Adult Care Nursing I / Theory

Faculty of Nursing
First Semester
2020-2021

Unit 4 – Chapters
17,18,19 :
Perioperative Concepts
and Nursing
Management
 Objectives:

1. Define the three phases of perioperative care.

2. Identify legal and ethical consideration related to obtaining
informed consent for surgery.
3. Describe the immediate preoperative preparation for the
patient.
4. Describe the interdisciplinary approach to the care of the
patient during surgery.
5. Describe the role of the nurse in ensuring patient safety
during the intraoperative period.
6. Describe the responsibilities of the postanesthesia care nurse
7. Identify common postoperative problems and their
management.
 Glossary:

Ambulatory Surgery: Includes outpatient, same day, or short

stay surgery that does not require an overnight hospital stay.

Informed Consent: the patient’s autonomous decision about

whether to undergo a surgical procedure, based on the nature of
the condition, the treatment options, and the risks and benefits
involved.
Preadmission Testing: Diagnostic testing performed before
admission to the hospital.

Minimally Invasive Surgery: Surgical procedures that use

specialized instruments inserted into the body through small
incisions or through natural orifices.
 Perioperative Nursing

• Perioperative Concept: Period of time that constitutes

the surgical experience; includes the preoperative,
intraoperative, & postoperative phases of nursing care
(Hinkle 2018).
1. Preoperative Phase: begins when the decision to
proceed with surgical intervention is made & ends with
the transfer of the patient onto the operating room (OR)
bed.
2. Intraoperative Phase: begins when the patient is
transferred onto the OR bed & ends with admission to the
PACU (Post Anesthesia Care Unit).
3. Postoperative Phase: begins with the admission of the
patient to the PACU & ends with a follow-up evaluation in
the clinical setting or home.
 Surgical Classification

• The decision to perform surgery may be based on

facilitating:
1. Diagnosis (a diagnostic procedure such as biopsy,
exploratory laparotomy, or laparoscopy).
2. Cure (e.g., excision of a tumor or an inflamed appendix).
3. Repair (e.g., multiple wound repair).
4. Reconstructive or cosmetic (such as mammoplasty or
a facelift).
5. Palliative (to relieve pain or correct a problem—such as
debulking a tumor to achieve comfort, or removal of a
dysfunctional gallbladder).
 Surgical Classification
• Surgery can also be classified based upon the degree of urgency
involved: emergent, urgent, required, elective, and optional.
 Phase One
Preoperative phase
 Preadmission Testing (PAT)

• It’s a part of preoperative phase & start prior to admission

• Helps in reduce hospital stays & contain costs.
• Initiates initial preoperative assessment
• Initiates teaching appropriate to patient’s needs
• Initiate the nursing preparation prior to admission.
• Admission data: demographics, health history, other
information pertinent to the surgical procedure.
• Verifies completion of preoperative diagnostic testing.
• Begins discharge planning by assessing patient’s need
for postoperative care.
 Preoperative Assessment
 Health History & Physical Exam
 Medications & Allergies:
For example: Diuretics during anesthesia may cause excessive
respiratory depression resulting from an associated electrolyte
imbalance. Corticosteroids can cause cardiovascular collapse.
 Nutritional, Fluid Status: (obesity, malnutrition,
dehydration, hypovolemia & electrolyte imbalances)
 Dentition (dental caries, dentures & partial plates)
particularly in elderly patients)
 Drug or Alcohol Use: Alcohol weaken the immune
system, alcohol withdrawal syndrome (i.e., delirium is
associated with a significant mortality 48-72 hrs
postoperatively).
 Preoperative Assessment #1

 Respiratory Status: Assess for any respiratory

diseases & what medications are taken
 Assess if patient is smoking: poor wound healing
 Cardiovascular Status: Patient should be stabilized
 Treat hypotension & hypertension to meet oxygen,
fluid, & nutritional needs of the perioperative period.
 Surgery can be modified to meet cardiac tolerance.
 Hepatic, Renal Function
- kidney & liver function tests; Disorders of liver affect
anesthetic agents metabolism
- Surgery is contraindicated with acute nephritis,
oliguria, anuria (except in lifesaving measures)
 Preoperative Assessment #2

