Post-Operative Nursing Management o Meds/Anes side effect

 If amt >500ml=Replacement is given

Post-op period  Shock results from:
- Time patient leaves OR to last follow-up visit o Hypovolemia
- Focuses on: o Decreased intravascular volume
o Reestablishing physiologic equilibrium  Types
o Alleviate pain o Hypovolemic
o Preventing complications o Cardiogenic
o Educating pt about self-care o Neurogenic
o Anaphylactic
o Septic
Care of Patient in the PACU  Signs
o Pallor
o Cool/moist skin
Phases of Post anesthesia care
o Low RR
- Pt may remain in PACU for 4-6 hrs depending on surgery and
o Cyanosis
condition
o Weak thready pulse
- Phase 1
o Low BP
o Immediate recovery
o Conc urine
o Intensive nursing care given
 Prevent with prompt admin of IV fluids. Blood,
- Phase 2
blood products, & Meds that increase BP
o Patient is prepared for self-care
 Treatment = Volume replacement
- Phase 3
o 0.9 NSS
o Patient prepared for discharge
o lactated ringers
Admitting to the PACU
o Blood components
- During Transport
o Colloids
o Anes provider remains at head of pt to maintain airway
 If volume replacement fails, Give
o Surgical team member at opposite end to assist
o Vasodilators
o Mind the incision when pt is moved
o Corticosteroids
 Sutures carry a lot of tension
 Elevate legs
 Prevent further strain
 Monitor VS and general continuously until stable
o Position pt in a way that there is no blockages in
 Manage pain and Body Temp as this contribute to
contraptions
hemodynamic instability
 Drains
 Hemorrhage
 Tubes
 Uncommon yet serious
o Move patient carefully
 Can result to hypovolemic shock or death
 Prevent orthostatic Hypotension
 Can occur up to several days after surg
o Maintain comfort
 Signs
 Blankets (warmed)
o Hypotension
 Replace soiled gowns
o Rapid pulse
o Prevent falls
o Disorientation
 Raise side rails
o Restlessness
Nursing Management in the PACU
o Oliguria
A. Assessing the patient
o Cold pale skin
o Obtain baseline
o Labored breathing
o Check site for:
o Hypothermia
 Drainage
 Therapeutic measures:
 Hemorrhage
o Determine source
o Maintain functioning of:
o Transfuse blood(products)
 Monitoring tubes
o Place in shock position
 Drains
 Flat on back
o Check/Administer
 Elevated legs 20 degrees
 IV fluids
 Knees straight
 Meds
o If suspected but not visualized=Bring back to
o VS q15
OR for exploration
o Administer analgesics
o Facilitate early ambulation
B. Maintain patent airway
o Primary objective in immediate post-op is maintain
ventilation
 Prevent hypoxia/hypercapnia
o Prevent hypopharyngeal obstruction
 Tongue falls and obstructs air passage
o Artificial airway should not be removed until gagging reflex
has returned
o Assist in weaning and extubating
o If teeth are clenched, can be opened manually w/ padded
tongue dep
 ONLY UNLESS CONTRAINDICATED
o Suction vomitus/mucus if applicable
 Caution with post oral/laryngeal surg
 Risk for bleeding/discomfort
C. Maintain cardiovascular stability
o Assess
 Mental status
 VS
 Hypertension/Dysrhythmias
 Cardiac rhythm
 Common secondary to SNS stimulation from pain,
 Skin temp, color, moisture
hypoxia or bladder distension
 Urine output
 Dysrhythmias assoc w/:
 Central venous pressure
o Electrolyte imbalance
 Pulmonary artery pressure
o Altered resp func.
o Maintain patency of IV lines
o Pain
o Common CV complications
o Hypothermia
 Hypotension & Shock
o Stress
 Hypotension Result from:
o Anesthetic agents
o Blood loss
 TREAT UNDERLYING CAUSE
o Hypoventilation
o Positional changes
D. Relieving pain and anxiety
o Pooling of blood
o Opioid analgesic administered IV
  Immed pain relief - Ambulatory centers usually only have a sort of PACU similar to
 Short acting that of a Phase 2 PACU. The type of patient here is healthy and
 Minimizing drug interactions will be discharged directly to their home.
 Minimize prolonged rep depression - Give health teachings and written information about their
follow-up.
