postoperative care, the management of a patient after surgery. See also preoperative care. ▪ METHOD: Before the patient’s discharge from the operating room to the postanesthesia care unit, the surgical drapes, ground plate, and restraints are removed and a sterile dressing may be applied to the incision. The patency and connections of all drainage tubes and the flow rate of parenteral infusions are checked. The patient’s cleanliness and dryness are given attention, and the gown is changed, avoiding exposing the individual. The patient is transferred slowly and cautiously to a stretcher or bed, maintaining body alignment and protecting the limbs. When indicated, an oral or nasal airway is inserted or a previously inserted endotracheal tube is suctioned. Respiration may be assessed with a pulse oximeter; if respiration remains impaired, the anesthetist is notified. The blood pressure, pulse, and respirations are initially reported to the anesthetist and are then checked at least every 15 minutes or as ordered. At similar intervals the level of consciousness, reflexes, and movements of extremities are observed, and the incision, drainage tubes, and IV infusion site are inspected. Medication, blood or blood components, and oxygen are administered as ordered, and fluid intake and output are measured. Pain is controlled with analgesics. The patient is kept warm and dry and positioned for optimal ventilation and comfort. At the first sign of vomiting, the head or body is turned to one side and suction is applied to prevent aspiration. Oral hygiene is administered to keep the mouth and tongue moist. The chest is auscultated for breath sounds every 30 minutes, and the patient, when reactive, is helped to turn and deep breathe. The tympanic or axillary temperature is taken every 1 to 4 hours. When rested and able to move the extremities well, and after having exhibited stable vital signs, the patient may be transferred to the assigned room, if the drainage tubes are functioning, the dressings show no bleeding or excessive drainage, and the anesthesiologist approves the move. The family is informed of the patient’s progress and expectations for the postoperative period. The airway patency; rate, depth, and character of respirations; pulse; blood pressure; temperature; skin color; level of consciousness; and condition of dressings and drainage tubes are assessed. If respirations are noisy, the patient is assisted in coughing. A rapid, weak, thready pulse may indicate increased bleeding and is reported, especially if other signs of impending shock, such as hypotension or changes in level of consciousness, are evident. The dressing is examined at frequent intervals, and excessive drainage is reported immediately. The side rails of the bed are raised for safety and the head is slightly elevated, unless contraindicated. A cardiac monitor may be connected. Parenteral fluids and pain medication are administered as ordered. Fluid intake and output are measured; range-of-motion exercises to extremities are performed, and ambulation, when ordered, is assisted. ▪ INTERVENTIONS: The postanesthesia care nurse performs the immediate postoperative procedures, and the clinical unit nurse provides ongoing care, emotional support, and instructions for the patient and family. Special attention is given to preventing trauma postoperatively, as may occur when confused or elderly patients fall when getting out of bed. ▪ OUTCOME CRITERIA: Meticulous postoperative care prevents falls, infections, and other complications and promotes the healing of the incision and restoration of the patient to health.