 Endocrine Function: frequent monitoring of blood

glucose level; patients with diabetes undergoing
surgery is at risk for both hypoglycemia &
hyperglycemia.
 Patient received Corticosteroids at risk for adrenal /
renal insufficiency, Insulin, Uncontrolled thyroid : at
risk for thyrotoxicosis or respiratory failure
 Immune Function: (Any existing allergies (Latex Allergy),
sensitivity to medications, Immunosuppression)
 Spiritual, Cultural Beliefs: plays an important role in how
people cope with fear and anxiety.
 Previous Medication Use: (herbal, corticosteroids,
antidepressants, antibiotics, insulin & aspirin)
 Preoperative Assessment #2
 Psychosocial Factors:

1. Helps to decrease preoperative anxiety due to outcome

anticipation, such as:
I. Potential threat to patient role within the family
II. Permanent incapacity
III. Body integrity
IV. Increased responsibility or burden on family members

2. Also, Psychosocial assessment helps to alleviate fear

3. Avoid misinformation (e.g., giving wrong information)
4. Assess patients readiness to learn & determine the best
approach to comprehend which provides the basis for
preoperative patient education.
Special Considerations During Preoperative Period

 Gerontologic Considerations: Older adult patients

have less physiologic reserve than younger patients
because:
1. Cardiac reserves are lower; Renal and hepatic
functions are depressed; Gastrointestinal activity is
likely to be reduced; Respiratory compromise.
2. Decreased subcutaneous fat; more susceptible to
temperature changes.
3. May need more time and multiple explanations to
understand and retain what is communicated
restrictions.
Special Considerations During Preoperative Period

 Patients who are obese (Bariatric Patients):

obesity (BMI > 30kg/m2) increases the risk &
severity of complications such as wound infection.

 Patients with disabilities (mental or physical)

 The need for appropriate assistive devices (e.g
hearing aids, eyeglasses), modifications in
preoperative education, & assistance with positioning
or transferring.
Special Considerations During Preoperative
Period

D. Patients undergoing
ambulatory surgery
(outpatient, same-day, or
short-stay surgery; 23hr or
less).
For example;
Cataract Surgery & breast
biopsy …
The nurse must quickly and
comprehensively assess
and anticipate the needs of
the patient and at the same
time begin planning for
discharge and follow-up
home care.
Special Considerations During Preoperative
Period
E. Patients undergoing Emergency surgery
(unplanned surgery and occur with little time for
preparation); The nurse need to:
1. communicate with the patient and team members as calmly
and effectively as possible in these situations.

2. Make a quick visual survey of the

patient to identify all sites of injury
in case of trauma.

3. For the unconscious patient,

informed consent and essential
information, such as allergies, need
to be obtained from a family
member, if one is available.
 Informed Consent

• Should be in writing & voluntary before

nonemergent surgery.
• Legal mandate
 Should contain the following:
– Explanation of procedure, benefits, risks,
complications & alternatives by surgeon
– Offer to answer questions about procedure
– Instructions that patient may withdraw
consent
– Consent accompanies patient to OR
(Operating Room).
 Voluntary Consent

• Valid consent must be freely given

• Consent is valid ONLY when signed before
administering psychoactive premedication
• Patient must be at least 18 years of age
• Consent must be obtained by physician
• Nurse clarifies information & witnesses patient’s
signature
 Incompetent Patient

• Individual who is not autonomous

• Cannot give or withhold consent
– Cognitively impaired
– Mentally ill
– Neurologically incapacitated
 Note: In an emergency the surgeon operate
without the patients informed consent. Every
effort must be made to contact the patient’s
family.
 Preoperative Nursing Interventions

 Patient Education
 Individualized teaching, frequently education
sessions, full description of the procedure &
possible outcomes
1- Deep breathing, coughing, incentive spirometry
2- Mobility, active body movement
3- Pain management
4- Cognitive coping strategies
5- Instruction for patients undergoing ambulatory
surgery
 Patient Education

