osLoperaLlve nurslng

ManagemenL
8ellle u CasLro 8n
osLoperaLlve nurslng ManagemenL
W 1he posLoperaLlve perlod exLends from Lhe Llme Lhe
paLlenL leaves Lhe operaLlng room unLll Lhe lasL
followup vlslL wlLh Lhe surgeon
W 1hls perlod may be as shorL as 1 week or as long as
several monLhs
W Careful assessmenL and lmmedlaLe lnLervenLlon
asslsL Lhe paLlenL ln reLurnlng Lo opLlmal funcLlon
qulckly safely and as comforLably as posslble
osLoperaLlve nurslng ManagemenL
W uurlng Lhe posLoperaLlve perlod nurslng care
focuses on
reesLabllshlng Lhe paLlenL's physlologlc
equlllbrlum
allevlaLlng paln
prevenLlng compllcaLlons
Leachlng Lhe paLlenL
selfcare
osLprocedural CheckllsL
W lor Lhe perloperaLlve nurse Lhe care of Lhe
surglcal paLlenL does noL end wlLh Lhe
concluslon of Lhe surglcal procedure buL
conLlnues Lhrough Lo Lhe lmmedlaLe
posLoperarlve phase LhaL ls Lransfer of Lhe
paLlenL Lo Lhe osLanesLhesla Care unlL
(ACu)
osLprocedural CheckllsL
W 8efore Lhls Lransfer Lhls Lransfer ls accompllshed however
Lhe followlng acLlvlLles should be compleLed by Lhe
perloperaLlve nurse
1 lnLraoperaLlve documenLaLlon and charges are compleLed and
recelved for accuracy
2 Speclmens are properly ldenLlfled labeled and placed ln Lhe
approprlaLe conLalners
3 Speclal equlpmenL for Lhe posLanesLhesla area requesLed by
Lhe anesLheslologlsL or nurse anesLheLlsL has been
communlcaLed Lo approprlaLe personnel
4 aLlenL ls moved Lo a recovery bed and LransporLed Lo Lhe
ACu
3 verbal/wrlLLen reporLs are glven Lo Lhe approprlaLe ACu
nurse upon arrlval Lo Lhe unlL
1he osLanesLhesla Care unlL
W 1he postanesthes|a care un|t (ACU) also called Lhe
posLanesLhesla recovery room ls locaLed ad[acenL Lo
Lhe operaLlng rooms
W aLlenLs sLlll under anesLhesla or recoverlng from
anesLhesla are placed ln Lhls unlL for easy access Lo
experlenced hlghly skllled nurses
anesLheslologlsLs or anesLheLlsLs
surgeons
advanced hemodynamlc and pulmonary monlLorlng and
supporL
speclal equlpmenL and medlcaLlons
1he osLanesLhesla Care unlL
W 1he ACu
ls kepL quleL clean and free of unnecessary equlpmenL
ls palnLed ln sofL pleaslng colors
has lndlrecL llghLlng
has a soundproof celllng
has equlpmenL LhaL conLrols or ellmlnaLes nolse (eg plasLlc
emesls baslns rubber bumpers on beds and Lables)
ls lsolaLed buL vlslble quarLers for dlsrupLlve paLlenLs
should be well venLllaLed
W 1hese feaLures beneflL Lhe paLlenL by helplng Lo
decrease anxleLy and promoLe comforL
1he osLanesLhesla Care unlL
W 1he ACu bed
provldes easy access Lo Lhe paLlenL
ls safe and easlly movable
can be readlly placed ln poslLlon Lo faclllLaLe use of
measures Lo counLeracL shock
has feaLures LhaL faclllLaLe care such as
lnLravenous (lv) poles slde ralls wheel brakes
and a charL sLorage rack
AdmlLLlng Lhe aLlenL Lo Lhe ACu
W 1ransferrlng Lhe posLoperaLlve paLlenL from Lhe
operaLlng room Lo Lhe ACu ls Lhe responslblllLy
of Lhe anesLheslologlsL or anesLheLlsL
W uurlng LransporL from Lhe operaLlng room Lo Lhe
