NURS1008 Week 5

Tutorial
Post operative nursing
care
Presented by
NURS1008 Tutors
SNS

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 Harry Summers

Recall the scenario about this patient

He has undergone a right ORIF for his # R NOF

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 https://www.google.com.au/search?q=Fractured+NOF&rlz=1C1GGRV_enAU751AU
752&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj5p5vphe_VAhVlhlQKHRwXClI
Q_AUICigB&biw=1097&bih=543&dpr=1.75#imgrc=FjVYvZ-fNU3lWM:

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 Post op nursing care: PARU

From Theatre Mr Summers is transferred to PACU or PARU (post

anaesthetic recovery unit)
There the patient is closely monitored (A-G) by high
dependency RNs to ensure recovery from GA

What are the priorities for any patient in the immediate post-
operative phase?

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 Report from the PARU RN re Mr Summers

Vital signs:
HR 110 b/min, reg
BP 156/96mmHg
RR 10 b/min
Sp0 94% on Hudson mask at 6L/min
Temp 37.1 degrees Celcuis
Drowsy but rousable
Pain 4/10
Dressing dry & Intact
IDC insitu (minimal drainage)
Given Morphine 10mg

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 Would you accept Mr Summers???

Justify why or why not

Identify immediate post-op recovery issues

What would be the goals & nursing interventions?

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 Post-op priority problems

Difficulty clearing airway related to:

Retained secretions
Bronchospasm
Acute pain with movement/coughing
Decreased level of consciousness
Risk of impaired skin integrity related to:
Exposure to wound drainage
Altered fluid status
Altered sensation
Altered nutritional status

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 Post-op orders (typical)

Frequency of vital sign monitoring and any focused

assessments (e.g. related to drain tubes, NGTs, IDCs)
IV fluids and rates of infusion
postoperative medications (especially those for pain and
nausea)
fluids and food allowed by mouth
level of activity the patient is allowed to resume
position the patient is to maintain while in bed
intake and output recording
laboratory tests and X-rays
special directions relevant to the surgery performed

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 Day 2 post-op: Mr Summers

Heart rate 108 beats/minute and regular

Blood pressure 165/98 mmHg
Respiratory 28 breaths/minute, deep and laboured rate
Chest Appears to be some intercostal muscle recession.
Air entry diminished to both bases and crackles present in right
base.
SpO2 89% on Hudson mask at 6 L/minute oxygen
Temperature 38.5C

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 Day 2
http://www.dailymail.co.uk/health/article-1345949/Patients-broken-hips-STILL-
waiting-long-surgery.html

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 Whats happening and what does this mean?
What is the most likely cause/s?

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 Use the A-G approach to identify & prioritise interventions for
Mr Summers

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 Select an intervention-
outline 2 specific evaluation criteria that would indicate that
this intervention is having the desired effect

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 Acute care nurses play a key role in managing health problems
and preventing complications.
Gather information/data about your pts past illnesses because
this will impact upon the care you provide and the patients ability
to recover and heal from surgery.
Include family members and/or significant others as they help to
support the patient.
Preoperative assessment provide an important baseline to
compare with postoperative assessment.
Preoperative education has a positive effect on postoperative
complications.
(Phillips & Massey, 2017)

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 http://www.medscape.com/viewarticle/729944

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 Reference

Phillips, N.M., & Massey, D. (2017). Working in acute care

environments. In J. Crisp, C. Douglas, G. Rebeiro, & D. Waters
(Eds.), Potter and Perry's Fundamentals of Nursing (pp.1452-
1466). Chatswood: Elsevier.

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