1- Deep breathing, Coughing Exercises, and

Incentive Spirometry
 Deep Breathing Exercises
• To promote optimal lung expansion & prevent respiratory
complications postoperatively. To help the patient relax.
• Patients assumes a sitting position
• Splint or support the incision to promote maximal comfort
• Inhale deeply & slowly through the nostrils, exhale through
pursed lips.
• Hold breath for about 5 seconds to expand the alveoli
• Repeat this exercise 5 to 10 times hourly.
 Patient Education

 Deep Breathing Exercises

 Patient Education

• Coughing Exercise: to mobilize secretions so that they

can be removed, & to prevent atelectasis, pneumonia.
• Lean forward slightly from a sitting position in bed
• Putting the palms of both hands together, interlacing the
fingers across the incision site to act as a splint for
support when coughing.
• After practicing deep breathing several times (Deep
breathing before coughing stimulates the cough reflex)

• With mouth slightly open, breath in fully

• “Hack” out sharply for three short breaths.
• Keeping mouth open, take in a quick deep breath &
immediately give a strong cough once or twice.
 Patient Education

Incentive Spirometry: also referred to as sustained

maximal inspiration devices, measure the flow of air inhaled
through a mouthpiece.
• The nurse demonstrate how to use an incentive spirometer, a device
that provides measurement & feedback related to breathing
effectiveness.
 Patient Education

2- Mobility & Active Body Movement (Postoperatively)

- To improve circulation
- To prevent venous stasis
- To promote optimal respiratory function
• Patient taught that early & frequent ambulation
postoperatively as tolerated will prevent complications
• The nurse explains the rationale for frequent position
changes after surgery & then shows patient how to
turn from side to side.
 Patient Education

2- Mobility & Active Body Movement (Postoperatively)

• Teach patient how to perform Leg Exercises:

-Lie in a semi-Fowler’s position
-Bend the knee & rise foot- hold it a few seconds, then extend
the leg & lower it to the bed.
-Do this five times with one leg & then repeat with the other
leg
 Patient Education

2- Mobility & Active Body Movement (Postoperatively)

Foot Exercises: Trace circles with the feet by bending

them down, in toward each other, up & then out.
-Repeat these movements five times.
 Patient Education

3- Pain Management
• Pain intensity scale should be introduced & explained
to the patient to promote more effective post operative
pain management.
• Patient education also needs to include the difference
between acute & chronic pain.
• Postoperative pain medication for comfort
• Patient-controlled analgesia (PCA)
• After discharge to home patient will likely receive
oral analgesic agents.
 Patient Education

 Pain Intensity Scale

 Patient Education

4- Cognitive Coping Strategies

• Cognitive strategies useful for relieving tension,
Anxiety, decrease fear & achieving relaxation
 General Strategies Include:
Imagery: patient concentrate on a pleasant experience
or restful scene.
Distraction: patient thinks of an enjoyable story or
recites a favorite poem or song.
Optimistic self-recitation: patient recites optimistic
thoughts (“I know all will go well”).
Quran / Music: patient listens to Quran / soothing music
 Patient Education

5- Instruction for patients undergoing ambulatory

surgery:
• Preoperative education for the same day surgery
performed in the surgeons office or by telephone contact.
• Compromise all previously discussed education
• Tells the patient what to bring (insurance card, list of medications)
What to leave at home (jewelry, watch, medications)
• What to wear (loose-fitting, comfortable cloths; flat shoes)
• Patient is reminded not to eat or drink for a specified period of
time preoperatively.
Preoperative Instructions to Prevent
Postoperative Complications

• Diaphragmatic breathing Coughing

• Leg exercises

• Turning to side

• Getting out of bed

 General Preoperative Nursing Interventions

 Providing Psychosocial Interventions

– Reducing Anxiety, Decreasing Fear
– Respecting Cultural, Spiritual, Religious Beliefs
 Maintaining Patient Safety: protecting Patient from injury
• To prevent falls- mainly in elderly patients
 Managing Nutrition, Fluids: (The primary goal in
withholding food before surgery is to prevent aspiration)
 For example, adults may be advised to fast for 8 hours after
eating fatty food and 4 hours after ingesting milk products.
Healthy patients are allowed clear liquids up to 2 hours
before an elective procedure.
• IV fluids may be administered
 General Preoperative Nursing Interventions