ACu Lhe anesLhesla provlder remalns aL Lhe
head of Lhe sLreLcher (to ma|nta|n the a|rway)
and a surglcal Leam member remalns aL Lhe
opposlLe end
AdmlLLlng Lhe aLlenL Lo Lhe ACu
W 1ransporLlng Lhe paLlenL lnvolves speclal
conslderaLlon of Lhe lnclslon slLe poLenLlal
vascular changes and exposure
W As soon as Lhe paLlenL ls placed on Lhe sLreLcher
or bed Lhe solled gown ls removed and replaced
wlLh a dry gown
W 1he paLlenL ls covered wlLh llghLwelghL blankeLs
and warmed 1he slde ralls are ralsed Lo guard
agalnsL falls
AdmlLLlng Lhe aLlenL Lo Lhe ACu
W 1he nurse who admlLs Lhe paLlenL Lo Lhe ACu revlews
Lhe followlng lnformaLlon wlLh Lhe anesLheslologlsL or
anesLheLlsL
1 Medlcal dlagnosls and Lype of surgery performed
2 erLlnenL pasL medlcal hlsLory and allergles
3 aLlenL's age and general condlLlon alrway paLency vlLal
slgns
4 AnesLheLlcs and oLher medlcaLlons used durlng Lhe
procedure (eg oplolds and oLher analgeslc agenLs
muscle relaxanLs anLlbloLlc agenLs)
3 Any problems LhaL occurred ln Lhe operaLlng room LhaL
mlghL lnfluence posLoperaLlve care (eg exLenslve
hemorrhage shock cardlac arresL)
AdmlLLlng Lhe aLlenL Lo Lhe ACu
6 aLhology encounLered (lf mallgnancy ls an lssue
durlng surgery Lhe nurse needs Lo know wheLher
Lhe paLlenL and/or famlly have been lnformed)
7 lluld admlnlsLered esLlmaLed blood loss and
replacemenL flulds
8 Any Lublng dralns caLheLers or oLher supporLlve
alds
9 Speclflc lnformaLlon abouL whlch Lhe surgeon
anesLheslologlsL or anesLheLlsL wlshes Lo be noLlfled
(eg blood pressure or hearL raLe below or above a
speclfled level)
hases of osL AnesLhesla Care
hase l ACu
W lmmedlaLe recovery phase lnLenslve nurslng care ls
provlded
hase ll ACu
W paLlenLs who requlre less frequenL observaLlon and
nurslng carealso referred as S1Ldown SlLup or
progresslve CareunlLs
nurslng ManagemenL ln Lhe ACu
W 1C provlde nurslng care unLll Lhe paLlenL has
recovered from Lhe effecLs of AnLS1PLSlA
8esumpLlon of MoLor and Sensor y luncLlon
CrlenLed
Pas sLable vlLal Slgns
Shows no evldence of Pemorrhage
Assesslng Lhe aLlenL
aLenL Alrway
Cardlovascular luncLlon
CondlLlon of Lhe surglcal slLe
luncLlon of Lhe CenLral nervous SysLem
Pypopharyngeal CbsLrucLlon
W Slgns
Choklng
nolsy and lrregular resplraLlons
C2 SaLuraLlon Scores
Cyanosls
W 8ecause movemenL of Lhe Lhorax and Lhe
dlaphragm does noL necessarlly lndlcaLe LhaL Lhe
paLlenL ls breaLhlng Lhe nurse needs Lo place Lhe
palm of Lhe hand aL Lhe paLlenL's nose and mouLh
Lo feel Lhe exhaled breaLh
Pypopharyngeal CbsLrucLlon
Pypopharyngeal CbsLrucLlon
W 18LA1MLn1 lC8 P?CPA8?nCLAL C8S18uC1lCn
use of an alrway Lo prevenL resplraLory dlfflculLy afLer
anesLhesla
1he alrway passes over Lhe base of Lhe Longue and permlLs
alr Lo pass lnLo Lhe pharynx ln Lhe reglon of Lhe eplgloLLls
aLlenLs ofLen leave Lhe operaLlng room wlLh an alrway ln
place
1he alrway should remaln ln place unLll
Lhe paLlenL recovers sufflclenLly Lo breaLhe normally
