术后护理

Postoperative care

                               
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Postoperative care

Definition

Postoperative care may be the management of the patient after surgery. Including care given throughout quick postoperative period, in the operating room and post anesthesia care unit (PACU), in addition to throughout the days following surgery.

Purpose

The aim of postoperative care would be to prevent difficulties for example infection, to promote or encourage healing from the surgical incision, and also to return the individual to some state of health.

Preparation

Patients get a lot of home elevators postoperative care. They might be offered pain medicine when preparing for just about a procedure that's prone to cause discomfort. Patients may obtain educational materials for example handouts and video tapes, so they may have a definite knowledge of what to anticipate postoperatively.

Post anesthesia care unit (PACU)

The individual is used in the PACU following the surgical treatment, anesthesia reversal, and extubation whether it was necessary. How long the individual spends within the PACU depends upon along surgery, kind of surgery, status of regional anesthesia e.g., spinal anesthesia, and also the patient's degree of consciousness. Instead of being delivered to the PACU, some patients might be transferred straight to the critical care unit. For instance, patients who may have had heart bypass grafting are sent straight to the critical care unit. Within the PACU, the anesthesiologist or even the nurse anesthetist reports about the patient's condition, kind of surgery performed, kind of anesthesia given, approximated loss of blood, and total input of fluids and output of urine in the course of surgery. The PACU nurse also needs to be advised associated with a problems during surgery, such as variations in hemodynamic (blood flow) stability. Assessment from the patient's airway patency, vital signs, and degree of consciousness are the initial priorities upon admission towards the PACU. The next is really a listing of other evaluation categories:

• pain status
• body temperature
• surgical site
• circulation/sensation in extremities after vascular or orthopedic surgery
• patency of drainage tubes/drains
• nausea/vomiting
• patency/rate of intravenous (IV) fluids
• level of sensation after regional anesthesia
  

The individual is discharged in the PACU when she or he meets established criteria for discharge, as based on a scale. One of these may be the Aldrete scale, which scores the patient's mobility, respiratory status, circulation, awareness, and pulse oximetry. With respect to the kind of surgery and also the patient's condition, the individual might be admitted either to an over-all surgical floor or even the intensive care unit. Because the patient can always be sedated from anesthesia, safety factors are a primary goal. The patient's call light ought to be within the hand and side-rails up. Patients one day surgery setting are generally discharged in the PACU towards the unit, or are directly released home once they have urinated, gotten up out of bed, and tolerated a tiny bit of oral intake.

First Twenty four hours

Following the hospitalized patient transfers in the PACU, the nurse overtaking his/her care should measure the patient again, utilizing the same earlier mentioned categories. When the patient reports "hearing" or feeling pain during surgery the observation shouldn't be discounted. The anesthesiologist or nurse anesthetist should discuss the potential of a chapter of consciousness under anesthesia using the patient. Vital signs, respiratory status, pain status, the incision, and any drainage tubes ought to be monitored every 1 to 2 hours not less than the very first eight hours. Body's temperature should be monitored, since patients in many cases are hypothermic after surgery, and could require a warming blanket or warmed IV fluids. Respiratory status ought to be evaluated frequently, which includes assessment of lung sounds and chest excursion, and occurrence of the adequate cough. Fluid intake and urine outputs ought to monitor each 1 to 2 hours. When the patient doesn't have a urinary catheter, the bladder ought to be assessed for distension, and also the patient monitored for wherewithal to urinate. Problems ought to be notified when the patient hasn't urinated 6 to 8 hours after surgery.

