POST OPERATIVE CARE

Mr. Leo DevasiaLeo Home Health Serviceswww.leohomehealth.com

INTRODUCTIONINTRODUCTION The post operative The post operative

period begins from period begins from the time the the time the patient leaves the patient leaves the operating room operating room and ends with the and ends with the follow up visit by follow up visit by the surgeon.the surgeon.

The post operative The post operative care is provided by care is provided by --

PACUPACU SICUSICU

PURPOSESPURPOSES

To enable a successful and faster To enable a successful and faster recovery of the patient post recovery of the patient post operatively.operatively.To reduce post operative mortality To reduce post operative mortality rate.rate.To reduce the length of hospital stay To reduce the length of hospital stay of the patient.of the patient.To provide quality care service.To provide quality care service.To reduce hospital and patient cost To reduce hospital and patient cost during post operative period.during post operative period.

SCOPESCOPEAll the patients who undergoing surgery

Responsibility And Authority

Registered Nurse

POST OPERATIVE CARE UNIT POST OPERATIVE CARE UNIT OROR POST ANESTHETIC CARE POST ANESTHETIC CARE

UNIT[PACU]UNIT[PACU] Patients still under anesthesia or Patients still under anesthesia or

recovering from anesthesia are recovering from anesthesia are placed in the unit for observation by placed in the unit for observation by highly skilled nurses,anesthetist and highly skilled nurses,anesthetist and surgeon.surgeon.

PACU should be sound proof, painted PACU should be sound proof, painted in soft colour, isolated and these in soft colour, isolated and these features will help the patient to features will help the patient to reduce anxiety and promote comfort.reduce anxiety and promote comfort.

PHASES OF POST OP UNITPHASES OF POST OP UNIT

Two phases-Two phases- Phase IPhase I Phase IIPhase II

Phase IPhase I

It is the immediate recovery phase It is the immediate recovery phase and requires intensive nursing care and requires intensive nursing care to detect early signs of complication.to detect early signs of complication.

Receive a complete patient record Receive a complete patient record from the operating room which to from the operating room which to plan post operative care.plan post operative care.

It is designated for care of surgical It is designated for care of surgical patient immediately after surgery patient immediately after surgery and patient requiring close and patient requiring close monitoringmonitoring

Phase IIPhase II

Care of the surgical patient who has Care of the surgical patient who has been transferred from the Phase I been transferred from the Phase I post op unit.post op unit.

Patient requiring less observation Patient requiring less observation and less nursing care than Phase Iand less nursing care than Phase I

This phase is also known as Step This phase is also known as Step down or progressive care unit.down or progressive care unit.

NURSING MANAGEMENT IN POST NURSING MANAGEMENT IN POST OP UNITOP UNIT

To provide care until To provide care until the patient has the patient has recovered from the recovered from the effect of anesthesia.effect of anesthesia.

Assessing the patient Monitor vitals-pulse

volume and regularity, depth and nature of respiration.

Assessment of patient’s O2 saturation.

Skin colour.

KEEP MONITORING VITALSKEEP MONITORING VITALS

Check the level of consciousness.Ability to respond to commands.

MAINTAIN INTAKE AND OUTPUTMAINTAIN INTAKE AND OUTPUT

Protect airway

By proper positioning of patient’s head.

By clearing airway. Oxygen therapy. Pharyngeal obstruction

can occur when the patient lies on the back as there are chances for tongue to fall back.

Maintaining IV StabilityMaintaining IV Stability

Hypovolemic shock: can be avoided by timely administration of IV Fluids, blood and blood products and medication.

Replacement of fluids.[colloids and crystalloids]

Keep the patient warm. Monitor intake and output

balance. Monitor the vitals continuously

with the patient condition.

Shock PositionShock PositionKeep the patient in shock position, flat on back, Keep the patient in shock position, flat on back,

legs elevated at 20 degree+knee kept straightlegs elevated at 20 degree+knee kept straight..