 Preparing Bowel:
• Instruct Patient to evacuate bowel (go to bathroom)
• Cleansing enema before abdominal or pelvic surgery)
• Antibiotic may be prescribed to reduce intestinal flora
 Preparing Skin:
• To decrease bacteria without injuring the skin
• For example, using a soap containing detergent-
germicide for several days before surgery
• Shaving is no longer recommended; clipping the hair is
evidence-based practice.
Preoperative Checklist
Immediate Preoperative Nursing Interventions

• Follow the Preoperative Checklist: gown, dentures

removal, jewelry, Void & bowel emptying, valuables stored in a
secure place

• Administering Preanesthetic Medication: (Having the

patient void prior to administering a premedication is necessary for
patient safety to prevent falls & injury)
 Sedatives or anxiolytics (they might be “on call to OR“ due to
delays in the OR). It usually administered in the preoperative
holding area and it takes 15 to 20 minutes to prepare the
patient for the OR.
 If given in the ward, the patient is kept in bed with the side
rails raised, because the medication can cause
lightheadedness or drowsiness, and the nurse should keep a
close eye on the patient (drowsiness may develop).

• Maintaining preoperative record

o Patient file, diagnostic test, consent form, and nurse’s notes
 Immediate Preoperative Nursing
Interventions
 Transporting patient to presurgical area
o On a bed or stretcher 30-60 minutes before surgery or when
called
o Maintain comfort (use pillow and blanket)
o Avoid unpleasant sounds and conversation (can be
misinterpreted by sedated patient)
o Use a standard process to verify patient identity, the surgical
procedure, and the surgical site

 Attending to family needs

o Waiting areas (if available)
o Communicate with family members and reassure them
(especially if delays happen)
Expected Outcomes from this phase

 Relief of anxiety
 Decreased fear
 Understanding of the surgical intervention
 No evidence of preoperative complications
 Phase Two

Intraoperative
Nursing
Management
Members of the Surgical Team & Roles

1. Patient
2. Anesthesiologist (physician) or certified registered
nurse anesthetist (CRNA)
 Assesses the patient before surgery, selects the
anesthesia, administers it, intubates the patient if
necessary, manages any technical problems related
to the administration of the anesthetic agent, and
supervises the patient’s condition throughout the
surgical procedure.
3. Surgeon
 Performs the surgical procedure, heads the surgical
team.
Members of the Surgical Team & Roles
4. Circulating Nurse (circulator)
A qualified registered nurse, works in collaboration with surgeons,
anesthesia providers, and other health care providers to plan the best
course of action for each patient (Rothrock, 2014).
 Manages the OR and protects the patient’s safety and health by
monitoring the activities of the surgical team, checking the OR
conditions, and continually assessing the patient for signs of injury
and implementing appropriate interventions. For example:
I. Verifying consent
II. Planning for and assisting with patient positioning, preparing the site for
surgery, managing surgical specimens, anticipating the needs of the
surgical team.
III. Documenting intraoperative events
IV. Ensures cleanliness, proper temperature, humidity, appropriate lighting,
safe function of equipment, and the availability of supplies and
materials.
V. Monitors aseptic practices
VI. Implementing fire safety precautions
Members of the Surgical Team & Roles

4. Scrub Role
 Performing hand hygiene; setting up and preparing the sterile
equipment and supplies, tables and sterile field; preparing sutures,
ligatures.
 As the surgical incision is closed, the scrub person and the
circulating nurse count all needles, sponges, and instruments to
be sure that they are accounted for and not retained as a foreign
body in the patient (Association of PeriOperative Registered Nurses
[AORN], 2014; Rothrock, 2014).

