Post-Operative CarePost-Operative Care

ABCDE Assessment and Vital ABCDE Assessment and Vital SignsSigns

Airway – clear & patent? May require an airway adjunct while Airway – clear & patent? May require an airway adjunct while unconscious.unconscious.

Breathing – Monitor respirations for rate, character and Breathing – Monitor respirations for rate, character and symmetry. Osymmetry. O22 therapy until fully conscious and target therapy until fully conscious and target saturations reached.saturations reached.

Circulation – Monitor pulse for rate, volume, character. Monitor Circulation – Monitor pulse for rate, volume, character. Monitor blood pressure.blood pressure.

Disability – Level of Consciousness will initially be low but Disability – Level of Consciousness will initially be low but should rise as anaesthetic dissipates. Monitor blood glucose in should rise as anaesthetic dissipates. Monitor blood glucose in diabetic patients.diabetic patients.

Exposure – Monitor temperature for signs of infection. Monitor Exposure – Monitor temperature for signs of infection. Monitor wound sites (usually not disturbed for first 24hrs) and drain wound sites (usually not disturbed for first 24hrs) and drain sites. Regular pain scoring and analgesia, may also require sites. Regular pain scoring and analgesia, may also require anti-emetics. Maintain comfort.anti-emetics. Maintain comfort.

COMMUNICATION WITH THE PATIENT IS KEY THROUGHOUT!COMMUNICATION WITH THE PATIENT IS KEY THROUGHOUT!

Oxygen TherapyOxygen Therapy

►Oxygen is considered a drug – it must be Oxygen is considered a drug – it must be prescribed.prescribed.

►Oxygen is usually delivered around 4-6l by Oxygen is usually delivered around 4-6l by Hudson mask post-op until anaesthetic has Hudson mask post-op until anaesthetic has dissipated and saturations recover.dissipated and saturations recover.

► Care must be taken to maintain moist Care must be taken to maintain moist mucous membranes and avoid pressure mucous membranes and avoid pressure around the mask and elastic.around the mask and elastic.

► Fire precautions must be taken as Oxygen is Fire precautions must be taken as Oxygen is flammable.flammable.

Specifics of SurgerySpecifics of Surgery

► Each surgery has its own considerations:Each surgery has its own considerations: A range of drains may be used e.g. T-tube drains in A range of drains may be used e.g. T-tube drains in

gall bladder surgery; multiple drains in head and gall bladder surgery; multiple drains in head and neck or breast surgery.neck or breast surgery.

Stoma care may be required after bowel surgery – Stoma care may be required after bowel surgery – colour, size, surrounding skin and activity must be colour, size, surrounding skin and activity must be considered.considered.

Orthopaedic surgery may require extensive physio Orthopaedic surgery may require extensive physio input.input.

Cardiac surgery involves transfer to ITU for 24 Cardiac surgery involves transfer to ITU for 24 hours.hours.

Body image may be affected esp in head and neck, Body image may be affected esp in head and neck, breast, genito-urinary or bowel surgery.breast, genito-urinary or bowel surgery.

IV InfusionsIV Infusions

► IV infusions may be used to replace IV infusions may be used to replace fluids while patient is NBM.fluids while patient is NBM.

►Additional constituents may be GKI for Additional constituents may be GKI for diabetics, Potassium or antibiotics.diabetics, Potassium or antibiotics.

►Fluids must be prescribed and charted Fluids must be prescribed and charted and care taken esp with patients with and care taken esp with patients with heart failure who may suffer overload.heart failure who may suffer overload.

Blood TransfusionsBlood Transfusions

► Student Nurses may not take part in blood Student Nurses may not take part in blood transfusions except for monitoring vital signs.transfusions except for monitoring vital signs.

► Blood transfusions are usually given when Hb Blood transfusions are usually given when Hb < 8 or blood loss over 30% (approx 1500mls)< 8 or blood loss over 30% (approx 1500mls)

► Blood must be appropriate to the individual to Blood must be appropriate to the individual to avoid reactions and ‘group and save’ must be avoid reactions and ‘group and save’ must be within a week or redone.within a week or redone.

► Transfusion reactions usually take place within Transfusion reactions usually take place within 15 minutes of start.15 minutes of start.

Pain AssessmentPain Assessment

► Assessment of pain is fundamental to managing Assessment of pain is fundamental to managing pain successfully. It is a crucial part of nursing care pain successfully. It is a crucial part of nursing care and should be carried out at regular intervals and should be carried out at regular intervals following surgery.following surgery.

► Pain assessment can involve:Pain assessment can involve: Observation- looking for non-verbal signs such as guarding, Observation- looking for non-verbal signs such as guarding,

bracing or even lying perfectly still. Non-verbal clues are bracing or even lying perfectly still. Non-verbal clues are important when nursing unconscious patients.important when nursing unconscious patients.

Communication- talking to the patient and asking them Communication- talking to the patient and asking them questions like where is your pain? What makes it worse? questions like where is your pain? What makes it worse? Describe the type of pain- sharp, dull, stabbing etc.Describe the type of pain- sharp, dull, stabbing etc.