When the patient were built with a vascular or neurological process performed, circulatory status or neurological status ought to be assessed as ordered through the surgeon, usually each 1 to 2 hours. The individual may need medication for nausea / vomiting, in addition to pain. Patients having a patient-controlled analgesia pump should be reminded using it. When the patient is simply too sedated soon after the surgery, the nurse may push the button to provide pain medicine. The individual ought to be asked to rate his/her pain level on the pain scale to be able to determine his/her acceptable degree of pain. Controlling pain is vital so the patient may carry out coughing, breathing exercises, and could have the ability to submit bed, crunches, and, gradually, walk. Effective preoperative teaching includes a positive effect on the very first Twenty four hours after surgery. If patients realize that they have to perform respiratory exercises to avoid pneumonia; which movement is imperative for preventing thrombus, encouraging circulation towards the extremities, and keeping the lungs clear; they'll be more likely to do these tasks. Comprehending the requirement for movement and respiratory exercises also underscores the significance of keeping pain in check. Respiratory exercises like coughing, breathing, and incentive spirometry ought to be done every 2 hours. The individual ought to be turned every 2 hours, and really should a minimum of be sitting about the fringe of patient’s bed by eight hours after surgery, unless contraindicated, e.g., after hip replacement. Patients who're unable to crunches during sex because of their surgery may have sequential compression devices on the legs until they could move about. They are stockings that inflate with air to be able to simulate the result of walking about the leg muscles, and return blood towards the heart. The individual ought to be asked to splint any chest and abdominal incisions having a pillow to diminish the pain sensation brought on by coughing and moving. Patients ought to be kept NPO at least nothing orally, if ordered through the surgeon, a minimum of until their cough and gag reflexes have returned. Patients usually have a dry mouth following surgery, which may be relieved with oral sponges drizzled with cold water or lemon ginger mouth swabs.

Patients who're discharged home following a day surgery procedure receive prescriptions for his or her pain medications, and therefore are accountable for their very own pain control and respiratory exercises. Their own families or caregivers ought to be contained in preoperative teaching to enable them to assist the individual in your own home. The individual ought to be reminded to call his / her physician if any problems or uncontrolled pain arise. These patients in many cases are managed in your own home on the follow-up basis with a hospital-connected visiting nurse or home care service.

After Twenty four hours Following the initial Twenty four hours, vital signs could be monitored every 4 to 8 hours when the patient is stable. The incision and dressing ought to be monitored for that quantity of drainage and signs and symptoms of infection. The doctor may order a dressing change throughout the first postoperative day; do this using sterile method. For home-care patients this method should be emphasized. The hospitalized patient ought to be sitting upright inside a chair in the bedside and ambulating with assistance by now. Respiratory workouts are still being carried out every 2 hours, and incentive spirometry values should improve. Bowel sounds are monitored, and also the patient's diet slowly increased as tolerated, with respect to the kind of surgery and also the physician's orders.

The individual ought to be monitored for just about any proof of potential complications, for example leg edema, redness, and pain, difficulty breathing, dehiscence from the incision, or ileus. The surgeon ought to be notified immediately if these occur. If dehiscence occurs, sterile saline-soaked dressing packs ought to be positioned on the wound.

Description

Postoperative care involves evaluation, diagnosis, planning, intervention, and consequence evaluation. The degree of postoperative care needed depends upon the individual's pre-surgical health status, kind of surgery, and if the surgery was performed inside a day-surgery setting or perhaps in a healthcare facility. Patients who've procedures completed in a day-surgery center generally require just a few hours of care by healthcare professionals before they're discharged to visit home. If post anesthesia or postoperative problems occur within these hours, the individual should be admitted at the hospital. Patients who're admitted at the hospital may need days or weeks of postoperative care by hospital staff before they're discharged.

Normal results

The aim of postoperative care would be to make sure that patients have good results after surgical treatments. A great outcome includes recovery without problems and sufficient pain management. Another objective of postoperative care would be to assist patients in taking responsibility for recovering optimum health.

Aftercare

Aftercare consists of making certain patients are comfy, in a choice of bed or chair and they have their call lights accessible. After dressing changes, blood-soaked dressings ought to be properly discarded inside a bio-hazard container. Pain medication ought to be offered before any procedure that may cause soreness. Patients ought to be given the chance to inquire about questions. In some instances, they might ask the nurse to show certain techniques to enable them to perform them properly after they return home.