As Lhe paLlenL regalns consclousness Lhe alrway usually
causes lrrlLaLlon and should be removed
Pypopharyngeal CbsLrucLlon
Shock
W Classlc SlCnS of SPCCk
allor
Cool molsL skln
8apld breaLhlng
Cyanosls of Lhe llps gums and Longue
8apld weak Lhready pulse
dec pulse pressure
dec blood pressure and concenLraLedurlne
Shock
W nursg ln1L8vLn1lCns for SPCCk
rlmary vCLuML 8LLACLMLn1
W lnfuslon of lacLaLed 8lnger's SoluLlon
W poslLlon aLlenL flaL on bed wlLh legs elevaLed aL 20
and knees sLralghL
W Speclal conslderaLlons for !LPCvAP's wlLness or Lhose
who decllne blood Lransfuslons
nausea and vomlLlng
W 1urn paLlenL Lo Lhe one slde Lo promoLe
mouLh dralnage prevenL asplraLlon of
vomlLus (can cause asphyxlaLlon and deaLh)
W AnLlemeLlcs
CndanseLron (Zofran)
uroperldol (lnapslne)
MeLoclopromlde(8eglan)
romeLhazlne(henergan)
8eadlness for ulSCPA8CL from Lhe
ACu
4 SLable vlLal SlCnS
4 CrlenLaLlon Mlnlmal aln
4 uncompromlsed ulmonary lxn
4 AdequaLe C2 saL levels
4 urlne CuLpuL aL leasL 30ml/hr
4 n v under conLrol
AldreLe Scorlng
W Many hosplLals use a scorlng sysLem (eg AldreLe score)
Lo deLermlne Lhe paLlenL's general condlLlon and
readlness for Lransfer from Lhe ACu
W 1he paLlenL ls assessed aL regular lnLervals (eg every
13 or 30 mlnuLes) and Lhescore ls LoLaled on Lhe
assessmenL record
W aLlenLs wlLh a score lower Lhan 7 musL remaln ln Lhe
ACu unLll Lhelr condlLlon lmproves or Lhey are
Lransferred Lo an lnLenslve care area dependlng on
Lhelr preoperaLlve basellne scores
osLoperaLlve Care
l lmmedlaLe posLoperaLlve sLage
1he perlod of 14 hours afLer surgery
8esplraLory SysLem
MonlLor vlLal slgns
MonlLor lrway paLency and adequaLe venLllaLlon
because prolonged venLllaLlon durlng anesLhesla may
affecL posLoperaLlve lung funcLlon
8emember LhaL exLubaLed cllenLs who are leLharglc
may noL be able Lo malnLaln an alrway
MonlLor for secreLlons lf cllenL ls unable Lo clear Lhe
alrway by coughlng sucLlon Lhe secreLlons from Lhe
cllenL's alrway
Cbserve chesL movemenL for symmeLry and Lhe use of
accessory muscles
8esplraLory SysLem
MonlLor oxygen admlnlsLraLlon lf prescrlbed
MonlLor pulse oxlmeLry
Lncourage deep breaLhlng and coughlng exerclses as soon
as posslble
noLe Lhe raLe depLh and quallLy of resplraLlons Lhe 88
should be greaLer Lhan 10 and less Lhan 30 breaLhs/mln
Assess breaLh sounds sLrldor wheezlng or crowlng can
lndlcaLed pasrLlal obsLrucLlon bronchospasm
laryngospasm crackles or rhonchl may lndlcaLe pulmonary
edema
MonlLor slgns of aLelecLasls pneumonla or pulmonary
embosllsm
Cardlovascular SysLem
Assess Lhe skln and check caplllary reflll
Assess for perlpheral pulses
Assess for perlpheral edema
MonlLor for bleedlng
Assess pulse for raLe and rhyLhm a boundlng
pulse may lndlcaLe hyperLenslon fluld overload
or exclLemenL
MonlLor for cardlac dysrhyLhmlas
Assess for Poman's slgn parLlculary ln cllenLs
poslLloned ln llLhoLomy poslLlon durlng surgery
MusculoskeleLal SysLem
Assess Lhe cllenL for movemenL of Lhe exLremlLles