5. Registered Nurse First Assistant (RNFA):

 The RNFA practices under the direct supervision of the surgeon.
 Handling tissue, providing exposure at the operative field,
suturing, and maintaining hemostasis (Rothrock, 2014)
 Prevention of Infection

• Surgical Environment: To help decrease microbes, the

surgical area is divided into three zones.
1. Unrestricted zone: area in the operating room that
interfaces with other departments; includes patient
reception area and holding area. (Street clothes are
allowed)
2. Semirestricted zone: area in the operating room where
scrub attire is required; may include areas where surgical
instruments are processed. (Scrub clothes and caps are
worn)
3. Restricted zone: area in the operating room where scrub
attire and surgical masks are required; includes operating
room and sterile core areas. (where scrub clothes, shoe
covers, caps, and masks are worn. Masks are worn at all
times).
Prevention of Infection

• Environmental Controls
 Free from contamination, dust, pollution, and noise
 All equipment that comes into direct contact with the
patient must be sterile
 The OR has special air filtration devices to decrease
the amount of bacteria in the air (Airborne bacteria).
 Room temperature between 20 to 24 0C (68°F to
73°F), humidity between 30% and 60%.
 Unnecessary personnel and physical movement may
be restricted to minimize risk of infection.
• Surgical Asepsis: Absence of microorganisms in the
surgical environment to reduce the risk of infection and
prevents the contamination of surgical wounds.
 Basic Guidelines for Surgical Asepsis

 All materials in contact with the surgical wound or used

within the sterile field must be sterile.
 Gowns of the surgical team are considered sterile in
front from the chest to the level of the sterile field. The
sleeves are also considered sterile from 2 in above the
elbow to the stockinette cuff.
 Sterile drapes are used to create a sterile field. Only
the top surface of a draped table is considered sterile.
 Items are dispensed to a sterile field by methods that
preserve the sterility of the items and the integrity of
the sterile field. After a sterile package is opened, the
edges are considered unsterile.
 Basic Guidelines for Surgical Asepsis

Figure 18-2: Proper draping exposes only the surgical site,

which decreases the risk of infection
 Guidelines for Surgical Asepsis

 Sterile supplies, including solutions, are delivered to a

sterile field or handed to a scrubbed person in such a
way that the sterility of the object or fluid remains
intact.
 The movements of the surgical team are from sterile to
sterile areas and from unsterile to unsterile areas.
 Scrubbed people and sterile items contact only sterile
areas; circulating nurses and unsterile items contact
only unsterile areas.
 Movement around a sterile field must not
contamination of the field.
 Sterile areas must be kept in view during movement
around the area.
 Guidelines for Surgical Asepsis

 At least a 1-ft distance from the sterile field must be

maintained to prevent inadvertent contamination.
 Whenever a sterile barrier is breached, the area
must be considered contaminated.
 Items of doubtful sterility are considered unsterile.
 Sterile fields are prepared as close as possible to the
time of use.
 The routine administration of hyperoxia (high levels
of oxygen) is not recommended to reduce surgical
site infections.
Surgical Environment
• Safety
 Prevent wrong site surgery, retained foreign objects
 Labeling and handling of specimens.
 Prevent electrical, chemical, thermal burns
 Safe blood, fluid, medication administration
 Prevention of positioning injuries and the position
must not obstruct/compress respirations, vascular
supply, or nerves
 Extra safety precautions for older adults, patients
who are thin or obese, and anyone with a physical
deformity
 Light restraint before induction in case of
excitement.
Laparotomy Position, Trendelenburg Position, Lithotomy
Position and Side-Lying Position for Kidney Surgery

Light
restraints
Types of anesthesia
 Intraoperative Complications

• Anesthesia awareness • Infection

• Nausea, Vomiting: Turn pt to • Malignant hyperthermia: is
side, suction, Antiemetics a rare life threatening condition,
induced by anesthetic agents.
• Anaphylaxis: can occur in (inherited muscle disorder
response to many medications, characterized by muscle
latex, or other contraction that can overwhelm
the body’s capacity to supply
• Hypoxia, respiratory oxygen, remove CO2, and
complications regulate body temperature
leading to circulatory collapse
• Hypothermia: pt’s temperature and death if untreated).
may fall. Glucose metabolism is Tachycardia (heart rate
reduced, and as a result, metabolic greater than 150 bpm) may be
acidosis may develop. This an early sign.
condition is indicated by a core
body temperature that is lower
than normal (36.6°C [98°F] or
less).
Adverse Effects of Surgery and Anesthesia