ASSESSMENT OF THE SURGICAL SITEASSESSMENT OF THE SURGICAL SITE Haemorrhage

It is a serious complication of surgery that resulting death.

It can occur in immediate post operatively or upto several days after surgery.

If left untreated,cardiac output decreases and blood pressure and Hb level will fall rapidly.

• Blood transfusion if Blood transfusion if necessary.necessary.

• The surgical The surgical site+incision should site+incision should always be inspected.always be inspected.

• If bleeding,If bleeding,pressurepressure dressing are placed.dressing are placed.

• If the bleeding is If the bleeding is concealed,the patient is concealed,the patient is taken in OR for taken in OR for emergency exploration emergency exploration of concealed of concealed haemorrhage in body haemorrhage in body cavity.cavity.

KEEP THE PATIENT WARMKEEP THE PATIENT WARM Use warmer(Use warmer(Bair Bair

HuggerHugger) blankets) blankets Use warm lightsUse warm lights

Relieving pain +AnxietyRelieving pain +Anxiety Administer opioid Administer opioid

analgesia as per analgesia as per Doctor’s order.Doctor’s order.

Epidural analgesia.Epidural analgesia. NSAIDS.NSAIDS. Psychological support Psychological support

to relieve fear+To to relieve fear+To give support.give support.

Controlling Nausea+VomittingControlling Nausea+Vomitting

These are common These are common problem in post problem in post operative period.operative period.

Medication can be Medication can be administered as administered as per doctor’s order.per doctor’s order.

Example:Example: Inj MetaclopramideInj Metaclopramide Inj OndansetronInj Ondansetron ( Emeset ) ( Emeset )

Discharge from the Post Operative UnitDischarge from the Post Operative Unit

A patient remains in the post op unit, untill the patient A patient remains in the post op unit, untill the patient has fully recoverd from anesthesia.has fully recoverd from anesthesia.

Following measures are used to determine the Following measures are used to determine the patient ready for disharge from post operative unit.patient ready for disharge from post operative unit.

Stable vital signsStable vital signs Orientation to PersonOrientation to Person PlacePlace Time or eventsTime or events Adequate oxygen saturation level.Adequate oxygen saturation level. Urine out put at least 30ml/hourUrine out put at least 30ml/hour Minimal pain.Minimal pain. Adequate respiratory function.Adequate respiratory function. Aldrete score more than ‘ 9 ‘ before shifting fromAldrete score more than ‘ 9 ‘ before shifting from Post Operative Anaesthesia Care Unit Post Operative Anaesthesia Care Unit

ALDRETE SCORE Post-Anesthesia Score A total discharge score of 8-10 is necessary

Post-Anesthesia Score

PRE-ANESTHESIA VITAL SIGNS/SOURCE TIME ADM 15" 30" 45" 1' 2' 3' 4' DISCHARGE

SYSTOLIC BP 20% OF PRE-ANESTHETIC LEVEL 2

CIRCULATION 20-50% 1 > 50 0 FULLY AWAKE 2 CONCIOUSNESS

AROUSABLE ON CALLING 1

NOT RESPONDING 0 WARM, DRY SKIN W/ PREPROCEDURAL

COLORING 2

COLOR PALE, DUSKY, BLOTCHY, JAUNDICED, OTHER 1

CYANOTIC 0 ABLE TO DEEP BREATHE & COUGH FREELY

2

RESPIRATION DYSPNEA OR LIMITED BREATHING APKEIC 1

0 ABLE TO MOVE 4 EXTREMITIES 2 ACTIVITY ABLE TO MOVE 2 EXTREMITIES 1 ABLE TO MOVE 0 EXTREMITIES 0 COMMENTS TOTAL

Teaching, Patient Self CareTeaching, Patient Self Care• Expected out comesExpected out comes• Immediate post Immediate post

operative changesoperative changes• Written instructions Written instructions

likelike

Wound careWound care

Activity+dietary Activity+dietary recommendationrecommendation

MedicationsMedications

Follow upFollow up

THANK YOU