CHAPTER ELEVEN

Post-operative patient care

 Learning Objectives

After studying this chapter, the learner will be able to:

1.State the most common causes of death within 24
hours of postoperative period.
2.Identify areas of competences for a nurse working in
the recovery room (RR).
3.List some major responsibilities of the recovery room
nurse.
4.Mention some patient care equipment required in the
recovery room.
5.List main emergency drugs required in the recovery
room.
 Introduction
Surgical procedures are performed in many
diverse settings, including surgeon’s offices,
ambulatory surgery centers, and hospital-based
surgical suites and specialty units.
In general, the selection of the surgical setting is
influenced by:
 The anticipated complexity of the
procedure
 The patient’s health status
 Available technology, and
 Financial resources
 Cont…
Regardless of the surgical setting or
procedure, the patient should be observed
and monitored postoperatively.
 The monitoring is performed in a controlled
postsurgical or post-anesthesia environment
before the patient being transferred to a
patient care unit or discharged from the
facility.
The postoperative phase of the surgical
patient’s perioperative experience begins
after the surgical procedure is completed and
the patient is admitted to a post-procedural
area (usually the recovery room, RR).
 The Recovery Room
Patients who have had all kinds of surgery,
from the most minor to the most major, will
be admitted to the recovery room (RR) after
their operation.
 It follows therefore, the staff, facilities and
equipment for the care of such patients must
be available.
The most important requirement is,
undoubtedly, the presence of adequate
numbers of well-trained nursing and medical
staff to observe patients and treat them as
necessary.
 Cont…
 Causes of death documented within the first 24 hours of
anesthetic administration and surgical procedure were:
 Obstruction of airway
 Laryngospasm
 Hemorrhage
 Cardiac arrest, and
 Inappropriate administration of
medications
 Contributing factors for this include:

 Inadequate postoperative patient care

 Lack of standardized observation
parameters, and
 Absence of medical supervision
 Postoperative Observation of the Patient
The duration and type of postoperative observation
and care will vary according to the following:
 Patient’s condition (e.g., alert and oriented vs.
unresponsive)
 Need for physiologic support (e.g., ventilator-
dependent, vs. awake and extubated)
 Complexity of the surgical procedure (e.g., open
laparotomy vs. laparoscopy)
 Type of anesthesia administered (e.g., a general
inhalation agent vs. local infiltration)
 Prescribed period for monitoring parameters to
evaluate physiologic status (e.g., stable vs. unstable
vital signs)
 The Recovery Room Patient Care Personnel
 Adequate personnel should be available to monitor
patients and to provide appropriate care as needed.
The education and training of a recovery room nurse
should include knowledge of the following:

Airway management techniques, including
positioning, chin lift, jaw thrust, suctioning,
bagging, and placement of an airway
 Circulatory assessment,
 Neurological condition
 Anesthetic agents and their action
 Medications and their actions
 Most invasive and minimally invasive
procedures
The nurses working in the recovery
room should demonstrate
competence in the following
 Physical assessment (e.g., heart and lung
sounds)
 Recognition of physiologic complications (e.g.,
airway obstruction, hypothermia, pain, nausea
or vomiting, and/or oropharyngeal aspiration)
 Management of physiologic emergences (e.g.,
airway obstruction, hemorrhage, cardiac arrest)
 Interpretation of monitoring data from
electrocardiogram (ECG) and oximetry devices
 Application of cardiopulmonary resuscitation
(CPR)
Admission of the Postoperative Patient
to the Recovery Room
As the patient enters the recovery room (RR),
his/her immediate physiologic and psychological
status is reported to the recovery room nurse by
the accompanying personnel (usually the
circulating nurse, assistant surgeon, or anesthesia
provider).
The recovery room nurse observes the
postoperative patient’s wound (for bleeding),
catheter, drain material, and intravenous infusions
(whether they are in place).
Then, the nurse monitors the vital signs of the
patient as prescribed.
 Postoperative Report
The postoperative report provides information
from the anesthesia provider, the surgeon
(assistant surgeon), and the nurse.
Much of the report is delivered verbally, but
postoperative orders and pertinent information
regarding the patient’s condition and
intraoperative care are reinforced in writing.
 Patient Care Activities
The application of physiologic and psychosocial
knowledge, principles of asepsis, and technical
knowledge and skills are necessary to promote,
restore, and maintain the patient’s physiologic
processes in a safe, comfortable and effective
environment.
Particular attention is given to monitoring
oxygenation, ventilation and circulation.
 Recovery room care includes:

