8-23. POSTOPERATIVE PATIENT CARE ACCORDING TO BODY SYSTEM a. Respiratory System. The cough reflex is suppressed during surgery and mucous accumulates in the trachea and bronchi. After surgery, respiration is less effective because of the anesthesia and pain medication, and because deep respirations cause pain at the incision site. As a result, the alveoli do not inflate and may collapse, and retained secretions increase the potential for respiratory infection and atelectasis.
b. Cardiovascular System. Venous return from the legs slows during surgery and may actually decrease in some surgical positions. With circulatory stasis of the legs, thrombophlebitis and emboli are potential complications of surgery. Venous return is increased by flexion and contraction of the leg muscles.
c. Urinary System. Patients who have had abdominal surgery, particularly in the lower abdominal and pelvic regions, often have difficulty urinating after surgery. The sensation of needing to urinate may temporarily decrease from operative trauma in the region near the bladder. The fear of pain may cause the patient to feel tense and have difficulty urinating.
d. Gastrointestinal System. Inactivity and altered fluid and food intake during the perioperative period alter gastrointestinal activities. Nausea and vomiting may result from an accumulation of stomach contents before peristalsis returns or from manipulation of organs during the surgical procedure if the patient had abdominal surgery.
e. Integumentary System. Follow doctor's orders for wound care, wound irrigations and cultures. In addition to assessment of the surgical wound, you should evaluate the patient's general condition and laboratory test results. If the patient complains of increased or constant pain from the wound, or if wound edges are swollen or there is purulent drainage, further assessment should be made and your findings reported and documented. Generalized malaise, increased pain, anorexia, and an elevated body temperature and pulse rate are indicators of infection. Important laboratory data include an elevated white blood cell count and the causative organism if a wound culture is done. Staples or sutures are usually removed by the doctor using sterile technique. After the staples or sutures are removed, the doctor may apply Steri-StripĀ® to the wound to give support as it continues to heal.
8-24. GENERAL POSTOPERATIVE NURSING IMPLICATIONS a. Monitor vital signs as ordered. b. Report elevated temperature and rapid/weak pulse immediately to supervisor (infection). c. Report lowered blood pressure and increased pulse to supervisor (hypovolemic shock). d. Administer analgesics as ordered. e. Apply all nursing implications related to the patient receiving analgesics whether narcotic or nonnarcotic, to include the following.
f. Administer IV fluids as ordered. Maintain and monitor all IV sites. Follow SOP for infection control. g. Participate with the health team in the patient's nutrition therapy. h. Apply all nursing implications related to the patient diets (serving, recording intake, and food tolerance). i. Coordinate with team leader for "take-home" wound care supplies and prescriptions for self-administration. j. Prepare the patient and the family for disposition (transfer, return to duty, discharge). Supply the patient or family member with written instructions for:
k. Document the patient's disposition in the nurse's notes in accordance with unit SOP. 8-25. CLOSING Surgical intervention often alters physical appearance and normal physiological functions and may threaten the patients psychological security. Any or all of these may lead to alterations in the patient's self-concept and body image. Some surgical patients react to the loss of a body part as to a death. Be aware of the patient's needs and establish interventions that will support his strengths and effective coping skills. The nursing process is used throughout the perioperative period to provide the patient with individualized care and the knowledge and ability for self-care following disposition. Continue with Exercises |