Postoperative Nursing management

By: Omimah QadhiKSU/SON

Postoprative Nursing acre

1. Maintaining patent airway (why??).

Head @ side, deep breathing, coughing, and IS.

Position changing Q 2 hours, activities as tolerated and prescribed.

Assess breath sounds.

Contd,

2. Maintain circulation

3. Maintain fluid and electrolytes.

Elastic stocking for ↑ risk for thrombosis.

Encourage bed exercises and ambulation as prescribed.

Monitor intake & output (1200 ml output).

IVFs, body weight, encourage oral intake, ↑protein.

Contd,

4. Maintain nutrition.

5. Promote activity.

6. Promote comfort.

7. Teach patient

↑ protein and ↑ vit. C, carbohydrate, frequent meals for anorexia.

Leg exercises, ADLs, reassume ambulation as permitted.

Pain relieve, expressing.

Self care, diet, activities,

Postoprative com;ications

1. C.V.S. (shock, hemorrhage, DVT, phlebities.

2. Pulmonary: atelectasis, pneumonia, aspiration, embolism.

3. G.I.T. : conception, paralytic ileus, intistinal obstruction.

4. Urinary sys. : urinary retention, urinary tract infection (UTI).

5.

Contd,

5. Wound: infection, hematoma, hemorrhage, delay healing, rupture.

6. Psychological: delirium, stroke.

Posop. Devices

Drains, chest tubes,

Contd,

Hematoma

Shock

Its serious condition postoperatively. Definition: inadequate cellular

perfusion and inadequate cellular oxygenation that lead to a build up of waste (byproducts) from metabolism (unarorobic) .

Types:

Hypovolemic. Cardiogenic. Nurogenic= septic Anaphylactic = distributive.

We will ONLY discuss hypovelemia:

Cause: ↓ fluid volume ( include blood, plasma, body fluids e.g. prolonged vomiting or diarrhea).

What are the manifestations ??• V/S:(↓ arterial blood pressure, weak

pulse, ↑respiration.• Skin: pale, cool, moist.• Urinary: oliguria & concentrated urine

why ?? think

Contd,

Nuerologic: Change in LOC. What ??? C.V.S. : ↓ CVP (central Venus pressure)

what ??. Psychological: anxiety.

management

Airway patent (why) think ?? blood and fluids replacement (why) ?? Indwelling urethral catheter. Central line (CVP).Nurse`s role: • Give O2 • Trendelenburg position (why)?

Contd,

• Maintain body temprature (warm) NO HEATING.

• IVFs.• V/S & CVP q 15 minutes.• Maintain urinary output.• Input & output monitoring.• Emotional support.

Heamorrage

Types : 1. Primary: operation.2. Intermediate or reactionary: first few

hours post surgery.3. Secondary: sometimes after the

operation because of infection or insecure tying. It can be seen and on the surface (external or evident) if not seen its called (concealed or internal).

Further calssification:

This classification is according to the kind of the vessel bleeding:

1. Capillary hemorrhage: slow, general ooze.

2. Venous hemorrhage: bubbles, dark.3. Arterial hemorrhage: bright, spurts

with each heart beat.

Manifestation:

According to the amount and the rapidity.↓ temperature, ↑ pulse, ↑ respiration

(deep, air gasping) , ↓ blood pressure, cold, moist, & pale skin, rapid ↓ hemoglobin, thirsty, apprehension & restlessness.

Management:

Shock position. Observe the wound for bleeding. Pressure dressing on the bleeding

wound. Elevate bleeding part when possible. Blood transfusion. V/S q 15 minutes. Sedation or narcotic if indicated.

Circulatory problems:

1. Thrombophlebitis: ( thrombosis in diseased vein). It could be mild or sever inflammation of the vein associated with clot formation.

Causes: 2. Concentrated blood.3. Prolonged immobility & obesity.4. Direct Pressure.

Contd,

4. Injury to the vein. Manifestations of thrombophlebites:

Painful calf muscle & tenderness.Swelling & warmth or heat.? Fever.

phlebothrombosis

Its thrombosis in a healthy vein. Clot without inflammation in a vein.

Common where ?? Calf muscles.Manifestations: Pain & tenderness in calf muscle. Homan`s sign. Slight edema in foot, ankle, or calf. ↑ pulse rate, mild fever.

Contd, Its dangerous because the clot can

dislodged and form an ambolus e.g. P.E.

Nursing Management of BOTH

Prevent or stop the clot formation: ( IVFs post op, ambulation, leg exercise, NO ELEVATION may cause knee constriction.

Active treatment: anticoagulant agents, bed rest and elevation of the affected part, elastic stocking.

Pulmonary embolism (PE)

Commonly caused by dislodgment of a thrombus from a vein in the leg.

Manifestations: • SOB, tachycardia, cyanosis, stabbing C.P.,

tachypnea, anxiety. how it could be prevented??By preventing the formation of thrombosis

(ambulation, leg exercise, early detection of

DVT or any thrombosis)

Respiratory complication:

1) Atelectasis: collapse of some alveoli or may be the entire lung.

2) Bronchitis.3) Bronchopneumonia.4) Hypostatic pulmonary congestion.5) Pleuristy.

Nursing manegment:

Prevention: pre op deep breathing and coughing exercise, hydration, positioning (semi prone or lateral) in recovery room, suctioning, isolate from ppl with res. Problems, ambulation, IS frequently.

Contd,

Investigations may be required: bronchoscope, postural drainage, antibiotic,O2.

Post op complicatoin

Infected wounds = infected surgical incisions

Contd,

Risk factors for wound infection (sepsis):• Obesity, old age, no aseptic technique

in dressing, anticancer drugs & steroids, poor technique in OR, disease (diabetes, jaundice).

Manifestations:Redness, swelling, tenderness, heat,

drainage, ↑pulse, ↑ temperature, positive wound swab.

Contd,

Treatment could be incision and drainage.

Rupture of wound

1. Evisceration 2. dehiscence