Providing Postoperative Care When Patient Returns to Room

Goal: The patient will recover from the surgery with postoperative risks minimized by frequent assessments.

Immediate Care
1. When patient returns from the PACU, obtain a report from the PACU nurse and review the operating room and PACU data.

2. Perform hand hygiene and put on PPE, if indicated.

3. Identify the patient.

4. Close curtains around bed and close the door to the room, if possible. Explain what you are going to do and why you are going to do it to the patient.

5. Place patient in safe position (semi- or high Fowler’s or side-lying). Note level of consciousness.

6. Obtain vital signs. Monitor and record vital signs frequently. Assessment order may vary, but usual frequency includes taking vital signs every 15 minutes the first hour, every 30 minutes the next 2 hours, every hour for 4 hours, and finally every 4 hours.

7. Assess the patient’s respiratory status. (Refer to Skill 2-4, in Chapter 2, Health Assessment.) Measure the patient’s oxygen saturation level.

8. Assess the patient’s cardiovascular status. (Refer to Skill 2-5, in Chapter 2, Health Assessment.)

9. Assess the patient’s neurovascular status, based on the type of surgery performed. (Refer to Skill 2-7, in Chapter 2, Health Assessment.)

10. Provide for warmth, using heated or extra blankets, as necessary. Assess skin color and condition.

11. Check dressings for color, odor, presence of drains, and amount of drainage. Mark the drainage on the dressing by circling the amount, and include the time. Turn the patient to assess visually under the patient for bleeding from the surgical site.

12. Verify that all tubes and drains are patent and equipment is operative; note amount of drainage in collection device. If an indwelling urinary (Foley) catheter is in place, note urinary output.

13. Verify and maintain IV infusion at correct rate.

14. Assess for pain and relieve it by administering medications ordered by the physician. If the patient has been instructed in use of PCA for pain management, review its use. Check record to verify if analgesic medication was administered in the PACU.

15. Provide for a safe environment. Keep bed in low position with side rails up, based on facility policy. Have call bell within patient’s reach.

16. Remove PPE, if used. Perform hand hygiene. Ongoing Care

17. Promote optimal respiratory function.

a. Assess respiratory rate, depth, quality, color, and capillary refill. Ask if the patient is experiencing any difficulty breathing.
b. Assist with coughing and deep breathing exercises (Refer to Skill 6-2).
c. Assist with incentive spirometry (Refer to Skill 14-2).
d. Assist with early ambulation.
e. Provide frequent position change.
f. Administer oxygen as ordered.
g. Monitor pulse oximetry (Refer to Skill 14-1).

18. Promote optimal cardiovascular function:
a. Assess apical rate, rhythm, and quality and compare with peripheral pulses, color, and blood pressure. Ask if the patient has any chest pains or shortness of breath.
b. Provide frequent position changes.
c. Assist with early ambulation.
d. Apply antiembolism stockings or pneumatic compression devices, if ordered and not in place. If in place, assess for integrity.
e. Provide leg and range-of-motion exercises if not contraindicated (Refer to Skill 6-3).

19. Promote optimal neurologic function:
a. Assess level of consciousness, motor, and sensation.
b. Determine the level of orientation to person, place, and time.
c. Test motor ability by asking the patient to move each extremity.
d. Evaluate sensation by asking the patient if he or she can feel your touch on an extremity.

20. Promote optimal renal and urinary function and fluid and electrolyte status. Assess intake and output, evaluate for urinary retention and monitor serum electrolyte levels.
a. Promote voiding by offering bedpan at regular intervals, noting the frequency, amount, and if any burning or urgency symptoms.
b. Monitor urinary catheter drainage if present.
c. Measure intake and output.

21. Promote optimal gastrointestinal function and meet nutritional needs:
a. Assess abdomen for distention and firmness. Ask if patient feels nauseated, any vomiting, and if passing flatus.
b. Auscultate for bowel sounds.
c. Assist with diet progression; encourage fluid intake; monitor intake.
d. Medicate for nausea and vomiting, as ordered by physician.

22. Promote optimal wound healing.
a. Assess condition of wound for presence of drains and any drainage.
b. Use surgical asepsis for dressing changes.
c. Inspect all skin surfaces for beginning signs of pressure ulcer development and use pressure-relieving supports to minimize potential skin breakdown.

23. Promote optimal comfort and relief from pain.
a. Assess for pain (location and intensity using scale).
b. Provide for rest and comfort; provide extra blankets, as needed, for warmth.
c. Administer pain medications, as needed, or other nonpharmacologic methods.

24. Promote optimal meeting of psychosocial needs:
a. Provide emotional support to patient and family, as needed.
b. Explain procedures and offer explanations regarding postoperative recovery, as needed, to both patient and family members.