Postoperative Phase

Definition
The postoperative period oI the surgical experience extends Irom the time the client is
transIerred to the recovery room or past-anesthesia care unit (PACU) to the moment he or she is
transported back to the surgical unit, discharged Irom the hospital until the Iollow-up care.

Goals during the Postoperative Period
During the postoperative period, reestablishing the patient`s physiologic balance, pain
management and prevention oI complications should be the Iocus oI the nursing care. To do
these it is crucial that the nurse perIorm careIul assessment and immediate intervention in
assisting the patient to optimal Iunction quickly, saIely and comIortably as possible.
1. aintaining adequate body system Iunctions.
2. Restoring body homeostasis.
3. Pain and discomIort alleviation.
4. Preventing postoperative complications.
5. Promoting adequate discharge planning and health teaching.


Patient Care during Immediate Postoperative Phase: Transferring the Patient
to RR or PACU
Patient Assessment
Special consideration to the patient`s incision site, vascular status and exposure should be
implemented by the nurse when transIerring the patient Irom the operating room to the
postanethesia care unit (PACU) or postanesthesia recovery room (PARR). Every time the patient
is moved, the nurse should Iirst consider the location oI the surgical incision to prevent Iurther
strain on the sutures. II the patient comes out oI the operating room with drainage tubes, position
should be adjusted in order to prevent obstruction on the drains.
1. Assess air exchange status and note patient`s skin color
2. VeriIy patient identity. The nurse must also know the type oI operative procedure
perIormed and the name oI the surgeon responsible Ior the operation.
3. Neurologic status assessment. Level oI consciousness (LOC) assessment and Glasgow
Coma Scale (GCS) are helpIul in determining the neurologic status oI the patient.
4. Cardiovascular status assessment. This is done by determining the patient`s vital signs in
the immediate postoperative period and skin temperature.
5. Operative site examination. Dressings should be checked.

Positioning
oving a patient Irom one position to another may result to serious arterial hypotension.
This occurs when a patient is moved Irom a lithotomy to a horizontal position, Irom a lateral to a
supine position, prone to supine position and even when a patient is transIerred to the stretcher.
Hence, it is very important that patients are moved slowly and careIully during the immediate
postoperative phase.

Promoting Patient Safety
When transIerred to the stretcher, the patient should be covered with blankets and secured
with straps above the knees and elbows. These straps anchor the blankets at the same time
restrain the patient should he or she pass through a stage oI excitement while recovering Irom
anesthesia. To protect the patient Irom Ialls, side rails should be raised.
SaIety checks when transIerring the patient Irom OR to RR:
S Securing restraints Ior I.V. Iluids and blood transIusion.
A Assist the patient to a position appropriate Ior him on her based on the location oI incision
site and presence oI drainage tubes.
F Fall precaution implementation by making sure the side rails are raised and restraints are
secured well.
E Eliminating possible sources oI injuries and accidents when moving the patient Irom the OR
to RR or PACU.

ursing Care for Patient in the PACU or RR

AIRWAY: Maintain a patent airway.
1. eep airway in place until the patient is Iully awake and tries to eject it. The airway is
allowed to remain in place while the client is unconscious to keep the passage open and
prevents the tongue Irom Ialling back. When the tongue Ialls back, airway passage
obstruction will result. Return oI pharyngeal reIlex, noted when the patient regains
consciousness, may cause the patient to gag and vomit when the airway is not removed
when the patient is awake.
2. 2. Suction secretions as needed.

REATHIG: Maintaining adequate respiratory function.
B Bilateral lung auscultation Irequently.
R Rest and place the patient in a lateral position with the neck extended, iI not contraindicated,
and the arm supported with a pillow. This position promotes chest expansion and Iacilitates
breathing and ventilation.
E Encourage the patient to take deep breaths. This aerates the lung Iully and prevents
hypostatic pneumonia.
A Assess and periodically evaluate the patient`s orientation to name or command. Cerebral
Iunction alteration is highly suggestive oI impaired oxygen delivery.
T Turn the patient every 1 to 2 hours to Iacilitate breathing and ventilation.
H HumidiIied oxygen administration. During exhalation, heat and moisture are normally lost,
thus oxygen humidiIication is necessary. Aside Irom that, secretion removal is Iacilitated when
kept moist through the moisture oI the inhaled air. Also, dehydrated patients have irritated
respiratory passages thus, it is very important make sure that the inhaled oxygen is humidiIied.

CIRCULATIO: Assess status of circulatory system.
1. Obtain patient`s vital signs as ordered and report any abnormalities.
2. onitor intake and output closely.
3. Recognize early symptoms oI shock or hemorrhage such as cold extremities, decreased
urine output less than 30 ml/hr, slow capillary reIill greater than 3 seconds, dropping
blood pressure, narrowing pulse pressure, tachycardia increased heart rate.

THERMOREGULATIO: Assessing the patient`s thermoregulatory status.
1. Hourly temperature assessment to detect hypothermia or hyperthermia.
2. Report temperature abnormalities to the physician.
3. onitor the patient Ior postanethesia shivering or PAS. This is noted in hypothermic
patients, about 30 to 45 minutes aIter admission to the PACU. PAS represents a heat-gain
mechanism and relates to regaining the thermal balance.
4. Provide a therapeutic environment with proper temperature and humidity. Warm blankets
should be provided when the patient is cold.