- Usually same day or ambulatory
surgery
- Promoting home and Community-
Based Care
o Verbal and written instructions should
be given since the patient’s memory will be
clouded by anesthesia

E. Controlling Post-Operative Nausea and Vomiting (PONV)

o Common o Discharge Prep
o Intervene before occurring  Pt and caregiver are informed of expected outcomes
o Give meds and post-op changes
o Surgical risks increase due to:  Given written information
 Increased intra abd pressure  Surgeon phone number
 Elev central venous pressure  Nursing unit
 Increased HR & BP  Limit activity for 24-48 hrs
 Risk for aspiration  Fluids as desired
o PONV Increases risk for myocardial ischemia and  Meals can be smaller portions
dysrhythmias  No important decisions: Anesthesia clouds
F. Gerontologic Considerations o Continuing Care
o Transfer slowly and gently  Patients that may require home care are:
 Orthostatic hypotension  Older
 Fragile skin = more padding  Frail
o Keep pt warm as elderly are more prone to hypothermia  Lives alone
o Change position frequently  Other problems or disabilities
 Stimulate respirations  Assess physical status and ability to adhere to
 Comfort treatment regimen
 Circulation  Reinforce education
o Post-op care is the same as anay surg client but addt’l  Home care nurse responsibilities:
support is give if there are cardio, pulmo, renal  Monitor patency of drain
impairments  Administer medications
o Slower recovery due to prolonged elimination of substances  Importance of follow ups
o Post-op confusion and delirium is common  Follow-up phone calls
 May result from:
 Pain
 Analgesia Care of the Hospitalized
 Hypotension


Fever
Hypoglycemia
Postoperative Patient
 Fluid loss - Seriously ill patients and those patients that have undergone
 Anemia major CV, Neuro, Pulmo surgery may be admitted to special
 Provide adequate hydration ICUs
 Reorient to environment o Close monitoring
G. Determining readiness for PACU discharge o Support
o Pt stays in PACU until fully recovered from anesthetic o Advanced interventions
agents Receiving The Patient In The Clinical Unit
 Indicators of recovery include: - Pt room is prepped with:
 Stable BP o IV poles
 Norm Resp func o Drainage receptacle
 Norm O2 sat o Suction
o Scoring system (Aldrete score) o O2
 Determine condition and readiness of pt to be
o Emesis basing
transferred
 Less than 7/10 must stay within PACU o Tissues, disposable pads
o Forms

Nursing Management After Surgery

- Continue recovery from anesthesia

- Monitor for Complications
- Manage pain
- Teach independence
- Upon transfer, the priorities are:
o adequate ventilation
o hemodynamic stability
o incisional pain
o surgical site integrity
o nausea and vomiting
o neurologic status
o spontaneous voiding
- VS
o Q15 for 1st hr
o Q30 for next 2 hrs
o Temp q4 for 1st 24 hrs
- Although there might still be pain, pt usually feel mo re alert,
Preparing the Post-Op patient for direct discharge and less nauseous and anxious several hrs after waking or the
next morning.
- Start leg exercises if appropriate
 - Ambulate with assistance - Infection
- Can tolerate light meal and discontinue IV fluids - Pulmonary embolism
- Focus shifts to relief of anes side effects and regaining - Wound dehiscence or evisceration
independence Planning & Goals
- Optimal respiratory function
- Pain relief
The Nursing Process: The hospitalized patient - Optimal CV function
Recovering from surgery - Increased activity tolerance
Assessment - Unimpaired wound healing
- Perform Review of systems - Maintenance of body temperature
- Monitor VS - Maintenance of nutritional balance
o Respiratory status - Resumption of normal urinary/bowel function
 MOST IMPORTANT - Identification of positioning injuries
 Check patency of airway - Sufficient knowledge on self care
 Laryngeal edema - Absence of complications
 Quality of respirations
 Depth
 Rate Nursing Intervention
 Sound A. Preventing Respiratory Complications ()
 Slow respirations - Atelectasis
 Analgesic/anesthetic effect  Causes
 Shallow rapid respirations  Mucus plug obstructs one of the bronchi
 Pain completely
 Constricting dressings  Depressive Effects of Opioid
 Abd distention  Decreased lung expansion from pain
 Obesity  Decreased mobility
 Noisy Breathing  S S/x
 Obstruction  Decreased breath sounds
o Fluids  Crackles
o Tongue  Cough
 Flash pulmonary edema - Pneumonia
 Protein and fluid accumulate in alveoli  S S/x
 S s/x  Chills
o Agitation tachypnea  Fever
