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