After the surgery, the patient enters the postoperative period. The immediate post-
operative period requires close monitoring as the patient emerges from anesthesia.
The patient will then be transferred to either a same-day surgery area for discharge
home that day or an inpatient surgical unit for care. After discharge from the hospi-
tal, the patient may need home care. Return to full activities may take several weeks.

POSTANESTHESIA CARE
The patient is transferred from the operating room to the postanesthesia care unit
(PACU) for close monitoring in the immediate postoperative period. Initial assess-
ment is focused on ABC: airway, breathing, and circulation. Monitor the patient’s
airway, gas exchange, pulse oximetry, oxygen delivery, accessory muscle use, and
breath sounds. The patient can develop stridor due to edema or bronchospasm. The
cardiovascular status is checked next. Vital signs are checked every 15 minutes
until stabilized; pulse, blood pressure, and cardiac rhythm are monitored.
The surgical wound is checked for signs of drainage or bleeding. The dressing
is checked. The drains are checked for output and patency. Tubes that need to be
connected to suction (such as nasogastric tubes) are connected. Intravenous fluids
are monitored.
Neurologic assessment is performed to check level of consciousness. Following
general anesthesia, the patient follows a predictable progression in the return to
consciousness. Initially there is muscular irritability, and then restlessness followed
by pain recognition and the ability to reason and control behavior. Pupil responses
are monitored, looking for bilaterally equal responses to light. Motor responses are
monitored, looking initially for purposeful response to painful stimuli and later for
response to command. Pain management is begun during this time. As the anes-
thetic agent wears off, it is important to assess the patient’s level of pain. This may
be assessed through subjective information in patients who are conscious, or through
more objective signs in patients who are still in semiconscious states. Monitor for
changes in vital signs (elevated pulse and BP), changes in movement, and moan-
ing. Expected pain levels can be estimated from the type of surgery and give a start-
ing point for those patients as they begin to come out of the anesthesia.
Gastrointestinal status is monitored for presence of nausea or vomiting. This
may be a reaction or side effect to anesthesia. Check for abdominal distention and
presence of bowel sounds. Monitor drainage from nasogastric tube; note amount
and color of drainage.
Monitor laboratory results as indicated. Electrolyte levels, hemoglobin or hema-
tocrit levels, BUN and creatinine, arterial blood gases (ABGs), or other studies may
be necessary in the immediate postoperative period. The diagnostic studies neces-
sary will depend on the patient’s history, the estimated blood loss during surgery,
and the type of procedure performed.
After the initial recovery time, the stable patient who is transferred from the
PACU to the same-day surgical area continues to be monitored. Vital signs are
taken, although not as frequently. Respiratory and cardiovascular functions are
monitored. Cardiac rhythm is no longer monitored. The dressing is checked for
any drainage. Bowel sounds are checked. Clear fluids are given if the patient is not
experiencing nausea. Patients are monitored for urinary output prior to being dis-
charged to home.
Patients who are admitted to the hospital are transferred from the PACU to a
surgical unit. Vital signs, respiration, and cardiovascular status are checked. The
dressing is monitored for drainage; drainage tubes are monitored for output. Intra-
venous lines are monitored for signs of infiltration and proper flow rates. Bowel
sounds are monitored.
Patients who are unstable or who have had extensive procedures are transferred
to intensive care for close monitoring. Nurses who are used to caring for complex,
unstable patients care for these patients. Their vital signs are closely monitored.
Some patients will still be on mechanical ventilation.

POSTOPERATIVE COMPLICATIONS
The focus of care that is common for all of these postoperative patients is identi-
fication of complications. Common complications involve the cardiac, respiratory,
and gastrointestinal areas, and infections.

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