o Tachycardia  Tachypnea
o Decreased pulse ox  Tachycardia
o Frothy pink sputum  Cough w/ or w/out sputum
o Crackles - Hypostatic pulmonary Congestion
o Pain Level  Weakened CV system
 Pain scale  Stagnation of secretion in lung
o Mental status o Immobile Pts
 LOC  S/sx
 Speech  Slight elev in temp, BP, HR, RR
 Orientation  Cough
 Change in menatal status may be due to pain, anxiety,  Dullness & crackles at base of lung
medication. It could also root from oxygen deficit or  May be fatal
hemorrhage - Hypoxemia
o General discomfort/ Restlessness  Subacute
 Laying in one position  constant low level of oxygen saturation when
 Reaction to anesthesia breathing appears normal
 Anxiety  Episodic
 Urinary retention  develops suddenly
 Tx  at risk for cerebral dysfunction, myocardial
 Analgesic ischemia, and cardiac arrest
 Frequent positional changes  Risk factors:
 Addressing the anxiety  Abdominal surgery
 Change tight, soaked bandages  Obese
 Preexisting pulmo conditions
Diagnosis  Interfere w Pulse ox result
Nursing diagnosis  Cold extremities
- Risk for ineffective airway clearance related to depressed  Tremor
respiratory function, pain, and bed rest  Atrial fibrillation
- Acute pain related to surgical incision  Acrylic & Black or blue nail polish
- Decreased cardiac output related to shock or hemorrhage o Disrupts reading
- Risk for activity intolerance related to generalized weakness - Tx & Preventive measures
secondary to surgery  Turn frequently
- Impaired skin integrity related to surgical incision and drains  Deep breaths
- Ineffective thermoregulation related to surgical environment  Expel residual anes agents
and anesthetic agents  Prevent atelectasis
- Risk for imbalanced nutrition, less than body requirements  Coughing exercises
related to decreased intake and increased need for nutrients  Contraindicated in pt undergone
secondary to surgery cranial/ophthalmic surgery and plastic surgery
- Risk for constipation related to effects of medications, o Increased in ICP or IOP
surgery, dietary change, and immobility o Plastic surg = Tear delicate tissues
- Risk for urinary retention related to anesthetic agents  Use on incentive spirometer q2h
- Risk for injury related to surgical procedure/positioning or  Careful splinting of surgical sites
anesthetic agents  Decreased pt fear of coughing leading to
- Anxiety related to surgical procedure opening of wound
- Risk for ineffective management of therapeutic regimen  Analgesic agents given
related to wound care, dietary restrictions, activity  Permit more effective coughing
recommendations, medications, follow-up care, or signs and  Oxygen given
symptoms of complications  Prevent hypoxia
 Inhale deeply
Collaborative Problems or Potential Complications  “Yawn”
- Pulmonary infection/hypoxia  Create neg intrathoracic pressure
- Deep vein thrombosis (DVT)  Expand total lung capacity
- Hematoma or hemorrhage  Early ambulation
  Increased metab  Watch hematocrit & hemoglobin
 Pulmonary aeration  Decreased levels may mean dilution by IV
 Valuable in preventing pulmonary compli in fluids or blood loss
older pt  Will rise once stress response ends and fluids
B. Relieving Pain are excreted
- Factors for degree and severity of Post-OP pain:  Venous thromboembolism
 Surg procedure  From venous stasis
 Incision site o Dehydration
 Extent of trauma o Immobility
 Type of anesthesia o Pressure on leg veins
 Route of admin  Leg exercises & frequent position changes
 Anxiety o Avoid compromising venous return
 Lack of knowledge  Promote venous return
 Incorrect expectations o Stockings
 Unprepared D. Encouraging Activity
- Intense pain > Stress response > Affect cardiac & - Early ambulation
immune  Prevent:
- Pain > increased muscle tension & vasoconstriction >  Atelectasis
Further stimulates pain receptors > increased myocardial  Hypostatic pneumonia
demand & O2 consumption  GI discomfort
- Hypothalamic stress response > increased blood  Circ problems
viscosity & platelet aggregation > increased risk for  Reduces Abd distention
thrombosis & PE  Increased Gi wall tone
- Opioid Analgesics  Stimulates peristalsis
 Commonly Rx  Pain is decreased
 Preventive (set interval/sched) rather than as  Postural/Orthostatic Hypotension
needed  Sudden abnorm drop in BP from supine to
 Addiction is related to short term relief (dosing standing/sitting
when pain occurs) not preventive  Common
- Patient-controlled analgesia  Changes in blood vol
