3-4. NURSING CARE OF A SURGICAL PATIENT
Nursing interventions immediately after surgery are carried out by the recovery room nurses. These nurses have special skills to care for a patient recovering from anesthesia and surgery. Their main goals are to make sure the patient is comfortable and safe while in the recovery room. The nurses will:
a. Maintain proper functioning of drains, tubes, and intravenous fluids.
b. Prevent kinking or clogging that interferes with adequate drainage of catheters and drainage tubes.
c. Encourage and assist the patient to cough, to turn frequently, and to take deep breaths several times each hour.
d. Monitor the patient's intake and output accurately, including all IVs, blood products, urine, emesis, NG tube drainage, etc.
e. Implement safety measures to protect dependent and lethargic patients. These safety measures are given below.
(1) Keep siderails in the high position at all times (see Figure 3-5).
Figure 3-5. Position of the siderails. A. High positon. B. Intermediate postion. C. Low position
(2) Keep the patient warm and comfortable.
(3) If call bells are in the wall unit, teach the patient how to use them (if he is alert). Keep them readily available for the patient.
(4) Position the patient so that he is not resting on his tubes and thus preventing future skin breakdown.
(5) No head pillow is used for the unconscious patient or for 8 hours following spinal anesthesia.
(6) The patient's head is turned to one side when the patient is in the supine position so that secretions can drain from the mouth, and the tongue cannot fall back into the throat to block the air passages.
f. Prevent nosocomial infections by washing your hands before and after working with each patient. Maintain aseptic technique for incisional wound care and turn the patient frequently to prevent respiratory infections.
g. Observe for and report any feeling/movement of the patient if he has had a spinal anesthetic.
(1) Spinal anesthesia wears off slowly.
(2) Observe for spontaneous movements as recovery time goes by.
(3) Movement usually returns before feelings and is first observed in the patient's toes and then moves up the legs.
(4) As anesthesia wears off, the patient will begin to have sensation often described as "pins and needles."
(5) Keep the patient in the supine position for 6 to 8 hours to prevent spinal headache.
(6) The patient may turn from side to side and prop up with pillows if the physician permits. This is done to relieve pressure from his back, but only for a few minutes at a time.
h. Observe and document the recovery room patient's level of consciousness.
(1) Specific criteria are usually used in the recovery room for categorizing the recovering patient as follows:
(a) Alert -- The patient will be able to give appropriate response to stimuli.
(b) Drowsy -- The patient is half asleep and sluggish.
(c) Stupor -- The patient is lethargic and unresponsive, unaware of surroundings.
(d) Comatose -- The patient is unconscious and unresponsive to stimuli.
(2) Engage the patient in a conversation, if possible, to observe his level of orientation.
i. Take into consideration each patient's baseline (normal) responses due to various physical factors.
(1) Hearing deficit.
(2) Inability to understand speech/speaks a foreign language.
(3) Previous physical weaknesses.
j. Provide emotional support to the patient and family.
(1) When the patient is alert, tell him about his whereabouts and that you are nearby and will help him as needed.
(2) Teach the patient using brief, simple sentences about the tasks you will be doing.
(3) Encourage conversation with the patient. This will decrease anxiety and increase his lung expansion.
(4) Reinforce information from the surgeon.
(5) Stay with the family members if they are permitted in the recovery room. Remember, they may be frightened of the environment and the way their loved one looks.
k. When the patient is cleared by the surgeon, call the receiving nursing unit and give the report. Include the following information.
(1) Patient's name.
(2) Type of surgery.
(3) Update of care in the recovery room.
(4) Mental alertness.
(5) Time of vital signs and results.
(6) Interaction with family in the recovery room.
(7) Presence, type, and functioning of drainage tubes, IV, etc.
(8) If patient has voided or not.
l. Record all of the above information on the Nursing Notes. Transfer the patient per recovery room SOP.
Section III. SUCTIONING THE PATIENT IN THE RECOVERY ROOM