Patent Airway • Maintain ventilation and oxygenation! • Supplemental oxygen as indicated. • Keep head of bed elevated 15 -30 o unless contraindicated. • Use of Oral Airway • May require suctioning. Mosby items and derived items © 2005 by Mosby, Inc.
![• Circulatory complications –Hemorrhage –Hypovolemic shock –Thrombophlebitis –Thrombus formation –Embolus Mosby items and • Circulatory complications –Hemorrhage –Hypovolemic shock –Thrombophlebitis –Thrombus formation –Embolus Mosby items and](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-10.jpg)
• Circulatory complications –Hemorrhage –Hypovolemic shock –Thrombophlebitis –Thrombus formation –Embolus Mosby items and derived items © 2005 by Mosby, Inc.
![• Gastrointestinal & Urinary complications; –Abdominal distention –Paralytic ileus –Nausea and vomiting –Urinary • Gastrointestinal & Urinary complications; –Abdominal distention –Paralytic ileus –Nausea and vomiting –Urinary](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-11.jpg)
• Gastrointestinal & Urinary complications; –Abdominal distention –Paralytic ileus –Nausea and vomiting –Urinary retention –Urinary tract infection Mosby items and derived items © 2005 by Mosby, Inc.
![• Integumentary complications –Wound infection –Dehiscence –Evisceration –Skin breakdown –Pain Mosby items and • Integumentary complications –Wound infection –Dehiscence –Evisceration –Skin breakdown –Pain Mosby items and](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-12.jpg)
• Integumentary complications –Wound infection –Dehiscence –Evisceration –Skin breakdown –Pain Mosby items and derived items © 2005 by Mosby, Inc.
![TREATMENT OF POSTOPERATIVE PAIN • • • Analgesic Drug Therapy Opioids Local anaesthetic agents TREATMENT OF POSTOPERATIVE PAIN • • • Analgesic Drug Therapy Opioids Local anaesthetic agents](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-13.jpg)
TREATMENT OF POSTOPERATIVE PAIN • • • Analgesic Drug Therapy Opioids Local anaesthetic agents Paracetamol NSAIDS Volatile/Gaseous agents Fentanyl • Routes; • Oral/Transdermal • Rectal • Parenteral (IV, SC) • Spinal/ Epidural/ Regional techniques • Non pharmacological methods Mosby items and derived items © 2005 by Mosby, Inc.
![Paraceramol N S A I D S Mosby items and derived items © 2005 Paraceramol N S A I D S Mosby items and derived items © 2005](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-14.jpg)
Paraceramol N S A I D S Mosby items and derived items © 2005 by Mosby, Inc.
![Mosby items and derived items © 2005 by Mosby, Inc. Mosby items and derived items © 2005 by Mosby, Inc.](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-15.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
![Patient Controlled Analgesia (PCA) Advantages • • Safe Effective good analgesia reduces delay saves Patient Controlled Analgesia (PCA) Advantages • • Safe Effective good analgesia reduces delay saves](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-16.jpg)
Patient Controlled Analgesia (PCA) Advantages • • Safe Effective good analgesia reduces delay saves nursing time high patient satisfaction, few complications Mosby items and derived items © 2005 by Mosby, Inc.
![• Maintaining respiratory function –Positioning and turning –Suctioning –Deep breathing (incentive spirometer), coughing • Maintaining respiratory function –Positioning and turning –Suctioning –Deep breathing (incentive spirometer), coughing](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-17.jpg)
• Maintaining respiratory function –Positioning and turning –Suctioning –Deep breathing (incentive spirometer), coughing –Comfort –Early ambulation –Oral hygiene –Oxygen Mosby items and derived items © 2005 by Mosby, Inc.
![• Preventing circulatory stasis –Leg exercises –TED stockings (Thrombo Embolic Deterrent) –Early ambulation • Preventing circulatory stasis –Leg exercises –TED stockings (Thrombo Embolic Deterrent) –Early ambulation](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-18.jpg)
• Preventing circulatory stasis –Leg exercises –TED stockings (Thrombo Embolic Deterrent) –Early ambulation –Positioning –Anticoagulants –Fluid intake Mosby items and derived items © 2005 by Mosby, Inc.