Definition

Postoperative care may be the management of the patient after surgery. Including care given throughout quick postoperative period, in the operating room and post anesthesia care unit (PACU), in addition to throughout the days following surgery.

Purpose

The aim of postoperative care would be to prevent difficulties for example infection, to promote or encourage healing from the surgical incision, and also to return the individual to some state of health.

Preparation

Patients get a lot of home elevators postoperative care. They might be offered pain medicine when preparing for just about a procedure that's prone to cause discomfort. Patients may obtain educational materials for example handouts and video tapes, so they may have a definite knowledge of what to anticipate postoperatively.

Post anesthesia care unit (PACU)

The individual is used in the PACU following the surgical treatment, anesthesia reversal, and extubation whether it was necessary. How long the individual spends within the PACU depends upon along surgery, kind of surgery, status of regional anesthesia e.g., spinal anesthesia, and also the patient's degree of consciousness. Instead of being delivered to the PACU, some patients might be transferred straight to the critical care unit. For instance, patients who may have had heart bypass grafting are sent straight to the critical care unit. Within the PACU, the anesthesiologist or even the nurse anesthetist reports about the patient's condition, kind of surgery performed, kind of anesthesia given, approximated loss of blood, and total input of fluids and output of urine in the course of surgery. The PACU nurse also needs to be advised associated with a problems during surgery, such as variations in hemodynamic (blood flow) stability.

Assessment from the patient's airway patency, vital signs, and degree of consciousness are the initial priorities upon admission towards the PACU. The next is really a listing of other evaluation categories:

• pain status
• body temperature
• surgical site
• circulation/sensation in extremities after vascular or orthopedic surgery
• patency of drainage tubes/drains
• nausea/vomiting
• patency/rate of intravenous (IV) fluids
• level of sensation after regional anesthesia
  

The individual is discharged in the PACU when she or he meets established criteria for discharge, as based on a scale. One of these may be the Aldrete scale, which scores the patient's mobility, respiratory status, circulation, awareness, and pulse oximetry. With respect to the kind of surgery and also the patient's condition, the individual might be admitted either to an over-all surgical floor or even the intensive care unit. Because the patient can always be sedated from anesthesia, safety factors are a primary goal. The patient's call light ought to be within the hand and side-rails up. Patients one day surgery setting are generally discharged in the PACU towards the unit, or are directly released home once they have urinated, gotten up out of bed, and tolerated a tiny bit of oral intake.

First Twenty four hours

Following the hospitalized patient transfers in the PACU, the nurse overtaking his/her care should measure the patient again, utilizing the same earlier mentioned categories. When the patient reports "hearing" or feeling pain during surgery the observation shouldn't be discounted. The anesthesiologist or nurse anesthetist should discuss the potential of a chapter of consciousness under anesthesia using the patient. Vital signs, respiratory status, pain status, the incision, and any drainage tubes ought to be monitored every 1 to 2 hours not less than the very first eight hours. Body's temperature should be monitored, since patients in many cases are hypothermic after surgery, and could require a warming blanket or warmed IV fluids. Respiratory status ought to be evaluated frequently, which includes assessment of lung sounds and chest excursion, and occurrence of the adequate cough. Fluid intake and urine outputs ought to monitor each 1 to 2 hours. When the patient doesn't have a urinary catheter, the bladder ought to be assessed for distension, and also the patient monitored for wherewithal to urinate. Problems ought to be notified when the patient hasn't urinated 6 to 8 hours after surgery. When the patient were built with a vascular or neurological process performed, circulatory status or neurological status ought to be assessed as ordered through the surgeon, usually each 1 to 2 hours. The individual may need medication for nausea / vomiting, in addition to pain. Patients having a patient-controlled analgesia pump should be reminded using it. When the patient is simply too sedated soon after the surgery, the nurse may push the button to provide pain medicine. The individual ought to be asked to rate his/her pain level on the pain scale to be able to determine his/her acceptable degree of pain. Controlling pain is vital so the patient may carry out coughing, breathing exercises, and could have the ability to submit bed, crunches, and, gradually, walk. Effective preoperative teaching includes a positive effect on the very first Twenty four hours after surgery. If patients realize that they have to perform respiratory exercises to avoid pneumonia; which movement is imperative for preventing thrombus, encouraging circulation towards the extremities, and keeping the lungs clear; they'll be more likely to do these tasks. Comprehending the requirement for movement and respiratory exercises also underscores the significance of keeping pain in check. Respiratory exercises like coughing, breathing, and incentive spirometry ought to be done every 2 hours. The individual ought to be turned every 2 hours, and really should a minimum of be sitting about the fringe of patient’s bed by eight hours after surgery, unless contraindicated, e.g., after hip replacement. Patients who're unable to crunches during sex because of their surgery may have sequential compression devices on the legs until they could move about. They are stockings that inflate with air to be able to simulate the result of walking about the leg muscles, and return blood towards the heart. The individual ought to be asked to splint any chest and abdominal incisions having a pillow to diminish the pain sensation brought on by coughing and moving. Patients ought to be kept NPO at least nothing orally, if ordered through the surgeon, a minimum of until their cough and gag reflexes have returned. Patients usually have a dry mouth following surgery, which may be relieved with oral sponges drizzled with cold water or lemon ginger mouth swabs.