8evlew physlclan's orders regardlng cllenL poslLlonlng
or resLrlcLlons
unless conLralndlcaLed place cllenL ln a low lowler's
poslLlon afLer surgery Lo lncrease slze of Lhe Lhorax for
lung expanslon
Avold poslLlonlng Lhe cllenL ln a suplne poslLlon unLll
pharyngeal reflexes have reLurned
lf Lhe cllenL ls comaLose or semlcomaLose poslLlon on
Lhe slde and keep an oral alrway ln place
neurologlcal SysLem
Assess level of consclousness
lrequenL perlodlc aLLempLs Lo awaken Lhe cllenL
should conLlnue unLll Lhe cllenL awakens
CrlenL Lhe cllenL Lo envlronmenL
Speak ln a sofL Lone fllLer ouL exLraneous nolses ln
Lhe envlronmenL
MalnLaln body LemperaLure and prevenL heaL loss
by provldlng Lhe cllenLs wlLh warm blankeLs and
ralslng Lhe room LemperaLure as necessary
1emperaLure ConLrol
MonlLor LemperaLure
MonlLor for slgns of hypoLhermla LhaL may resulL
from anesLhesla a cool operaLlng room or
exposure of Lhe skln and lnLernal organs durlng
surgery
Apply warm blankeLs and conLlnue oxygen as
prescrlbed lf Lhe cllenL ls shlverlng
lnLegumenLary SysLem
Assess surglcal slLe dralns and wound dresslngs
MonlLor for and documenL any dralnage or
bleedlng from surglcal slLe
Assess skln for redness abraslons or breakdown
LhaL may have resulLed from surglcal poslLlonlng
lluld and LlecLrolyLe 8alance
MonlLor lv admlnlsLraLlon as prescrlbed
8ecord lnLake and ouLpuL
MonlLor for slgns of hypocalcemla hyperglycemla
and meLabollc or resplraLory acldosls or alkalosls
CasLrolnLesLlnal SysLem
MonlLor for nausea and vomlLlng
MalnLaln paLency of nC1 lf presenL
MonlLor for abdomlnal dlsLensLlon
MonlLor for reLurn of bowel sounds
8enal SysLem
Assess for bladder for dlsLenLlon
MonlLor color quanLlLy and quallLy of urlne
ouLpuL lf a loley caLheLer ls presenL
LxpecL Lhe cllenL Lo vold 68 hours afLer Lhe
surglcal procedure dependlng on Lhe Lype of
anesLhesla admlnlsLered
aln managemenL
Assess for paln
Assess Lhe Lype anesLheLlc used and preoperaLlve
medlcaLlon LhaL Lhe cllenL recelved and noLe weLher Lhe
cllenL recelved any paln medlcaLlons ln Lhe posLaneLhesla
perlod
lnqulre abouL Lhe Lype and locaLlon of paln
Ask Lhe cllenL Lo raLe Lhe degree of paln on a scale of 1 Lo
10 wlLh 10 belng Lhe mosL severe
MonlLor for ob[ecLlve daLa relaLed Lo paln such as faclal
expresslons body gesLures lncreased pulse raLe lncreased
blood pressure ad lncreased resplraLlons
lnqulre abouL Lhe effecLlveness of Lhe lasL paln medlaLlon
AdmlnlsLer paln medlcaLlon as prescrlbed
aln managemenL
Lnsure LhaL a cllenL wlLh a cllenL conLrolled analgesla
pump undersLands how Lo use lL
lf a narcoLlc has been prescrlbed durlng Lhe lnlLlal
admlnlsLraLlon assess Lhe cllenL every 30 mln for 88
and paln rellef
use nonlnvaslve measures Lo relleve posLoperaLlve
paln lncludlng dlsLracLlon comforL measures
poslLlonlng backrubs and provldlng a quleL and resLful
envlronmenL
uocumenL effecLlveness of paln medlcaLlon and
nonlnvaslve paln rellef measures