Postoperative Phase
After the patient’s condition has been stabilized in
the recovery room, a physician will order the patient’s
transfer to another area of 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 normal
physiological functions, every effort must be made to
prevent postoperative complications.
POSTOPERATIVE GOALS.—From the time
the patient is admitted to the recovery room to the time
recovery from the operation is complete, there are
definite goals of care that guide the entire
postoperative course. These goals are as follows:
Promoting respiratory function
Promoting cardiovascular function
Promoting renal function
Promoting nutrition and elimination
Promoting fluid and electrolyte balance
Promoting wound healing
Encouraging rest and comfort
Encouraging movement and ambulation
Preventing postoperative complications
The physician will write orders for postoperative
care that are directed at accomplishing the above goals.
Although the orders will be based on each individual
patient’s 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 paragraphs.
R e s p i r a t o r y f u n c t i o n
i s p r o m o t e d b y
encouraging frequent coughing and deep breathing.
Early movement and ambulation also help improve
respiratory function.
For some patients, oxygen
therapy may also be ordered to assist respiratory
function.
Cardiovascular function is assisted by
frequent position changes, early movement and
ambulation, and, in some cases, intravenous therapy.
Renal function is promoted by adequate fluid intake
and early movement and ambulation.
Nutritional
status is promoted by ensuring adequate oral and
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 help 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
b o w e l o u t p u t , a n d p r o m p t l y a d m i n i s t e r i n g
pain-relieving medications.
Early movement and
ambulation are assisted by ensuring maximum
c o m f o r t f o r t h e p a t i e n t a n d p r o v i d i n g t h e
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.
POSTOPERATIVE COMPLICATIONS.—
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
p n e u m o n i a ,
p h l e b i t i s
a n d
s u b s e q u e n t
thrombophlebitis, gastrointestinal problems ranging
from abdominal distention to intestinal obstruction,
a n d , f i n a l l y, w o u n d i n f e c t i o n s .
A c c u r a t e
implementation of the physician’s orders and careful
observation, reporting, and recording of the patient’s
condition will contribute markedly to an optimal and
timely postoperative recovery course for the patient.
THE ORTHOPEDIC PATIENT
LEARNING OBJECTIVE: Evaluate the
needs of the orthopedic patient.
Patients receiving orthopedic services are those
who require treatment for fractures, deformities, and
diseases or injuries of some part of the musculoskeletal
system.
Some patients will require surgery,
immobilization, or both to correct their condition.
General Care
The basic principles and concepts of care for the
surgical patient will apply to orthopedic patients. The
majority of patients not requiring surgical intervention
2-19
