The Postoperative Phase

PACU

Cg Ramlah (2/8/2017)

The postoperative phase

-the postoperative phase of a surgical pt’s perioperative exp bgines after the surgical procedure is completed and the pt is admitted to a post-procedure area (usually PACU ir an intnsive care unit (ICU) or discharged home).

-the goal od postanaesthesia/postprocedure care us ti assist the pt in returning to a safe physiologic evel after having a surgical

The PACU is equipped w sophosticated monitors, equipment, devices and drugs (eg suction, o2, emergency trolley containing emergency drugs) needed for routine postoperaive care, such as supplemental o2, suctining,

-equipment for emergency resuscittion id lose tbhand

-the doctor s ananesthetis from the operating room check ont he condition of the pt freuqently a ca be rwached quicjly when needed

-postoperative pr remains in the pacu until they ahve recovered fromthe anasethasia or able to respond to stimuli aroudn them; this generally take from 2-6 hrous

-criticlalt ill pt are transported directly from the opraring room to te icu ad looked after by the critical care nurse

Postoperative care procedure

-pospoperarv report

=the anaesthasia provider, the dsurgeon and the circulting nurse handover or give a report to the nurse who will care for the fresh posoperatove pt.

-the usual ratio of staff is one neurse per 1-2 pt

Anasthesia provder’s handover/report

-pt name, gender, age, preoprative and postoperative diagnos, surgical pricedure (may differ from the scheduled operation), and surgeon

-type of anaesthesia and pt’s responses

-significant med conditions and interventions to counterac them (eg. Diaberes, COPD, prev myocardial infarction)

-Detais of vital sign: bp, pulse, RT

-allergies and reaction to allergen

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-med adminstered preoperatively, intraoperatively and postoperativl (eg, preoperatve sedation, intraoperative antibx, cont infusion of med) anticipated needs and when the next dose is due

IV fluid administration and body flui output (eg. Blood products, urine, gastric contents, BL)

-the pt anxiety lvl and preoperative

-monitoring req in the recovery room (SPO2)

Surgeon’s report

-postperartiv orders pertaiing to imm treatment or therapies to be performed in the PACU or in the imm poroperative period (eg. Passive range of motion device, radiographic study to check of central lie catheter).

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-specific intervention pertaining t care of the surgical site (eg. Dressing change)

Nursing staff handover include:

-care and placement if drains

-types of dressing and precautions about dressing

-intraoperative urinary catheteruzation and output (note the flow and the output)

-special nursing requirements, such as the position of the pt (lateral position)

-nursing problems such as pressure areas, and psyhoclogical status (eg. Drowsy)

-organization of the pt’s notes

-ensuring corret charts and xray accompany the pt

-personal belongig, such as dentures and hearing aids

Cont care in PACU

>monitoring after admission

Have 2 fucntions:

-to alert the nurse to life-threatening situations (act as a baseline) in order to compare the difference

-to allow the nurse to more easily follow treands in the physiological variables, such a bp, pulse and oxygenation.

Initial assessment

-on admission to the recovery room imm check in the following order the A, B, C, D and Es.

Airways

-make sure the pt has a clear airway, is breathig nd the air is moving freely and quietly in and out of the chest.

-if ecessary gently suck out the pt’s mouth and pharynx. If he is still unconscious make sure an oral airway is properly located between his teeth and tongue, and lips are in no danger

-Administer o2 w a mask. Begin with a flow rate of 6 litres of o2 per min. Attach a pulse oximeter.

Breathing

-check his chest is moving and you can feel air flowing in and out of hi mouth

-look for any sign of cyanosis nd note the reading on the pulse oximeter. If it is reading less than 97% the search for the reason (hypoxia)

Circulation

-only then measure the bp, pulse rate and rhythm and record these observations on the chart.

-the vital signs and bp are monitored and recorded every 15 min intervals.

-A regular observation helps in early recognition of the onset of postoperatve shock, haemorrhage or resp depression.

DRUGS, DRIPS AND DRAINS

-notes drusg given in theatre, particularly analgesics, that may affect the pt’s breathing. Check whether the pt has any allergies (eg morphine), and what drugs he will require while in the recovery room.

-note the IVF in progress, jow much fluid and what type have been given during the operation. Check that the drip is running freely, and is well sited. Maintained precribed rate.

-note drain tubes: with what and how fast they are draiing. Report excessive drainage to the surgeon.

-make sure the urinary catheter is not obstructed, note the contents of the collecting bag. The tubing should be checked for any disconnecting, clamping and kinks which will prevent free flow.

Extras

-if the pt is a diabetic measure his blood glucose or urinary sugars.