 Prevention that sporadic tx  Decrease of 20mmhg in sys and 10 mmhg in
 Pt administer own meds dias
 Two req’s  Weakness
 Understanding of need to self-dose  Dizziness
 Ability to Self-dose  Fainting
 Amt and time span of med admin is controlled by  Elderly more at risk
PCA device  Assist in getting out of bed
 Features:  Gradual move from lying to sitting
 Eliminates delayed analgesic response  Raise head of bed
 Maintain therapeutic level  Splint the incision
 Enable the pt to move turn cough and breath  Position completely upright
without pain o Legs dangling on side
o Reducing pulmo compli  Help pt stand
- Epidural Infusions and Intrapleural Anesthesia  After accustomed to standing, help walk w/ support
 Caution in chest procedures,  Don’t tire pt Commented [JM1]:
 May ascend along spinal cord and affect  Whether or not can ambulate, perform Bed
respiration exercises
 Intrapleural  Arm > Hand > Finger
 Admin of local anes by cath between parietal o Abduction & ext. rotation of shoulder
and visceral pleura  Leg > Foot
 Sensory anes w/out affecting motor func and o Prevent DVT, footdrop, toe deformities,
intercostal musc good circulation
 Allows more effective breathing and coughing  Abdominal > Gluteal contraction
o In chest surgeries, wherein pain would  One way to increase activity is making them
interfere with these exercises perform hygiene as much as they can tolerate
 Epidural  Restores self-control and prepares them for
 Opioid or combination anes (opioid + local self-care for discharge
anes) used  Pt needs to be able to ambulate a certain distance,
- Other Pain Relief Measures get in and out of bed independently, and toilet
 Subcutaneous Pain management independently for safe discharge
 Pain difficult to control  Maintain patient SAFETY
 Nylon cath inserted at affected area E. Caring for Wounds
o Connected to pump that automatically - Wound healing
dispenses continuous amt prescribed  Surgical wound healing may occur in three ways:
 Nonpharmacologic  First-intention
 Guided imagery o Aseptically created wound
 Music o Minimum tissue destruction
 Application of hot and cold o Granulation tissue not visible when
 Positioning healed
 Distraction o Scar formation is minimal
 Back massage o If tissue adhesive is used instead of
 Promoting relaxation sutures, dressing is contraindicated
C. Promoting Cardiac Output  Second-intention
- Needed when: o Infected wounds
 Hemorrhage o Edges not approx.
 Shock o Incised abscess collapses partly into
 Changes in circulating volume cavity and is expelled with a drain
 Stress o Necrotic material soon disintegrates
 Effects of meds and leaves sensitive tissue that easily
- Tx: bleeds
 IV fluids  Tissue is formed of thin
 Close monitoring walled capilliaries and buds
 Volume deficit called granulations that
 Tissue perfusion enlarged until they fill the
 Decreased CO cavity
 ^^^ all can increase discomfort which can o Cells lining cavity are turned into long
lengthen hosp stay thin versions from round versions that
 Accurate I&O create a scar (cicatrix)
 Report urine <30ml/hr
 o Healing is complete when skin cells - Pt with anes is at risk for chills
grow over these granulations  Maintain room temp
 Method is called healing by  Balnkets
granulation  O2 admin
o Post op wounds to be healed in this  Adequate hydration
fashion are usually filled with saline  Proper nutrition
soaked sterile dressings and covered - Monitored for cardiac dysthymias
with a dry dressing G. Maintaining GI Function and Resuming Nutrition
 Third-intention - N/V, Hiccups
o Deep wounds  Problem for both nurse and pt
o Not sutured correctly - If pt has high risk of vomiting, NGT is applied pre op
o Broke down - NGT also applied when suspected of abd distention
o Resutured later - NGT also applied when pt who has food in stomach is for
o Bring together two granulated edges emergency surgery
o Deeper wider scar - Hiccups
 Intermittent spasms of diaphragm 2ndary to
irritation of phrenic nerve
 Irritation may be from distended stomach
 Abscess in sub diaphragm
 Indirect irritation:
 Toxemia
 Uremia
 May produce distress or vomiting
 Exhaustion
 Wound dehiscence
 Meds: Phenothiazine
 Chlorpromazine
- Return to normal diet
 Patient’s pace
 Procedure and anes affect rate at which normal
activity resumes
 Liquids are first tolerated
 Cool fluids are better than cold and hot
 Soft foods are gradually added after liquid
toleration
 As soon as soft foods are tolerated, solids can be
incorporated