• Allergic reactions, drug toxicity or reactions

• Cardiac dysrhythmias
• CNS changes, oversedation, undersedation
• Trauma: laryngeal, oral, nerve, skin, including burns
• Hypotension
• Thrombosis
 Nursing Process: Interventions

• Reducing anxiety
• Reducing latex exposure
• Preventing positioning injuries.
• Protecting patient from injury
• Serving as patient advocate
• Monitoring, managing potential complications
 Protecting the Patient From Injury

• Patient identification • Monitoring, modifying

physical environment
• Correct informed consent
• Safety measures
• Verification of records of (grounding of equipment,
health history, Physical restraints, not leaving a
exam sedated patient)
• Results of diagnostic tests • Verification, accessibility
• Allergies (include latex of blood
allergy)
Phase three: Postoperative Nursing
Management
 Nursing Management in the Post
Anesthesia Care Unit (PACU)

 Provide care for patient until patient has recovered from

effects of anesthesia
o Resumption of motor and sensory function
o Oriented
o Stable VS
o Shows no evidence of hemorrhage or other
complications of surgery
 Vital to perform frequent skilled assessment of patient
 Admitting the patient to PACU

• Transferring the postoperative patient from the OR to

PACU is the responsibility of the anesthesiologist or
anesthetist.
• The anesthesia provider remains at the head of streacher
(to maintain the airway), surgical team member remains
at the opposite end.
• Patient is covered with lightweight blanket and warmed.
• Raised the side rails to prevent falls.
• The nurse reviews diagnosis, type of surgery, anesthetic
meds., any intraoperative complications, pathology
encountered, IV therapy, any tubing, drains, catheters,
and any special orders.
Types of Surgical Drains
 Postanesthesia Care Unit (Recovery)

• Also called post anesthesia recovery room, located

adjacent to the operating rooms (OR).
• Patients still under anesthesia or recovering placed in
PACU
• PACU environment
• Beds, other equipment
• Three Phases:
– Phase I PACU: used during immediate recovery phase
– Phase II: patient is prepared for self-care or care in
the hospital.
– Phase III: patients is prepared for discharge.
 Postoperative Nursing Care

• Immediate postoperative care:

– Assess airway and breathing
– Monitor vital signs and surgical site
– Assess mental status, level of consciousness
– Emotional support
– Assess and manage hydration status
– Assess pain level
Immediate Postoperative Nursing Interventions
 Responsibilities of the PACU Nurse

• Review pertinent information, baseline assessment upon

admission to unit
• Assess airway, respirations, cardiovascular function,
surgical site, function of CNS, IVs, all tubes and
equipment, Prevent aspiration from excessive secretions
or vomiting. Turn pt to one side and suction if necessary
• Reassess VS, patient status every 15 minutes or more
frequently as needed
• Transfer report, to another unit or discharge patient to
home, refer to Charts 19-1 and 19-3
 Outpatient Surgery/Direct Discharge

• Discharge planning, discharge assessment (see next figure)

• Provide written, verbal instructions regarding follow-up

care, complications, wound care, activity, medications,
diet
• Give prescriptions, phone numbers
– Discuss actions to take if complications occur
• Give instructions to patient, responsible adult who will
accompany patient
• Patients are not to drive home or be discharge to home
alone
– Sedation, anesthesia may cloud memory, judgment
Example of Postanesthesia care unit record; modified Aldrete score
 Nursing Management in the PACU

Maintaining a Patent Airway

• Primary consideration: necessary to maintain
ventilation, oxygenation
• Provide supplemental Oxygen as indicated
• Assess breathing by placing hand near face to feel
movement of air
• Keep head of bed elevated 15 to 30 degrees unless
contraindicated
• May require suctioning
• If vomiting occurs, turn patient to side
Head and Jaw Positioning to Open Airway

