How do you care for a post operative patient?

INTRODUCTION

The modern surgeon is involved with the management of a patient from preoperative evaluation, through the conduct of the operation into the postoperative care period, and often into generating a long-term plan. As the operating surgeon, he or she is best situated to apply evidence-based scientific knowledge and a deep understanding of potential complications to that patient’s care. The recovery from major surgery can be divided into three phases: (1) an immediate, or post anesthetic, phase; (2) an intermediate phase, encompassing the hospitalization period; and (3) a convalescent phase. During the first two phases, care is principally directed at maintenance of homeostasis, treatment of pain, and prevention and early detection of complications. The convalescent phase is a transition period from the time of hospital discharge to full recovery. The trend toward earlier postoperative discharge after major surgery has shifted the venue of this period. We often say “postop starts preop,” which essentially means that the postoperative plan should be considered and discussed before surgery to set expectations for the patient and their family.

THE IMMEDIATE POSTOPERATIVE PERIOD

The primary causes of early complications and death following major surgery are acute pulmonary, cardiovascular, and fluid derangements. The post anesthesia care unit (PACU) is staffed by specially trained personnel and provided with equipment for early detection and treatment of these problems. All patients should be monitored in this specialized unit initially following major procedures unless they are transported directly to an intensive care unit. While enroute from the operating room (OR) to the PACU, the patient should be accompanied by a physician and other qualified attendants. In the PACU, the anesthesiology service generally exercises primary responsibility for cardiopulmonary function. The surgeon is responsible for the operative site and all other aspects of the care not directly related to the effects of anesthesia. The patient can be discharged from the recovery room when cardiovascular, pulmonary, and neurologic functions have returned to baseline, which usually occurs 1-3 hours following operation. Patients who require continuing ventilatory or circulatory support, or who have other conditions that require frequent monitoring, are transferred to an intensive care unit. In this setting, nursing personnel specially trained in the management of respiratory and cardiovascular emergencies are available, and the staff-to-patient ratio is higher than it is on the wards. Monitoring equipment is available to enable early detection of cardiorespiratory derangements. Some hospitals may also have intermediate sites of care, either with telemetry or so-called “stepdown” units where the staff-to-patient ratio may be higher than on a regular floor with increased capabilities for monitoring of cardiorespiratory function, administration of specialty medications, and so on.

Postoperative Orders

Detailed treatment orders are necessary to direct postoperative care. The transfer of the patient from OR to PACU requires reiteration of any patient care orders. Unusual or particularly important orders should also be communicated to the nursing team orally. The ...

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Wound dressing

  • Following surgery, keep the wound clean and dry.
  • The dressing should be removed and wounds covered with adhesive bandages on the first or second day after surgery.
  • Do not remove the paper strips or cut any of the visible sutures.
  • Reapply the ace wrap, if applicable, for 5-7 days to control swelling.
  • Wounds should be kept dry for 48 hours.
  • Unless otherwise instructed, the 5th day after surgery the wound may be exposed in the shower, taking care not to scrub the area.
  • The wound should not be submerged in a bathtub or pool until the sutures are removed.

Icing

  • It is very important to apply ice for the first 5-7 days after surgery.
  • While the post-op dressing is in place, application of ice should be continuous.
  • Once the dressing is removed on the first or second day, ice should be applied for 20-minute periods, 3-4 times per day.
  • Care must be taken with ice to avoid frostbite.

Mobility

  • Follow weight bearing instructions you were given at discharge.
  • Crutches or a cane may be necessary to assist walking.
  • Elevate the operated limb elevation for the first 72 hours to minimize swelling.

Post-surgery

  • The anesthetic drugs used during your surgery may cause nausea for the first 24 hours.
  • If nausea occurs, drink only clear liquids (i.e., Sprite or 7-up).
  • The only solid food that should be eaten is dry crackers or toast.
  • If nausea and vomiting become severe or the patient shows sign of dehydration (lack of urination) please call the doctor or the surgery center.
  • A low-grade fever (100.5) is not uncommon in the first 24 hours, but is unusual beyond.
  • Please call the doctor with any temperature over 101.0 degrees.
  • If a spinal anesthetic was used, patients may suffer a spinal headache. Please call the surgery center should this occur and does not relieve the pain with ibuprofen or your pain medication.
  • You may take a baby aspirin (81 mg) daily until the sutures are removed in the office, as this may lower the risk of a blood clot developing after surgery.
  • Should severe pain in the affected limb or significant swelling of the joint occur, please call the doctor.

Pain medication

  • Local anesthetics (i.e., Novocaine) are put into the incision after surgery.
  • It is not uncommon for patients to encounter more pain on the first or second day after surgery. This is the time when swelling peaks.
  • Taking pain medication before bedtime will assist in sleeping.
  • It is important not to drink alcoholic beverages or drive while taking narcotic medication.
  • If you were prescribed narcotic medication (i.e., vicodin, hydrocodone, darvocet) you can supplement those medications with 200 mg or 400 mg of ibuprofen every 4-6 hours.
  • You should resume your normal medications for other conditions the day after surgery.

Activities

  • Most patients are able to drive if surgery does not involve their right leg as soon as they stop taking narcotic pain medication.
  • Driving while under the influence of narcotic pain medication is dangerous, illegal and greatly discouraged.
  • Returning to school or work also depends on the degree of postoperative pain and the demands of your job or classes.
  • Pain is generally a good guide as to whether you can return or not.

Follow-up

  • The doctor will need to re-examine you in 7-10 days after surgery. Please contact us to schedule an appointment.
  • If unexpected problems, emergencies or other issues occur and you need to talk to the doctor, call the cartilage center's administrative assistant. After hours our answering service will route your call to a physician who will be able to advise you concerning your problem.

Contact & additional information

View contact information for UK Center for Cartilage Repair and Restoration

This information is not intended to replace specific instructions from your physician. 

Check with your doctor to make sure these instructions apply to your case. 

What are 3 nursing interventions for a post

A. Nursing interventions that are required in postoperative care include prompt pain control, assessment of the surgical site and drainage tubes, monitoring the rate and patency of IV fluids and IV access, and assessing the patient's level of sensation, circulation, and safety.

What are three goals of post

The ultimate goal of post-surgery rehab is to increase endurance, strength and flexibility. Any post-operative exercises should be overseen by the care of a doctor or licensed physical therapist.

What are the types of post

Basically, there are two types of postoperative care – the inpatient care and the home-based care. Continue reading to understand postoperative care for seniors, in detail.