Postoperative Care

Postoperative care is the management of a patient’s health during the postoperative period. This typically begins when the patient is transferred from the operating suite to the post-anesthesia care unit, or PACU for short, and lasts until the patient is discharged from the health care facility.

Now, the most common complications during the postoperative period include pain, hemorrhage, hypothermia, and infection at the site of the surgery, called surgical site infection, or SSI for short, as well as wound dehiscence and evisceration.

There can also be respiratory complications, like airway obstruction, laryngospasm, pneumonia, atelectasis, and pulmonary embolism.

Cardiovascular complications can also occur, such as hypotension, hypertension, and dysrhythmias. Patients can also develop nervous system complications, including delirium and delayed emergence from anesthesia.

On the other hand, gastrointestinal complications include postoperative nausea and vomiting, constipation, and postoperative ileus; while urinary complications can manifest as urinary retention and urinary tract infections.

Finally, fluid and electrolyte imbalances can also occur. Okay, let’s look at the care you’ll provide to your patient during the postoperative period.

Your priority goals of care are to promote your patient’s recovery by managing pain, supporting oxygenation and cardiovascular stability, maintaining fluid balance, providing wound care, monitoring bowel function, and preventing complications.

First, obtain a handoff report from the PACU nurse. Then, perform an initial assessment of your patient’s incision site, dressings, and surgical drains, and perform dressing changes, wound care, and maintain patency and suction of surgical drains, as needed.

Also check their IV site, as well as the IV solutions, and infusion rate. Then, begin a focused assessment by taking a full set of vital signs.

Assess their pain, administer the prescribed analgesics, as needed, and encourage nonpharmacologic pain management techniques such as relaxation and distraction.

Then, monitor their level of consciousness, orientation, and ability to follow simple commands, and check sensation and ability to voluntarily move their extremities.

Move on to their respiratory status next. Auscultate their lung sounds, and institute measures to prevent atelectasis by encouraging them to take deep breaths.

Also show them how to splint their incision while coughing and assist them to change position regularly to promote chest expansion and perfusion to their lungs.

Then, assess their cardiovascular status. Watch for signs of hemorrhage or shock, such as a weak, rapid, thready pulse; hypotension; or cool, clammy skin.

Also assess their peripheral vascular status, and apply antiembolism stockings or sequential compression devices, as indicated.

Plan early ambulation to promote venous return; and administer prophylactic anticoagulants as prescribed. Also remember to monitor them closely for signs of infection, including a temperature above 100.4°F or 38°C; chills; and increased drainage; as well as warmth, tenderness, or swelling around the incision site.

Provide cooling measures, obtain cultures, administer the prescribed antipyretics and antibiotics; and monitor them closely for sepsis.

On the other hand, if your patient’s temperature is less than 96.8°F or 36°C, apply warmed blankets, and continue to monitor their temperature and level of comfort.

Be sure to monitor your patient’s fluid intake and output. If urine retention occurs, perform a bladder scan.

If the bladder is full, perform a straight catheterization as prescribed, and continue to monitor their fluid balance closely.

Next, check their abdomen for distention, auscultate for the return of bowel sounds, and watch for the presence of postoperative nausea and vomiting.

Administer the prescribed antiemetics and keep suctioning equipment and an emesis basin nearby. When peristalsis returns, advance their diet as tolerated.

Now, when your patient is ready for discharge, teach them about any newly prescribed medications, and ensure they know why they’re prescribed, as well as how and when to take them.

Next, teach them to keep their surgical site clean and dry; and advise them to avoid removing paper strips, staples, or sutures.

Let them know when they may take a shower and instruct them to gently pat their incision dry afterwards. Remind them not to scrub the incision, and to avoid submerging their incision.

Also remind them to watch for signs of infection and instruct them to contact their health care provider immediately if their incision becomes red or swollen; if there's increased drainage or bleeding from their incision, or if they have a fever of 100.4°F or 38°C or greater.

Be sure to encourage them to get plenty of rest and provide guidance on how to increase their activity as tolerated. Also remind them to avoid lifting anything heavier than 10 pounds.

Encourage them to drink enough fluids to keep their urine light yellow, and to choose nutritious foods that are high in protein, fiber, and calories.

Finally, emphasize the importance of attending all their follow-up appointments. Alright, as a quick recap… Postoperative care is the management of a patient’s health during the postoperative period.

Complications that could occur during the postoperative period include pain; hemorrhage; infection; atelectasis; postoperative nausea, vomiting, or ileus; and urinary retention.

Nursing considerations are focused on facilitating a smooth transition from the PACU and close monitoring to prevent complications.

Patient teaching centers around self-care at home and when to