Comprehensive Guide to Postoperative Care: Assessment, Management, and Education

Description

According to Stephens & Whitman (2015), postoperative care involves managing a patient after surgery. This encompasses care provided during the immediate postoperative period, both in the operating room and the post-anesthesia care unit (PACU), as well as during the days following the surgery. In the immediate postoperative period, the patient should not be left unattended immediately after the surgery in their drowsy state. The scrub nurse should clean the patient’s operative area with an antiseptic solution, and dressing of the incisions should be performed preferably with waterproof dressing. The patient is transferred to a specialized area for monitoring, such as the post-anesthesia care unit, and may continue after discharge until all activity restrictions have been lifted (Stephens & Whitman, 2015).

Upon admission of a patient to the PACU, the nurse’s priority assessment is respiratory adequacy. The physiological status of the patient is always prioritized with regard to the airway, breathing, and circulation. Respiratory adequacy is the first assessment priority of the patient on admission to the PACU from the operating room. Following the assessment of respiratory function, cardiovascular, neurological, and renal function should be assessed, as well as the surgical site. The PACU, also known as the recovery room, is located adjacent to the operating rooms suite. For patients still under anesthesia or recovering, it helps the patient through the physiological transition from intraoperative to postoperative progression, bridging the patient’s stabilization from the operating room to the PACU or ICU. In the PACU, the nurse receives a report about the patient’s condition from the anesthesia provider and the circulating OR nurse. They then conduct a complete systemic assessment of the patient immediately upon arrival, using arterial blood gases (ABGs) to prioritize initial assessment (AlJabari & Massad, 2016).

AlJabari & Massad (2016) indicated that Phase I of the PACU is an area designated for the care of surgical patients immediately after surgery and for patients whose condition warrants close monitoring. Phase II of the PACU is an area designated for the care of surgical patients who have been transferred from a Phase I PACU because their condition no longer requires the close monitoring provided in a Phase I PACU. Phase III of the PACU is a setting in which the patient is cared for in the immediate postoperative period and then prepared for discharge from the facility. Discharge from the PACU is based on a patent airway, the patient being awake (or at baseline), vital signs at baseline or stable, no respiratory depression, and oxygen saturation greater than 92%. Other factors include pain management, no excessive bleeding or drainage, and a report being given. The Modified Aldrete Scoring System is used to assess the patient’s transition from Phase I to Phase II, discontinuation of anesthesia to return of protective reflexes and motor function, and a score of 9 or 10 indicates readiness for transfer or discharge to the next phase of recovery (AlJabari & Massad, 2016).