- Assessment and Management
 GI subject to uncomfortable and life threatening
complications
 In shorter hosp stays, Most occurs at home  Abd distension
 Assessment  Anyone can have
 Approx of wound edges  Accumulation of gas
 Suture/staple integrity  Swallowed air & Secretions
 Redness  NO peristalsis
 Discoloration  Increased by:
 Warmth o Immobility
 Swelling o Anes agents
 Tenderness o Opioid meds
 Drainage  Manipulation of GI organs during Op
- Caring for Surgical drains  Produce loss of peristalsis for 24-48hr
 Drains  Tx:
 Tubes that exit peri-incisional area  Frequent turning
 Allows escape of fluids that would otherwise  Early ambulation
harbor bacteria  Exercise
 Types  COMPLICATIONS usually in abd op
o Penrose  Paralytic ileus
o Hemovac  Intestinal obstruction
o Jackson-pratt H. Promoting Bowel Function
 Output is recorded - Constipation
 Increased amounts should be reported  Common
 Esp if looks like fresh blood  Minor or serious
 Dressing with drain can be reinforced with sterile  Cause
gauze  Decreased mobility
 Time reinforced SHOULD be recorded  Decreased oral intake
o To approx. amt over time  Analgesia
- Changing the Dressing  Irritation and trauma during surg
 First post-op change usually done by member of  TX
surg team but succeeding can be done by nurse  Early ambulation
 Indications for dressing  Good diet
 Proper environment for wound healing  Stool softener
 Splint and immobilize wound  No bowel sounds by 2nd-3rd day = REPORT
 Absorb drain I. Managing Voiding
 Protect from injury - Retention
 Protect from bacterial contamination  Anesthetis
 promote hemostasis  Anticholinergics
 Mental and physical comfort  Opioids
 Change on right time - Inhibits ability to initiate voiding
 No visitors - Expected to void 8 hrs after
o Scars may have negative connotations - If pt has urge and distended bladder within 8hr period =
 Assure that scar will fade Catheterize
 Dressing are never touched ungloved - All methods to void should be done
 Adhesive is removed in direction of hair growth  Running water
 Elastic bandage is used when wound is suspected  Hot cold water
to become edematous as non-elastic bandages  Warm bedpan
can’t expand therefore causing tension on the skin - If pt dislikes bed pan, commode or toilet can be used
F. MAINTAINING NORMAL BODY TEMPERATURE - Keep pt safe from falls
- Pt at risk of malignant hyperthermia and hypothermia - Straight intermittent is preferred over indwelling cue to
even post-op less risk of infection
 - Note amt of void  Healing usually occurs through granulation or
- Intermittent cath can be admin q4-6h until normal secondary closure may be done
J. Maintaining a safe environment - Infection (Wound Sepsis)
- Immediate post-op  Surgical wound disrupts skin integ
 3 side rails up  Bypasses primary defense and protection
 4 is considered restraint against infection
 Bed in low position  Exposure of deep tissue to pathogen = Risk for
 Assess LOC and orientation infection & Life threatening
 Determine whether pt cain use assistive devices  Type of wound has expected risk of infection
 Eyeglasses hearing aids
 Increased risk for injury
 Impaired vision
 Inability to communicate
 All objects should be within reach of pt
 Post op orders should be followed
immediately
 Positioning
 Equipment needs
 Avoid restraints as much as possible
K. Providing Emotional Support to the Patient
and Family
- Stress and anxiety may remain even post op
- Factors
 Unfamiliar environment
 Inability to care for one’s self  Patient-related factors
 Fear of complications or long-term effects of  Age
surgery  nutritional status
 Fatigue  diabetes
 Spiritual distress  smoking
 Altered role in responsibility  obesity
 Ineffective coping  remote infections
 Altered body image  endogenous mucosal microorganisms
- Provide reassurance and information  altered immune response
 Spend time listening and address their concerns  length of preoperative stay
- Provide realistic expectations  severity of illness
- Educate on when they will be able to eat, drink, remove  Factors related to the surgical procedure
dressings/tubes  the method of preoperative skin
- Modify environment  preparation
- Privacy  surgical attire of the team
L. Managing Potentia; Complications  method of sterile draping
 duration of surgery
 antimicrobial prophylaxis
 aseptic technique
 factors related to surgical technique
 drains or foreign material
 OR ventilation
 length of procedure
 exogenous micro-organisms.