LUID VOLUME: Maintaining adequate fluid volume.
1. Assess and evaluate patient`s skin color and turgor, mental status and body temperature.
2. onitor and recognize evidence oI Iluid and electrolyte imbalances such as nausea and
vomiting and body weakness.
3. onitor intake and output closely.
4. Recognize signs oI Iluid imbalances. HYPOVOLEIA: decreased blood pressure,
decreased urine output, increased pulse rate, increased respiration rate, and decreased
central venous pressure (CVP). HYPERVOLEIA: increased blood pressure and CVP,
changes in lung sounds such as presence oI crackles in the base oI both lungs and changes
in heart sounds such as the presence oI S3 gallop.
SAETY: Promoting patient safety.
1. Avoid nerve damage and muscle strain by properly supporting and padding pressure areas.
2. Frequent dressing examination Ior possible constriction.
3. Raise the side rails to prevent the patient Irom Ialling.
4. Protect the extremity where IV Iluids are inserted to prevent possible needle dislodge.
5. ake sure that bed wheels are locked.

COMORT: Promoting patient comfort.
1. Observe and assess behavioral and physiologic maniIestations oI pain.
2. Administer medications Ior pain and document its eIIicacy.
3. Assist the patient to a comIortable position.

SKI ITEGRITY: Minimizing skin impairment.
1. Record the amount and type oI wound drainage.
2. Regularly inspect dressings and reinIorce them iI necessary.
3. Proper wound care as needed.
4. PerIorm hand washing beIore and aIter contact with the patient.
5. Turn the patient to sides every 1 to 2 hours.
6. aintain the patient`s good body alignment.

EVALUATIO in PACU
Patients in PACU are evaluated to determine the client`s discharge Irom the unit. The Iollowing
are the expected outcomes in PACU:
1. Patient breathing easily.
2. Clear lung sounds on auscultation.
3. Stable vital signs.
4. Stable body temperature with minimal chills or shivering.
5. No signs oI Iluid volume imbalance as evidenced by an equal intake and output.
6. Tolerable or minimized pain, as reported by the patient.
7. Intact wound edges without drainage.
. Raised side rails.
9. Appropriate patient position.
10.aintained quiet and therapeutic environment.

Patient Care during Immediate Postoperative Phase: Transferring the Patient
from RR to the Surgical Unit
To determine the patient`s readiness Ior discharge Irom the PACU or RR certain criteria must be
met. The parameters used Ior discharge Irom RR are the Iollowing:
1. Uncompromised cardiopulmonary status
2. Stable vital signs
3. Adequate urine output at least 30 ml/ hour
4. Orientation to time, date and place
5. SatisIactory response to commands
6. inimal pain
7. Absence or controlled nausea and vomiting
. Pulse oximetry readings oI adequate oxygen saturation
9. SatisIactory response to commands
10.ovement oI extremities aIter regional anesthesia

ost hospitals use a scoring system to assess the general condition oI patient in RR or
PACU. Observation and evaluation oI the patient`s physical signs is based on a set oI objective
criteria. The evaluation guide used is a modiIication oI the APGAR scoring system used Ior
newborns. Through this, a more objective assessment oI the patient`s physical condition is
guaranteed while recovering the RR or PACU. The perIect possible score in this modiIied
APGAR scoring system is 10. To be discharge Irom RR or PACU the patient is required to have
at least 7 to points. Patients with score less than 7 must remain in RR or PACU until their
condition improves. Areas oI assessment in PACU or RR evaluation guide are:
1. Respiration ability to breathe deeply and cough.
2. Circulation systolic arterial pressure ~0 oI preanesthetic level
3. Consciousness Level verbally responds to questions or oriented to location
4. Color normal skin color and appearance: pinkish skin and mucus
5. uscle activity moves spontaneously or on command

ursing care during the intermediate postoperative period:
Assessment
1. Respiratory status: airway patency, depth, rate and character oI respirations, nature oI
breath sounds
2. Circulatory Status: vital signs including blood pressure and skin condition
3. Neurologic: level oI responsiveness
4. Drainage: presence oI drainage, need to connect tubes to a speciIic drainage system,
presence and condition oI dressings
5. ComIort: type oI pain and location, nausea and vomiting, position change required
6. Psychologic: nature oI patient`s questions, need Ior rest and sleep, disturbance by noise,
visitors, availability oI call bell or call light
7. SaIety: need Ior side rails, drainage tubes unobstructed, IV Iluid properly inIusing and IV
sites properly splinted
. Equipment: checked Ior proper Iunctioning

Goals and Interventions
P Preventing and/or relieving complications
O Optimal respiratory Iunction
S Support: psychosocial well-being
T Tissue perIusion and cardiovascular status maintenance
O Observing and maintaining adequate Iluid intake
P Promoting adequate nutrition and elimination
A Adequate Iluid and electrolyte balance
R Renal Iunction maintenance
E Encouraging activity and mobility within limits
T Thorough wound care Ior adequate wound healing
I InIection Control
V Vigilant to maniIestations oI anxiety and promoting ways oI relieving it
E Eliminating environmental hazards and promoting client saIety