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.