 Prevention is focused on reducing risks
- Venous Thrombolism  Signs and symptoms of wound infection
 DVT  increased pulse rate %& temp
 PE  Increased WBC
 Prevention: LMW or low dose heparin  Swelling
 External pneumatic compression  Warmth
 Anti-embolism stockings  Tenderness
 EARLY AMBULATION  Discharge
 LEG EXERCISES  Pain on incision
 HYDRATE  Staphylococcus aureus = MOST COMMON CA
 Surgery > Stress response> inhibits fibrinolytic  RARELY occurring = beta-hemolytic streptococcal or
system > blood hypercoagulability clostridial infections rapid and deadly and need
 Factors that increase risk: strict infection control practices to prevent the
 Dehydration spread of infection to others
 Low CO  Once wound infection is diagnosed, a surgeon
 Blood pooling opens up the incision, inserts drainage and
 Bed rest antimicrobial therapy and wound care are initiated
 All post op pt are at risk - Wound Dehiscence and Evisceration
 Higher risk:  Serious medical complications
 History  Dehiscence
 Malignancy  Disrupt incision or wounds
 Trauma  Evisceration
 Obesity  Protrusion of wound contents
 Indwelling cath  Cuases pain and vomiting
 Hormone use  Esp serious in abd
 First symptom: Pain or cramp in calf > Swelling of  Cause = Sutures giving way for infection
entire leg w/ fever, chills, diaphoresis  Stretching and tension of suture frm coughing
 AVOID: ang abd distension
 Blanket rolls  Age
 Pillow rolls  Anemia
 Any elevation that can constrict the under  Jaundice
knee  Diabetes
 Prolonged dangling of legs on bed  Steroidal therapy
- Hematoma  Gender
 Concealed bleeding  Intestines MAY or MAY NOT protrude
 Stops and turns into clot  Early sign
 If clot small, then absorb  Bloody gush of peritoneal fluid
 If big then won’t be absorbed and healing will  Prevention
be delayed  Abd binder
 After removal of clot, lightly pack wound with gauze - GERONTOLOGIC CONSIDERATIONS
 Recover slowly
  Greater risk for post op compli  Change dressings and cath if needed
 Delirium, pneumonia, exacerbation of  Reinforce prev teachings
comorbid conditions  Remind follow up visits
 Pressure ulcer  Suggest resources and support group
 Decreased oral intake Evaluation
 Falls Expected Patient Outcomes
 Delirium Expected patient outcomes may include the following:
 confusion, perceptual and cognitive deficits, 1. Maintains optimal respiratory function
altered attention levels, disturbed sleep a. Performs deep-breathing exercises
patterns, and impaired psychomotor skills b. Displays clear breath sounds
 Freq assessment of mental status c. Uses incentive spirometer as prescribed
 Fluid electrolytes d. Splints incisional site when coughing to reduce pain
 Respi & hemo deterioration 2. Indicates that pain is decreased in intensity
 Factors 3. Increases activity as prescribed
o Age a. Alternates periods of rest and activity
o Alcohol abuse b. Progressively increases ambulation
o Serum chem c. Resumes normal activities within prescribed time frame
o Type of surg d. Performs activities related to self-care
 Confused with age related dementia 4. Wound heals without complication
 Well-lit room 5. Maintains body temperature within normal limits
 Near nurse’s area 6. Resumes oral intake
 Reduce sensory deprivation a. Reports absence of nausea and vomiting
 Reorient as much a possible b. Eats at least 75% of usual diet
c. Is free of abdominal distress and gas pains
d. Exhibits normal bowel sounds
7. Reports resumption of usual bowel elimination pattern
8. Resumes usual voiding pattern
9. Is free of injury
10. Exhibits decreased anxiety
11. Acquires knowledge and skills necessary to manage
therapeutic regimen
12. Experiences no complications

 Improve cognitive function

o Clock, calendar
 Physical activity shouldn’t be neglected
o Physical; deterioration can worsen
delirium
 NO restraints
o Worsen confusion
 Optimal nutritional status
 Dietary consultation
 Important for good healing
 Supplements
 Sensory deficits
 Repeat instructions
 Decreased energy
 Frequent rest periods
M. Promoting home and community based care
- Self-care
 Detailed instructions
 Shorter hosp stays req’ pt to learn a lot in very little
time
- Continuing care
 Elderly, live alone, no parent support, and chronic =
Require the most
 Discharge planning involves coordination with home
care nurses
 Home visits
 Assess for post-op compli
 Assess
o Incision
o Respi & Cardio
o Pain management
o Fluid & nutria
 Evaluation ability to change dressing and
admin meds