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What is post-operative care?
Girl 66 months of age having had a cleft palate operation as an infant: Good surgery and Post operative care ensured minimal Scar
What are the Phases of Post-operative Care?
Post-operative care is the care of a patient after surgery. Post-operative care expands into three different phases.
- Immediate Post-operative care
- Care of patients in the surgical wards
- Continued care after discharge
Immediate Post-operative Care
Immediate Post-operative care will be done in the recovery room. Recovery room is the place where patients recover from anesthesia after surgery.
Post-operative Care in the Recovery Room
Airway and Breathing: Special attention is paid to the airway and breathing of patients immediately after surgery as the effect of residual anesthetic gases might depress the airway of patients. Airway is maintained with the help of oral or nasal airway during this time and some of the patients may still be intubated.
Patients also may feel nauseated and may vomit during the immediate post-operative period and hence they are nursed in slightly head elevated or side lying position to prevent the aspiration of vomitus into the airways.
Oxygen is given by mask if the patient is not intubated. Oxygen saturation of the blood will be monitored with the help of a pulse oximeter.
Circulation: In the recovery room patents are continuously monitored by attaching them to an ECG monitor. An arterial cannula facilitates the continuous monitoring of blood pressure. A central venous catheter facilitates the monitoring of central venous pressure which is the indicator of fluid status of the patient.
During surgery there may be blood loss or fluid loss from the body. The fluid loss is calculated and is replaced systematically during the immediate post-operative period.
Wound dressings and drains from the surgical site are monitored continuously in the recovery room. Urinary output is also an important and indirect measure of circulation.
Post-Operative Care on the Ward:
Patients are shifted to wards from the recovery room once they are stabilized. That means patients will be fully conscious and will have attained stable cardiovascular and respiratory parameters.
Patients who require special attention like those after neurosurgery, orthopedic surgery, cardiac surgery and urosurgery may not be shifted to ward directly. Instead they will be shifted to another intensive care unit specifically meant for them as these patients require more distinctive monitoring and care.
General Care of the Patient on the Ward after Surgery
A patient after general surgery is ambulated very early to prevent the formation of blood clots in the body and to promote circulation. Early ambulation is done in different phases. First the patient is made to sit on the edge of the bed with his/her legs dangling. Then slowly he is made to stand up and then to walk. This will avoid the development of hypotension and giddiness on sudden standing.
Position is changed two hourly or four hourly for the patients who cannot be ambulated. Back massages and other pressure point massages are given to avoid the development of bed sores. Some patients may also need to be given wash while some others may be able to do it with some help.
Regular physiotherapy is given to such patients to improve the muscle strength and motor response.
Pre and Post - Operative Care
A Patient-Controlled Analgesia infusion pump, configured for Epidural administration of Fentanyl and Bupivacaine for Postoperative Analgesia
Pain Control after Surgery:
Fear of pain is experienced by patients undergoing surgery.
Pain can be controlled by medications given through the mouth, muscles, and veins or sometimes to the epidural space.
Immediately after surgery pain control is achieved mostly by intravenous routes.
There are alternative complementary measures like guided imagery also tested successfully for pain control.
Patient controlled analgesia is gaining popularity as patients can control the amount of drugs in relation to pain.
Fluid balance is monitored stringently for few days postoperatively till the patient stabilizes. Intake and output are recorded on a chart. Intakes include whatever the patient takes orally (if permitted and possible), intravenously and through nasogastric tube. Outputs include urine, drainage from the wounds, vomitus if any and nasogastric aspirations or diarrhea. Oliguria or less urine output in a surgical patient is mostly caused by hypovolemia.
Some patients may require blood transfusion if the Hb value is low or if the hypovolemia is severe.