 Maintaining adequate ventilation

 Preventing shock, and
 Alleviating pain
Patients are evaluated continually by
appropriate monitoring methods and frequent
observations by nurses.
Clinical evaluation of each patient’s status
through listening, watching, and feeling is
augmented by electronic monitoring devices if
available.
 Cont…
As in all other patient care areas, standard
precautions are carried out for the disposal of
needles and the handling of any item
contaminated by blood and body fluids.
Hand washing is essential after each patient
contact to prevent cross-contamination.
Family members are notified when a patient is
admitted to the recovery room (RR).
This lets them know the surgical procedure is
complete, which helps to relieve the anxiety
experienced during the hours of waiting.
 Documentation
Institutional policies and procedures should be
followed in documenting the care given in the
recovery room.
Observations of respiratory and circulatory
functions and level of consciousness are recorded
at frequent intervals.
Postoperative physiologic and psychological status
are documented at the time of any significant
event (e.g., the administration of medication), as
well as routinely at 5- to 7-minutes interval for the
first hour and at 15- to 30-minutes intervals for
the second hour and thereafter.
 Discharge of the Postoperative Patient from the Recovery Room

Most patients remain in the recovery room (RR) for at

least one hour or until they have sufficiently recovered
from anesthesia and that their vital signs have
stabilized and they are capable of reasonable self-care.
The patient’s condition is scored according to vital
signs, activity level, and consciousness.
After discharge from the recovery room, the patient is
transported to a patient care unit (ward) or an
intensive care unit (if present) or to home with follow-
up appointment.
A physician is responsible for the patient’s discharge
from the recovery room.
 Facilities in the Recovery Room
The recovery room will be divided into an
appropriate number of bays (areas), each of
which equipped to receive a patient on
his/her trolley or bed.
The bay should be separated by curtains
which can be drawn to provide privacy for
nursing and medical procedures and
withdrawn to allow easy observation of the
patient.
Each bay should be spacious enough to give
easy access of staff to the patient and also
room for bulky equipment such as a
resuscitation trolley or mobile x-ray machine.
 Cont…
Two vacuum sources are preferable since a patient
may require suction to be applied continuously to a
surgical drain while suction may also be required at the
same time to remove secretions from the airway.
The other very important facility which each bay
requires is an adequate number of electrical outlets.
At least six in each bay should be available, since
certain patients will require a number of items of
electrical apparatus to be in use simultaneously.
 For example, a patient may require a pulmonary
ventilator, an electrocardiograph monitor, a blood
warmer, a drip controller, etc. Thus, it is easy to see
why a large number of electrical outlets are required.
Many patients coming from the operating room will
have intravenous infusions running and some means of
supporting drip bottles and bags must be available
 Equipment in the Recovery Room
Equipment for airway management
 Oropharyngeal and nasopharyngeal airways
 Tracheal tubes (oral and nasal)
 Laryngoscopes
 Suction catheters and tubing.

Equipment for respiratory support

 Ambubag or similar type of manual device
for artificial ventilation
 Automatic ventilators
Equipment for oxygen therapy
 Oxygen flow meters
 Humidifier for oxygen
 Masks and tubing for delivery of oxygen to
patient

Equipment for monitoring

 Electrocardiograph
 Blood pressure apparatus
 Central venous pressure
 Temperature
 Urinary output
 Equipment for intravenous infusion
 Supply of intravenous (IV) fluids
 Plasma substitutes
 Refrigerator for storing blood for transfusion
 Intravenous giving sets
 Intravenous cannula
 Central venous catheters
 Drip controllers or infusion pumps
 Blood warmers
 Pressure infusers (for pressurizing bags of
intravenous fluid for rapid transfusion)
 Blood filters
 General
 Syringes and needles
 Swabs
 Preparations for cleaning skin prior to
injections, etc.
 Forms and appropriate sample tubes for
biochemistry, hematology, blood transfusion,
bacteriology,
 Requirements for general nursing care, e.g.
wound dressing materials, bed linen, pillows,
bed pans, sick bowels, etc.
 Drugs for resuscitation trolley

 There will be a small  A cardiac glycoside,

e.g. digoxin
range of drugs required
in acute cardiac or  An antihistamine, e.g.
respiratory emergences: promethazine
 Sodium bicarbonate  A bronchodilator, e.g.
solution 8.4% aminophylline
 Adrenaline 1:1000  Antinarcotics agents,
e.g. naloxone
 Atropine
 Hydrocortisone
 Lignocaine for
intravenous use  Sterile water for
injection when
 Beta-blocking drugs
necessary
e.g. propranolol
 Drugs in the Recovery Room
The most frequently used will be:
 Analgesic drugs such as morphine, pethidine, etc.
 Antibiotics
 Local anesthetic agents
 Insulin for diabetic patients
 Heparin, corticosteroids
 Diuretics and anti-emetics.

Read about ongoing post-operative nursing

care
THE END

ANY QS
Quiz
At least 4 types of patient positioning in the
operating room
Classification of hazards in the operating
room
Phases of general anesthesia
Types of anesthesia
Characteristics or effects of general
aneshesia