![• Achieving rest and comfort –Analgesics –PCA –Pain assessment Mosby items and derived • Achieving rest and comfort –Analgesics –PCA –Pain assessment Mosby items and derived](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-19.jpg)
• Achieving rest and comfort –Analgesics –PCA –Pain assessment Mosby items and derived items © 2005 by Mosby, Inc.
![• Temperature regulation –Warmed blankets –Monitoring for hypothermia and malignant hyperthermia –Assessment for • Temperature regulation –Warmed blankets –Monitoring for hypothermia and malignant hyperthermia –Assessment for](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-20.jpg)
• Temperature regulation –Warmed blankets –Monitoring for hypothermia and malignant hyperthermia –Assessment for signs of infection Mosby items and derived items © 2005 by Mosby, Inc.
![Time since surgery • 3 -7 days • First 24 hours – Systemic response Time since surgery • 3 -7 days • First 24 hours – Systemic response](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-21.jpg)
Time since surgery • 3 -7 days • First 24 hours – Systemic response to trauma – Pre-existing infection • 24 -72 hours – Atelectasis – Urinary tract infection – Chest infection – Wound infection – Intra-abdominal sepsis – Anastomotic leak – Thromobophlebitis – Cl. Diff colitis • 7 -10 days – DVT/PE – Prosthetic infection Mosby items and derived items © 2005 by Mosby, Inc.
![Fever • Common after surgery – 27 -58% in first 24 hours – Incidence Fever • Common after surgery – 27 -58% in first 24 hours – Incidence](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-22.jpg)
Fever • Common after surgery – 27 -58% in first 24 hours – Incidence of infection • Underlying cause dependent on: – Time since surgery – Type of surgery – Associated clinical features Mosby items and derived items © 2005 by Mosby, Inc.
![Non infectious causes – Medications (drug fever, malignant hyperthermia) – Blood transfusion reactions – Non infectious causes – Medications (drug fever, malignant hyperthermia) – Blood transfusion reactions –](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-23.jpg)
Non infectious causes – Medications (drug fever, malignant hyperthermia) – Blood transfusion reactions – Haematoma – Adrenal insufficiency – AMI (acute myocardial infarction) – Thyrotoxicosis – Alcohol withdrawal – Pancreatitis/acalculous cholecystitis Mosby items and derived items © 2005 by Mosby, Inc.
![Treatment options 1. Urine & blood culture 2. CXR 3. Iv A/B 4. Call Treatment options 1. Urine & blood culture 2. CXR 3. Iv A/B 4. Call](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-24.jpg)
Treatment options 1. Urine & blood culture 2. CXR 3. Iv A/B 4. Call surgical registrar 5. Give paracetamol Mosby items and derived items © 2005 by Mosby, Inc.
![• Neurologic function –Orientation to the environment –Level of consciousness Mosby items and • Neurologic function –Orientation to the environment –Level of consciousness Mosby items and](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-25.jpg)
• Neurologic function –Orientation to the environment –Level of consciousness Mosby items and derived items © 2005 by Mosby, Inc.
![• Maintaining fluid and electrolyte balance –IV therapy –Oral intake when appropriate –Urin • Maintaining fluid and electrolyte balance –IV therapy –Oral intake when appropriate –Urin](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-26.jpg)
• Maintaining fluid and electrolyte balance –IV therapy –Oral intake when appropriate –Urin output Mosby items and derived items © 2005 by Mosby, Inc.
![Fluid & electrolyte balance • Fluid replacement 1. Maintenance requirement 2. Replacement of losses Fluid & electrolyte balance • Fluid replacement 1. Maintenance requirement 2. Replacement of losses](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-27.jpg)
Fluid & electrolyte balance • Fluid replacement 1. Maintenance requirement 2. Replacement of losses 3. Ongoing losses Mosby items and derived items © 2005 by Mosby, Inc.
![Replacement of losses 1. Actual losses – Bleeding – Vomiting/diarrhoea 2. Ongoing losses – Replacement of losses 1. Actual losses – Bleeding – Vomiting/diarrhoea 2. Ongoing losses –](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-28.jpg)
Replacement of losses 1. Actual losses – Bleeding – Vomiting/diarrhoea 2. Ongoing losses – – – Stoma Drains Fistulae NGT U/O Mosby items and derived items © 2005 by Mosby, Inc.
