POST- OPERATIVE
CARE
Dr. Kamran Ahmad Khattak
Associate Professor Surgery
Post –operative care
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
• Immediate ( Post-anesthetic ) Phase (1)
• Intermediate ( Hospital Stay ) Phase (2)
• Convalescent ( After Discharge To Full Recovery )
Purposes
To enable a successful and faster recovery of the
patient post operatively.
To reduce post-operative mortality rate.
To reduce the length of hospital stay of the
patient.
To provide quality care service.
To reduce hospital and patient cost during
post- operative period.
Post - Operative Care Unit OR
PACU
PACU should be:-
• sound proof
• Painted in soft color
• Isolated
These features will help the patient to
reduce anxiety and promote comfort.
Phase 1
Immediate
(post-anesthetic)
Phase 1
• It is the immediate recovery phase and
requires intensive nursing care to detect early
signs of complications.
• Receive a complete patient record from the
operating room which to plan post operative
care.
• It is designed for care of surgical patients
immediately after surgery and patient
requiring close monitoring.
Nursing management in post
operative care unit
I. 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.
II. Maintaining a patent airway:
− The primary objectives are to maintain pulmonary
ventilation and prevent hypoxia and hypercapenia.
− Provide oxygen, and assesses respiratory rate and
depth, oxygen saturation.
Cont…
III- Maintaining cardiovascular stability:
− 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.
− The primary cardiovascular complications include
hypotension, shock, hemorrhage, hypertension and
dysarrythmias.
Cont…
IV. Relieving pain and anxiety:
− Opioid analgesic.
V. Assessing and managing the surgical site:
− The surgical site is observed for bleeding, type and
integrity of dressing and drains.
VI. Assessing and managing gastrointestinal
function:
− Nausea and vomiting are common after anesthesia.
− Check of peristalsis movement.
Cont…
VII- 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.
Cont..
VIII- 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.
Cont…
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
Acute pulmonary problems
Cardio-vascular problems
Fluid derangements
Preventions
Recovery room :
anesthetist responsibilities towards cardio-
pulmonary functions.
Surgeon’s responsibilities towards the operation site.
Trained nursing staff :-
To handle instructions.
Continuous monitoring of patient (vital signs etc.)
Discharge from recovery should be after
complete stabilization of cardio-vascular,
pulmonary and neurological functions which
usually takes 2-4 hours.
If not special care in icu.
The Intermediate Post-Operative
period
Starts with complete recovery from anaesthesia and lasts for the rest of
the hospital stay.
Care of the
wound
-Epithelialisation takes 48 hs.
-Dressing can be removed 3-4 days after operation.
-Wet dressing should be removed earlier and changed.
-Symptoms and signs of infection should be looked for, which if present
compression, removal of few stitches and daily dressing with swab for
C & S.
-R.O.S. usually 5-7 days Post-Op.
-Tensile strength of wound minimal during first 5 days, then rapid
between 5th 20th day then slowly again (full strength takes 1-2 years).
-Good nutrition.
Management of
drains
--To drain fluids accumulating after surgery, blood or pus.
--Open or closed system.
--Other types (Suction, sump, under water etc.)
--Should be removed as long as no function.
--Should come out throw separate incision to minimize risk of wound
infection.
--Inspection of contents and its amount.
--Soft drains e.g. Penrose should not be left more than 40 days because
they form a tract and acts as a plug.
--
THANKS