Patients who're discharged home following a day surgery procedure receive prescriptions for his or her pain medications, and therefore are accountable for their very own pain control and respiratory exercises. Their own families or caregivers ought to be contained in preoperative teaching to enable them to assist the individual in your own home. The individual ought to be reminded to call his / her physician if any problems or uncontrolled pain arise. These patients in many cases are managed in your own home on the follow-up basis with a hospital-connected visiting nurse or home care service.

After Twenty four hours

Following the initial Twenty four hours, vital signs could be monitored every 4 to 8 hours when the patient is stable. The incision and dressing ought to be monitored for that quantity of drainage and signs and symptoms of infection. The doctor may order a dressing change throughout the first postoperative day; do this using sterile method. For home-care patients this method should be emphasized.

The hospitalized patient ought to be sitting upright inside a chair in the bedside and ambulating with assistance by now. Respiratory workouts are still being carried out every 2 hours, and incentive spirometry values should improve. Bowel sounds are monitored, and also the patient's diet slowly increased as tolerated, with respect to the kind of surgery and also the physician's orders.

The individual ought to be monitored for just about any proof of potential complications, for example leg edema, redness, and pain, difficulty breathing, dehiscence from the incision, or ileus. The surgeon ought to be notified immediately if these occur. If dehiscence occurs, sterile saline-soaked dressing packs ought to be positioned on the wound.

Description

Postoperative care involves evaluation, diagnosis, planning, intervention, and consequence evaluation. The degree of postoperative care needed depends upon the individual's pre-surgical health status, kind of surgery, and if the surgery was performed inside a day-surgery setting or perhaps in a healthcare facility. Patients who've procedures completed in a day-surgery center generally require just a few hours of care by healthcare professionals before they're discharged to visit home. If post anesthesia or postoperative problems occur within these hours, the individual should be admitted at the hospital. Patients who're admitted at the hospital may need days or weeks of postoperative care by hospital staff before they're discharged.

Normal results

The aim of postoperative care would be to make sure that patients have good results after surgical treatments. A great outcome includes recovery without problems and sufficient pain management. Another objective of postoperative care would be to assist patients in taking responsibility for recovering optimum health.

Aftercare

Aftercare consists of making certain patients are comfy, in a choice of bed or chair and they have their call lights accessible. After dressing changes, blood-soaked dressings ought to be properly discarded inside a bio-hazard container. Pain medication ought to be offered before any procedure that may cause soreness. Patients ought to be given the chance to inquire about questions. In some instances, they might ask the nurse to show certain techniques to enable them to perform them properly after they return home.