The nurse on the medical-surgical unit is preparing to receive a hand-off report on a postoperative client from the postanesthesia care unit (PACU) nurse. Which question(s) should the receiving nurse ask the PACU nurse? Select all that apply.

“Does the client require an assistive device?”

“Does the client know how to care for the surgical site?”

“What was the estimated blood loss and total volume of fluids replaced?”

“What is the client’s primary language?”

“What medications have been administered to the client in the PACU?”

Postoperative care: Nursing

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Content Reviewers

Antonia Syrnioti, MD,Lisa Miklush PhD, RN, CNS,Viviana Popa, MD,Gabrielle Proper, RN, BScN, MN

Contributors

Mary Roberts, MSN, RN,Sam Gillespie, BSc,Alaina Mueller

Postoperative care is the management of a client’s health during the postoperative period. This begins right after the surgical procedure is complete, and lasts until the client is discharged from the healthcare facility. Postoperative care promotes the client’s recovery after surgery by managing pain, supporting oxygenation and cardiovascular stability, maintaining fluid balance, providing wound care, monitoring bowel function, assisting with mobility, and preventing complications.

Postoperative care typically begins when the client is transferred from the operating suite to the postanesthesia care unit, or PACU for short. How long they’re being cared for in this setting depends on the client’s health status, the type of procedure, and the type of anesthesia, as well as the rate of progression to alertness and hemodynamic stability. The goal of this phase of care is to stabilize the client for transfer to the next level of care, which could be an intensive care unit or another inpatient care unit; as well as being discharged home in the case of ambulatory surgery. In order for clients to transition to a different level of care, they should meet certain criteria such as responding easily to stimuli, having stable vital signs, and adequate pain control.

Now, the most common complications during the postoperative period include pain, hemorrhage, hypothermia, and infections 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. Clients 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, postoperative ileus, and hiccups; while urinary complications can manifest as urinary retention and urinary tract infections. Finally, fluid and electrolyte imbalances can also occur following surgical procedures.

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POSTOPERATIVE CARE
	KEY POINTS	NOTES
DEFINITION	Management of a patient's health during the postoperative period Following completion of surgical procedure and lasts until discharge Patient starts in post-anesthesia care unit (PACU) Stabilize patient for transfer to the next level of care Must meet certain criteria for responding to stimuli, vital signs, and pain control Common complications Pain Hemorrhage Hypothermia Infections Wound dehiscence or evisceration Respiratory complications Cardiovascular complications Nervous system complications Gastrointestinal complications Urinary complications Fluid and electrolyte imbalances
MANAGEMENT OF CARE	Goals of care Facilitate smooth transition of care Monitor for postoperative complications Provide supportive care Receive handoff report from PACU nurse Intraoperative course Medications administered Anesthesia time Estimated blood loss and fluid replacement Unexpected events Diagnostic tests Check incisional site and dressing Locate drains, tubes, and catheters Check IV site and fluids Medical history Complete a focused assessment Start with respiratory status Encourage coughing, deep breathing, and use of incentive spirometer Report to HCP Signs of airway obstruction Signs of atelectasis Signs of respiratory compromise Administer oxygen as prescribed Assess cardiovascular status Report to HCP Systolic BP <90 or >160 mmHg Heart rate <60 or >120 Narrow pulse pressure Changes in rhythm Administer corrective medications as prescribed Report to HCP Signs of hemorrhage or shock Apply pressure to sites of bleeding Assess peripheral vascular status Apply antiembolism stockings or SCDs Plan early ambulation Administer prophylactic anticoagulants as ordered Report to HCP Signs of venous thromboembolism Signs of pulmonary embolism Assess neurologic status Report to HCP Altered mental status Assess incision site Report to HCP Signs of dehiscence Signs of evisceration Report to HCP Signs of infection or hypothermia Assess fluid intake and output Report to HCP Urinary retention Urine output < 30 mL/h Assess abdomen Distention Bowel sounds Report to HCP Signs of postoperative ileus Manage pain Report to HCP Pain that is not controlled with prescribed analgesics Assess for readiness for discharge
PATIENT AND FAMILY TEACHING	Explain condition, plan of care, and how to safely self-administer medications Avoid driving while taking opioids Keep surgical site clean Pat incision dry after shower Signs of infection Report to HCP Incision red or swollen Increased drainage or bleeding Fever >100.4° F (38° C) Encourage rest Avoiding lifting >10 pounds Encourage hydration and nutrition Attend all follow-up appointments

Postoperative care: Nursing

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