Post Operative AssessmentManu Fonseca CrescioniJackson Park City Hospital, Chicago IL

Chicago Medical Training Center12/12/201

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Postoperative care is the management of a patient after surgery. This includes care given during the immediate postoperative period, both in the operating room and post anesthesia care unit (PACU), as well as during the days following surgery.

Definition

PurposeThe goal of postoperative care is to ;

•Prevent complications such as infection

•Promote healing of the surgical incision.

•Return the patient to a state of health.

PACU•The patient is transferred to the PACU after the surgical procedure.

•The amount of time the patient spends in the PACU depends on the length and type of surgery, also the patient's level of consciousness.

•The anesthesiologist reports the patient's condition, type of surgery performed, type of anesthesia given, estimated blood loss, and total input and output of fluids during surgery

•Assessment of the patient's airways (openness of the airway), vital signs , and level of consciousness are the first priorities upon admission to the PACU.

Respiratory Satus Assements• Oxygen Saturation

• Effort of breathing/use of accessory muscles

• Respiratory Rate

• Trachea central or not?

• Breath sounds

• Percussion tone

Volume Status Assesment• Hands- warm or cool, pink or pale

• Pulse Rate, volume and rhythm

• BP

• Conjunctival Pallor

• Jugular Venous Pressure

Mental Satus Assesment• Patient conscious and normally responsive(AVPU

Alert,Verbal,Painful,Unresponsive

• If something is abnormal determine;

• If confusion is present(AMT)

• Oxygen saturation and blood glucose

Check list for Postoperative Assesment• Past Medical History

• Medication

• Allergies

• Intraoperative complication

• Postoperative complication

• Recommended history and prophylaxis

Assessment Categories

The following is a list of other assessment categories:

• Surgical site (intact dressings with no signs of overt bleeding)• Patency (proper opening) of drainage tubes/drains• Body temperature (hypothermia/hyperthermia)• Rate of IV fluids• Circulation/sensation in extremities after vascular or orthopedic

surgery• Level of sensation after regional anesthesia• Pain status• Nausea/vomiting

PACU Discharge

The patient is discharged from the PACU when he or she meets established criteria for discharge, as determined by a scale. One example is the Aldrete scale, which scores the patient's mobility, respiratory status, circulation, consciousness, and pulse oximetry

Aldrete scale

ReferenceBeauchamp, Daniel R., M.D., Mark B. Evers, M.D., Kenneth L. Mattox, M.D., Courtney M. Townsend, and David C. Sabiston, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 16th ed. London: W B Saunders Co., 2001.

Lawrence, Peter F., Richard M. Bell, and Merril T. Dayton, eds. Essentials of General Surgery. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins, 2000.

Lubin, Michael F., H. Kenneth Walker, and Robert B. Smith, eds. Medical Management of the Surgical Patient. 4th ed. Cambridge, UK: Cambridge University Press, 2003.