Figure 19-1
Use of Oral Airway Note: Do Not Remove Oral
Airway Until Evidence of Gag Reflex Returns

Figure 19-2
 Maintaining Cardiovascular Stability

• Monitor all indicators of cardiovascular status

• Assess all IV lines

• Potential for hypotension, shock

• Potential for hemorrhage

• Potential for hypertension, dysrhythmias

• Refer to Table 19-4

 Indicators of Hypovolemic Shock

• Pallor
• Cool, moist skin
• Rapid respirations
• Cyanosis
• Rapid, weak, thready pulse
• Decreasing pulse pressure
• Low blood pressure
• Concentrated urine
 Relieving Pain and Anxiety

• Assess patient comfort

• Control of environment: quiet, low lights, noise level

• Administer analgesics as indicated; usually short-

acting opioids IV

• Family visit, dealing with family anxiety

 Controlling Nausea and Vomiting

• Intervene at first indication of nausea

• Medications

• Assessment of postoperative nausea, vomiting risk,

prophylactic treatment

• Refer to Table 19-2

Gerontologic Considerations

• Decreased physiologic • Increased likelihood of

reserve postoperative confusion,
delirium
• Monitor carefully,
frequently • Hypoxia, hypotension,
hypoglycemia
• Increased confusion
• Reorient as needed
• Dosage
• Pain
• Hydration
• Refer to Chart 19-7
 Nursing Care of the Postoperative pt in the
Surgical Unit
• Goals: help patient recover from anesthesia, frequent
assessment of physiologic status, monitoring for
complications, managing pain, and helping pt achieve
independence with self-care.
• Managing ventilation: observe for airway patency
and quality of respirations. Auscultation of the chest to
verify normal breathing sounds bilaterally, deep
breathing and coughing exercises, pulse oximetry, and
incentive spirometry.
• Managing hemodynamic stability: Assess for signs
of hemorrhage and shock, intake and output, fluid and
electrolyte balance, and prevent deep venous
thrombosis.
 Nursing Care of the Postoperative pt in the
Surgical Unit
• Assessing and managing the surgical site: observe
for bleeding, type and drains. Excessive amounts of
drainage should be reported to the surgeon.
• Assessing and managing pain
• Assessing neurovascular status
• Assessing and managing Gastrointestinal function
• Assessing and managing voluntary voiding
 Urinary retention can occur because of anesthesia, or
because of pain secondary to abdominal, pelvic or hip
surgery.
 Assess bladder distention and urge to void. If > 8 hrs,
or distended bladder and no urge, catheterization is
recommended.
 Purpose of Postoperative Dressings

• Provide healing environment

• Absorb drainage

• Splint or immobilize

• Protect

• Promote homeostasis

• Promote patient’s physical, mental comfort

 Change the Postoperative Dressing

• First dressing changed by • Applying dressing, taping

surgeon methods
• Types of dressing • Patient response
materials
• Patient teaching
• Sterile technique
• Documentation
• Assess wound
 Complications/ Collaborative Problems

• Pulmonary infection/Hypoxia
• Deep Vein Thrombosis (DVT)
• Hematoma/Hemorrhage
• Pulmonary Embolism (PE)
• Wound dehiscence (A) or
Evisceration (B)
 Nursing Diagnosis

• Activity intolerance
• Impaired skin integrity
• Ineffective thermoregulation
• Risk for imbalanced nutrition
• Risk for constipation
• Risk for urinary retention
• Risk for injury
• Anxiety
• Risk for ineffective management or therapeutic
regimen
Example: Nursing Intervention to prevent
Post operative Complications

• Assess airway, respirations; patient at risk for

ineffective airway clearance every 15 minutes

• Assess VS every 4 hours or as needed, other

indicators of cardiovascular status; patients at
risk for decreased cardiac output related to
shock or hemorrhage.

• Assess pain every 4 hours or per protocol