Assessment tools- Pain scales, Smiley faces etc. Assessment tools- Pain scales, Smiley faces etc.

Pain Assessment ToolsPain Assessment Tools

Wong-Baker Visual Recognition Scale

Numerical Recognition Scale

Pain Assessment ToolsPain Assessment Tools

Abbey Pain Scale (Dementia)

WHO Pain Ladder

Pain ManagementPain Management► Effective pain management rely’s on a good nurse/ patient Effective pain management rely’s on a good nurse/ patient

relationship. relationship. ► Pain can be managed with the use of medication e.g. Weak/ Pain can be managed with the use of medication e.g. Weak/

Strong Opioids, paracetamol etc. It very much depends on the Strong Opioids, paracetamol etc. It very much depends on the type of surgery. The route of administration needs to be type of surgery. The route of administration needs to be considered, as you cannot give oral meds to an unconscious considered, as you cannot give oral meds to an unconscious patient. patient.

► Certain surgeries use PCA, which allows the patient to have Certain surgeries use PCA, which allows the patient to have more control. This is not suitable for all surgeries and needs to more control. This is not suitable for all surgeries and needs to be monitored very closely.be monitored very closely.

► Patient’s pain may be managed with positional changes; Patient’s pain may be managed with positional changes; getting them up to sit when appropriate may help.getting them up to sit when appropriate may help.

► There is a specialised pain services team which can offer There is a specialised pain services team which can offer advice about the best way to manage a patients’ pain. They advice about the best way to manage a patients’ pain. They also offer educational services to health professionals and also offer educational services to health professionals and audit and evaluate the care that is given.audit and evaluate the care that is given.

Pain ManagementPain Management

► There are alternative methods regarding pain There are alternative methods regarding pain management that may be used after discharge-management that may be used after discharge-

► * Relaxation (in/out patient)* Relaxation (in/out patient)► * Massage* Massage► * Heat/ cold packs* Heat/ cold packs► * Hypnosis* Hypnosis► * Acupuncture* Acupuncture► Post-operative pain is managed by nurses, Post-operative pain is managed by nurses,

surgeons, anaesthetists and physio’s, it is very surgeons, anaesthetists and physio’s, it is very much a team effort. It should also be noted that much a team effort. It should also be noted that treatment must be tailored to the individual and treatment must be tailored to the individual and preventing pain should be the main goal.preventing pain should be the main goal.

MobilityMobility► If the patient is on bed rest as first you would be looking If the patient is on bed rest as first you would be looking

at positional changes and pressure relieving devices, at positional changes and pressure relieving devices, with the use of passive exercise ie. lifting and bending with the use of passive exercise ie. lifting and bending patients legs.patients legs.

► Encourage early mobilisation as this prevents Encourage early mobilisation as this prevents complications such as pressure damage and deep vein complications such as pressure damage and deep vein thrombosis, also promoting the patient’s independence thrombosis, also promoting the patient’s independence again as well. again as well. However only if their overall medical However only if their overall medical condition allows.condition allows.

► Mobilisation and multi-disciplinary team rehab should Mobilisation and multi-disciplinary team rehab should begin within 24 hours.begin within 24 hours.

► Initial emphasis should be on walking and the activities Initial emphasis should be on walking and the activities of daily living such as transferring, washing, dressing of daily living such as transferring, washing, dressing and toileting.and toileting.

► You should be assessing a patient’s balance and gait You should be assessing a patient’s balance and gait and if any pain on movement.and if any pain on movement.

MobilityMobility

► Since the patient’s condition has changed you Since the patient’s condition has changed you would need to update appropriate risk would need to update appropriate risk assessments. assessments.

► You should bear in mind a patient’s previous You should bear in mind a patient’s previous mobility before the operation. Such as the use of mobility before the operation. Such as the use of walking aids and make them available for use.walking aids and make them available for use.

► The physiotherapist would be involved with active The physiotherapist would be involved with active daily exercises, strengthening muscles and joints daily exercises, strengthening muscles and joints and can devise a patient rehab plan - giving advice and can devise a patient rehab plan - giving advice and patient education.and patient education.

► The occupational therapist could also be involved to The occupational therapist could also be involved to provide aids and prepare the patient for discharge provide aids and prepare the patient for discharge home.home.

Psychological IssuesPsychological Issues► Easily tiredEasily tired► Inability to concentrate e.g. unable to concentrate effectively Inability to concentrate e.g. unable to concentrate effectively

whilst reading a book or newspaper.whilst reading a book or newspaper.► Memory dysfunction e.g. reduced ability to remember things Memory dysfunction e.g. reduced ability to remember things

recently said or done.recently said or done.► Reduced ability to perform arithmetic Reduced ability to perform arithmetic ► Highly confused e.g. hallucinations due to medication on for Highly confused e.g. hallucinations due to medication on for

pain management.pain management.► Behavioural problems- more aggression due to increased Behavioural problems- more aggression due to increased

confusion after surgery.confusion after surgery.► Self-esteem issuesSelf-esteem issues► Body image issuesBody image issues► DepressionDepression► Sexuality issuesSexuality issues