NSB231 Chapter Notes - Chapter 16: Sleep Apnea, General Anaesthesia, Hypoxemia
Week 6: Postoperative Care
POSTOPERATIVE CARE OF THE SURGICAL PATIENT
• Immediately after surgery and until patient is discharged
• Most care involves protecting patient and preventing complications while the body repairs
itself
Post anaesthesia Recovery Unit
• Priority care includes monitoring and management of respiratory, circulatory and neurological
function, pain, nausea and vomiting, temperature and surgical site
• Assessment begins with ABC
• ECG monitoring to determine cardiac rate and rhythm
• Nurse needs to explain all activates to the patient form the moment of admission to PARU
because hearing is the first sense to return in the unconscious patient
RESPIRATORY PROBLEMS
• Most common causes of respiratory compromise are airway obstruction, hypoxaemia and
hypoventilation
• Patients at risk
o General anaesthesia
o Older
o Smoking history
o Sleep apnoea
o Lung disease
o Obese
• Hypoxemia: rapid breathing, gasping, anxiety, restlessness, confusion, rapid or thready pulse
o Caused by atelectasis = retained secretions or decreased respiratory excursion
• Airway assessment necessary for early recognition of problems
• Proper positioning facilitates respiration and protects the airway. Patient to be positioned in a
lateral "recovery" position.
• Nurse encourages deep breathing and coughing, spirometer and mobilisation aggressively
ASAP
CARDIOVASCULAR PROBLEMS
• Most common is hypotension, hypertension and arrhythmias
• Patients at risk:
o Hx of cardio disease
o Older
o Critically ill
• Hypotension: caused by inadequate fluid intake and blood loss, treatment begins with oxygen
therapy
• Hypertension: result of pain, anxiety, bladder distension, respiratory compromise. Treatment
eliminating the precipitating cause
• Arrhythmias: result of electrolyte and acid-base imbalance, hypoxemia, hypercapnea,
circulatory instability, hypothermia, Treatment to eliminate cause
NEUROLOGICAL/PSYCHOLOGICAL PROBLEMS
• Emergence delirium: restlessness, agitation, disorientation, shouting. Caused by anaesthetic
agent, hypoxia, bladder distension, pain
• Postoperative cognitive dysfunction (POCD): exclusively seen in older patients and is a decline
in cognitive function for weeks and months after surgery
• Hypoxemia is most common cause of postoperative agitation
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Document Summary
Immediately after surgery and until patient is discharged: most care involves protecting patient and preventing complications while the body repairs itself. Patient to be positioned in a lateral recovery position: nurse encourages deep breathing and coughing, spirometer and mobilisation aggressively. Treatment eliminating the precipitating cause: arrhythmias: result of electrolyte and acid-base imbalance, hypoxemia, hypercapnea, circulatory instability, hypothermia, treatment to eliminate cause. Neurological/psychological problems: emergence delirium: restlessness, agitation, disorientation, shouting. Low urine output (800ml-1500ml): first 24 hours is expected. Frequent assessment of patient"s temperature is important to detect patterns of hypothermia and/or fever: hypothermia occurs when heat loos is greater than heat production. Heat loos post-op may be because of skin exposure during surgery or use of cold irrigating fluids: temperature provides valuable info. A mild elevation (38c) during first 48 hours reflects surgical stress response: wound infection: fever that spikes in the afternoon/evening but normal in morning. Septicaemia: intermittent high fever with chills and diaphoresis.
