and general anesthesia consist of the following:
After the patients status has stabilized in the recovery room, a physician will order his or her transfer to another area in the facility. Generally, this transfer is to the unit that the patient was assigned to preoperatively. Since both surgery and anesthesia have unavoidable temporary ill effects on the normal physiological functions, every effort must be made to prevent postoperative complacations. From the time the patient is admitted to the recovery room to the time he or she has recovered from the operation, there are definite goals of care that guide the entire postoperative course. These goals are as follows:
The physician will write orders for postoperative care that are directed at accomplishing the above goals. Although each patients orders will be based on individual needs, there will be some common orders that apply to all patients. These orders will center around the promotion of certain physiological functions and areas addressed in the following paragraph.
Respiratory function is promoted by encouraging frequent coughing and deep breathing. Early movement and ambulation also help to improve respiratory function. For some patients, oxygen therapy may also be ordered to assist respiratory function. Cardiovascular function is assisted by frequent position changes, by early movement and ambulation, and, in some cases, by intravenous therapy. Renal function is promoted by adequate fluid intake and early movement and ambulation. Nutritional status is promoted by ensuring adequate oral or correct intravenous intake and by maintaining accurate intake and output records. Elimination functions are promoted by adequate diet and fluid intake. Postoperative patients should be advanced to a normal dietary regimen as soon as possible, since this too promotes elimination functions. Early movement and ambulation also helps to restore normal elimination activities. In addition to various medications and dressing change procedures ordered by the physician, wound healing is promoted by good nutritional intake and by early movement and ambulation. Rest and comfort are supported by properly positioning the patient, providing a restful environment, encouraging good basic hygiene measures, ensuring optimal bladder and bowel output, and promptly administering pain-relieving medications. Early movement and ambulation are assisted by ensuring maximum comfort for the patient and providing the encouragement and support for ambulating the patient, particularly in the early postoperative period. As indicated in the above discussion, the value of early movement and ambulation, when permissible, cannot be overemphasized.
During the early postoperative phase, the major complications to be guarded against are respiratory obstruction, shock, and hemorrhage. As the patient progresses in the postoperative period, other complications to avoid are the development of pneumonia, phlebitis and subsequent thrombophlebitis, gastrointestinal problems ranging from abdominal distention to intestinal obstruction, and finally wound infections. Accurate implementation of the physicians orders