Postoperative Phase of Surgery

The postoperative phase starts when your patient is admitted to the post-anesthesia care unit, or PACU, immediately after surgery and ends when they’ve completely recovered from the surgical procedure.

When caring for your patient during this phase, you’ll promote patient safety by following the steps of the Clinical Judgment Measurement Model to make clinical decisions about patient care.

Okay, as a postoperative nurse, you’ll ensure patient safety by recognizing important cues. These cues can be gathered while receiving report from the operating room nurse and the anesthesia provider as well as during your initial assessment.

Important cues may include indications of your patient’s response to anesthesia, like vital signs, ECG, and airway patency, as well as level of consciousness, IV status, estimated blood loss, and location of drains or dressings.

Other important cues can include indicators of perfusion, such as capillary refill, skin color, and temperature; urine output; and laboratory results such as CBC.

As you perform these assessments, you'll document your patient’s condition using scoring systems like the Post-Anesthetic Discharge Scoring System, or PADSS, which helps the nurse to determine discharge readiness from the PACU.

Next, you’ll analyze cues by determining the relationship between the cues and linking them to your patient’s history and clinical presentation.

You’ll consider whether your patient’s current level of consciousness, quality of respirations, motor ability, and sensation correlate to the type of anesthesia received and the surgical procedure performed.

You'll also determine whether cues are associated with postoperative complications. For instance, you’ll consider whether a patient’s hypoactive bowel sounds are due to slowing of peristalsis secondary to general anesthesia or if it’s related to a paralytic ileus.

Then, you’ll determine a priority hypothesis related to the postoperative phase, such as acute pain, risk for infection, or fluid imbalance.

You’ll rank the hypotheses according to urgency or likelihood, as well as considering whether they are potentially life-threatening, like hypovolemia or sepsis, or immediately life-threatening, like acute respiratory failure or hemorrhage.

Based on this information, you'll address the most serious hypothesis first, and then generate solutions. So, if your patient is experiencing severe pain, you would generate a solution like, my patient’s pain will be managed to an acceptable level within two hours of transfer to the PACU.

Okay, once the solutions have been generated, you'll take action to implement the solutions. For patients with acute pain, administer the prescribed analgesics and perform nonpharmacologic interventions, such as repositioning and application of heat or ice.

Now, if your patient is at risk for infection, you’ll monitor their vital signs, laboratory test results, such as white blood cell count and urinalysis, check their surgical incisions, dressings and drains for signs of infection, and administer the prescribed antibiotics.

If your patient is experiencing fluid imbalance administer prescribed IV fluids, monitor for any signs of continued bleeding, such as hypotension and tachycardia, and measure their intake and output.

Lastly, you'll evaluate whether the expected outcomes have been met by reassessing your patient. For example, you’ll monitor their level of pain to determine whether their condition is improving, declining, or remaining unchanged.

If their condition is declining or hasn’t changed, you’ll revise the plan of care, take additional actions to address your patient’s condition, and document your interventions accordingly.

For example, if you notice your patient is still in moderate pain after intervening, you'll bring this to the attention of the surgical team.

Alright, as a quick recap.... The postoperative phase starts when your patient is admitted to the post-anesthesia care unit, or PACU, immediately after surgery and ends when they’ve completely recovered from the surgical procedure.

When caring for your patient during this phase, you'll go through the steps of the Clinical Judgment Measurement Model to make clinical decisions about patient care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action,