jenny.general goal of post-operative care

8/6/2019 JENNY.general Goal of Post-Operative Care

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J E N N I F E R A N N E Z A I D EB S N I I I 2

GENERAL GOAL OF

POST-OPERATIVE CARE


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RECOVERY FROM BOTH THE SPECIFIC PHYSIOLOGIC

CHANGES AND THE GENERAL INFLAMMATORY

RESPONSE DUE TO THE SURGICAL PROCEDURE


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CARING FOR WOUNDS

Types of wound healing:

Primaryintention

a.k.a.primary wound healing

Wound edgesare brought togetherso that theyareadjacentto each other

Secondaryintention

a.k.a.secondary wound healing orspontaneous healing

Wound isleft open to heal without surgicalintervention


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CARING FOR WOUNDS

Surgical drains

Allow escape of fluids

Drainage from wound systemsis recorded

Amount of blood drainage on thesurgical dressing isassessed frequently

Spots of drainage

Excessiveamounts of drainage

Increasing amounts of fresh blood on the dressing


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PENROSE DRAIN


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PENROSE DRAIN


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PENROSE DRAIN


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JACKSON-PRATT DRAIN


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JACKSON-PRATT

DRAIN


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JACKSON-PRATT DRAIN


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CARING FOR WOUNDS

Changing the dressing

Inform thepatient

Perform the dressing changeat asuitable time

ProvideprivacyProvideassurance

Teach thepatient


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MAINTAINING NORMAL BODY

TEMPERATURE

Low body temperatureis reported to thephysician

Roomismaintained at acomfortable temperature


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DECREASED PAIN, EARLY

MOBILIZATION, AND PROMPT RETURN

TO NORMAL FUNCTION


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RELIEVING PAIN

Opioid analgesics

Preventiveapproach ismoreeffective than the as

needed aproach

Use of nonpharmacologic pain relief measures


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ENCOURAGING ACTIVITY

Earlyambulation haspositiveeffects on recoveryand theprevention of complications

Ambulation reducespostoperativeabdominal

distention Assist thepostoperativepatient in getting out of

bed for the first time

Encourage bed exercises to improvecirculation


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MANAGING GI FUNCTION AND

RESUMING NUTRITION

Management of hiccups

Liquids

Soft food

Solid food


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MANAGING GI FUNCTION AND

RESUMING NUTRITION

Assessment and management of GI function

Anypostoperativepatient maysuffer from distention

Abdominal distention is furtherincreased byimmobility,

anestheticagents,and the use of opioid medicationsAssess bowelsounds

Paralyticileusand intestinal obstruction


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PROMOTING BOWEL FUNCTION

Constipation

Patientsareadvised to engagein earlyambulation

to prevent constipation

Improve dietaryintakeisadvised

Stoolssoftenersmay beprescribed by the doctor


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MANAGING VOIDING

Thepatient isexpected to void within 8 hoursaftersurgery

Allmethods to encourage thepatient to void

should be tried Bedpan must be warm

Straight intermittent catheterization ispreferred overin-dwelling catheterization

Take note of amount of urine voided Palpate thesuprapubic area for distention or

tenderness


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PREVENTION AND EARLY

DETECTION OF COMPLICATIONS


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PREVENTING RESPIRATORY

COMPLICATIONS

Common respiratorycomplications: atelectasis,pneumonia,and hypoxemia

Encourage deep breathing,coughing exercises,

and ambulation Watch out forsignsand symptoms of thecommon

respiratorycomplications

Administer oxygen asprescribed to prevent or

relieve hypoxia


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MAINTAINING A SAFE ENVIRONMENT

Assess thepatientslevel of consciousnessandorientation which mayplace thepatient at riskforinjury

All objects thepatient may need should be withinreach

Instruct patient to askforassistance with any

activity


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MANAGING POTENTIAL

COMPLICATIONS

Deep vein thrombosis (DVT)

Low-molecular-weight orlow-dose heparin and low-

dose warfarin

Advise to avoid the use of blanket rolls,pillow rolls, orany form of elevation that can constrict vessels undertheknees

Prolonged dangling is not recommended


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DEEP VEIN THROMBOSIS


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DEEP VEIN THROMBOSIS


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MANAGING POTENTIAL

COMPLICATIONS

Hematoma

Sometimesconcealed bleeding occurs beneath theskin atthesurgicalsite


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MANAGING POTENTIAL

COMPLICATIONS

Infection

Multiple factorsplace thepatient at riskof infection

Watch out forsignsand symptoms of infection

Increased PR and temperature;elevated WBC; wound swelling,warmth, tenderness, or discharge,and incisionalpain

Staphylococcusaureus

Antimicrobial therapyand wound care regimen


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MANAGING POTENTIAL

COMPLICATIONS

Wound dehiscenceand evisceration

Both areserioussurgicalcomplications

Abdominal binder


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WOUND DEHISCENCE


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WOUND DEHISCENCE


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WOUND DEHISCENCE


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WOUND EVISCERATION

jenny.general goal of post-operative care

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