![IV fluids • Crystalloids – N/S – Hartmann’s/Ringer’s lactate – Dex N/5 – 5% IV fluids • Crystalloids – N/S – Hartmann’s/Ringer’s lactate – Dex N/5 – 5%](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-29.jpg)
IV fluids • Crystalloids – N/S – Hartmann’s/Ringer’s lactate – Dex N/5 – 5% Dex • Colloids – Blood products • Albumin – Gelofusin. Mosby items and derived items © 2005 by Mosby, Inc.
![Crystalloids Compos. Hartman N/S 4% Dex N/S Na 131 150 30 Cl 111 150 Crystalloids Compos. Hartman N/S 4% Dex N/S Na 131 150 30 Cl 111 150](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-30.jpg)
Crystalloids Compos. Hartman N/S 4% Dex N/S Na 131 150 30 Cl 111 150 30 K 5 nil HCO 3 29 nil 2 nil Ca Mosby items and derived items © 2005 by Mosby, Inc.
![• Promoting normal elimination and adequate nutrition – Gradual progression of dietary intake • Promoting normal elimination and adequate nutrition – Gradual progression of dietary intake](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-31.jpg)
• Promoting normal elimination and adequate nutrition – Gradual progression of dietary intake – Ambulation and exercise – Adequate fluid and food intake – Elimination aids: fiber, medications – Control of nausea and pain Mosby items and derived items © 2005 by Mosby, Inc.
![• Promoting urinary elimination –Normal positioning –Frequent assessment –Assess bladder distention –Input & • Promoting urinary elimination –Normal positioning –Frequent assessment –Assess bladder distention –Input &](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-32.jpg)
• Promoting urinary elimination –Normal positioning –Frequent assessment –Assess bladder distention –Input & Output Mosby items and derived items © 2005 by Mosby, Inc.
![Post operative oliguria • Pre-renal: – Hypovolaemia • Blood loss • Under resuscitation – Post operative oliguria • Pre-renal: – Hypovolaemia • Blood loss • Under resuscitation –](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-33.jpg)
Post operative oliguria • Pre-renal: – Hypovolaemia • Blood loss • Under resuscitation – Shock • Sepsis • Cardiogenic • Post-renal: – Calculi – Blood clot – Ureteric injury – BPH – Blocked catheter Renal: ATN- Hypovolaemia -Contrast Nephrotoxic drugs - Acute pyelonephritis Acute glomerulonephritis Mosby items and derived items © 2005 by Mosby, Inc.
![Management • Treat underlying cause • Volume resuscitation – Aim U/O ≥ 0. 5 Management • Treat underlying cause • Volume resuscitation – Aim U/O ≥ 0. 5](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-34.jpg)
Management • Treat underlying cause • Volume resuscitation – Aim U/O ≥ 0. 5 ml/kg/hr (adult) – Monitor vital signs • ICU – ? Inotropic support – Invasive monitoring • Art line • CVL Mosby items and derived items © 2005 by Mosby, Inc.
![• Promoting wound healing –Protect surgical site –Prevent strain –Observe healing –Provide wound • Promoting wound healing –Protect surgical site –Prevent strain –Observe healing –Provide wound](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-35.jpg)
• Promoting wound healing –Protect surgical site –Prevent strain –Observe healing –Provide wound care Mosby items and derived items © 2005 by Mosby, Inc.
![• Maintaining/enhancing self-concept – Provide privacy – Maintain client’s hygiene – Maintain a • Maintaining/enhancing self-concept – Provide privacy – Maintain client’s hygiene – Maintain a](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-36.jpg)
• Maintaining/enhancing self-concept – Provide privacy – Maintain client’s hygiene – Maintain a pleasant environment – Offer opportunities for client and family to express feelings and participate in care Mosby items and derived items © 2005 by Mosby, Inc.
![Discharge • written and verbal instructions; regarding follow-up care, complics. , wound care, activity, Discharge • written and verbal instructions; regarding follow-up care, complics. , wound care, activity,](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-37.jpg)
Discharge • written and verbal instructions; regarding follow-up care, complics. , wound care, activity, medications and diet. • Give prescriptions and phone numbers. • Discuss actions if complications occur. Mosby items and derived items © 2005 by Mosby, Inc.
![Mosby items and derived items © 2005 by Mosby, Inc. Mosby items and derived items © 2005 by Mosby, Inc.](http://slidetodoc.com/presentation_image/67966e4d6d87cefe59cb3d1093f2979c/image-38.jpg)
Mosby items and derived items © 2005 by Mosby, Inc.
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