Transcript 15. Interventions for Postoperative Clients Care

Interventions for
Postoperative Clients
Care
PACU Recovery Room
• Purpose is to provide ongoing
evaluation and stabilization of clients
to anticipate, prevent, and treat
complications after surgery.
• PACU is usually located close to the
surgical suite.
• The PACU nurse is skilled in the care
of clients with multiple medical and
surgical problems that can occur
Collaborative Management
• Assessment
• Physical assessment and clinical
manifestations
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Assess respiration.
Examine surgical area for bleeding
Monitor vital signs.
Assess for readiness to discharge once
criteria have been met.
POST OPERATIVE COMPLICATIONS
Potential Alterations
in Respiratory Function
• Airway obstruction (tongue!, laryngospasm, laryngeal
edema)
• Hypoxemia (SaO2 < 90%; agitation → somnolence)
• Atelectasis (alveolar collapse)
• Pulmonary edema (fluid-filled alveoli)
• Aspiration of gastric secretions
• Bronchospasm
• Hypoventilation
Etiology and
relief of airway
obstruction
caused by
patient’s tongue
Fig. 19-2
Resp complications
Postoperative Atelectasis
B. Mucous plug in
bronchiole
A. Normal
bronchiole and
alveolus
C. Collapse of alveoli
due to absorption of air
Fig. 19-4
Pulmonary Embolus
ARDS
ILEUS
SBO
Techniques for Splinting Wound
When Coughing
Fig. 19-5
Nursing Management
Cardiovascular Complications
• DVT prophylaxis
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Leg exercise (10-12/Q 1-2 hr)
Elastic stockings
Sequential compression devices
Anticoagulants (Heparin, LMWH)
Early ambulation
• Slowly progress
• Monitor pulse
• Assess for feelings of faintness
Postoperative Leg Exercises
Fig. 19-6
Skin Assessment
• Normal wound healing
• Ineffective wound healing: can be
seen most often between the 5th and
10th days after surgery
– Dehiscence: a partial or complete
separation of the outer wound layers,
sometimes described as a “splitting open
of the wound.”
(Continued)
Skin Assessment
– Evisceration: a total separation of all
wound layers and protrusion of internal
organs through the open wound.
• Dressings and drains, including casts
and plastic bandages, must be
assessed for bleeding or other
drainage on admission to the PACU
and hourly thereafter.
TYPES OF INCISIONS
Surgical Drainage systems
Jackson Pratt
Postoperative Care
A.
Dehiscence
B.
Evisceration
Fig 14-5 pg
162
Evisceration
Dressings and Drains
Acute Pain
Interventions include:
• Drug therapy
• Complementary and alternative
therapies such as:
– Positioning
– Massage
– Relaxation and diversion techniques
Epidural Anatomy
Acute Pain Transmission
Gottschalk A.,& Smith DS (2001)
AM Fam Physician
Physiology of pain
Epidural Pharmacodynamics
Spinal
Arteries
Systemic
circulation
Brain
Epidural
veins
Epidural Fat
Epidural dural
Opioid transfer
Dorsal
Horn
Brain
CSF
Epidural
Non
specific Veins
binding (Arachnoid
Granulations
)
Potential for Hypoxemia
Interventions include:
• Maintenance of airway patency and
breathing pattern
• Prevention of hypothermia
• Maintenance of oxygen therapy as
prescribed
Health Teaching
• Prevention of infection
• Dressing care
• Nutrition
• Pain medication management
• Progressive increase in activity level
• Use of proper body mechanics