Postoperative PhaseAfter the patient’s condition has been stabilized inthe recovery room, a physician will order the patient’stransfer to another area of the facility. Generally, thistransfer is to the unit that the patient was assigned topreoperatively. Since both surgery and anesthesiahave unavoidable temporary ill effects on normalphysiological functions, every effort must be made toprevent postoperative complications.POSTOPERATIVE GOALS.—From the timethe patient is admitted to the recovery room to the timerecovery from the operation is complete, there aredefinite goals of care that guide the entirepostoperative course. These goals are as follows:Promoting respiratory functionPromoting cardiovascular functionPromoting renal functionPromoting nutrition and eliminationPromoting fluid and electrolyte balancePromoting wound healingEncouraging rest and comfortEncouraging movement and ambulationPreventing postoperative complicationsThe physician will write orders for postoperativecare that are directed at accomplishing the above goals.Although the orders will be based on each individualpatient’s needs, there will be some common orders thatapply to all patients. These orders will center aroundthe promotion of certain physiological functions andareas addressed in the following paragraphs.R e s p i r a t o r y f u n c t i o ni s p r o m o t e d b yencouraging frequent coughing and deep breathing.Early movement and ambulation also help improverespiratory function. For some patients, oxygentherapy may also be ordered to assist respiratoryfunction.Cardiovascular function is assisted byfrequent position changes, early movement andambulation, and, in some cases, intravenous therapy.Renal function is promoted by adequate fluid intakeand early movement and ambulation.Nutritionalstatus is promoted by ensuring adequate oral andcorrect intravenous intake and by maintaining accurateintake and output records. Elimination functions arepromoted by adequate diet and fluid intake.Postoperative patients should be advanced to a normaldietary regimen as soon as possible, since this, too,promotes elimination functions. Early movement andambulation also help to restore normal eliminationactivities.In addition to various medications and dressingchange procedures ordered by the physician, woundhealing is promoted by good nutritional intake and byearly movement and ambulation. Rest and comfortare supported by properly positioning the patient,providing a restful environment, encouraging goodbasic hygiene measures, ensuring optimal bladder andb 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 gpain-relieving medications. Early movement andambulation are assisted by ensuring maximumc 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 eencouragement and support for ambulating the patient,particularly in the early postoperative period. Asindicated in the above discussion, the value of earlymovement and ambulation, when permissible, cannotbe overemphasized.POSTOPERATIVE COMPLICATIONS.—During the early postoperative phase, the majorcomplications to be guarded against are respiratoryobstruction, shock, and hemorrhage. As the patientprogresses in the postoperative period, othercomplications to avoid are the development ofp 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 tthrombophlebitis, gastrointestinal problems rangingfrom 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 eimplementation of the physician’s orders and carefulobservation, reporting, and recording of the patient’scondition will contribute markedly to an optimal andtimely postoperative recovery course for the patient.THE ORTHOPEDIC PATIENTLEARNING OBJECTIVE: Evaluate theneeds of the orthopedic patient.Patients receiving orthopedic services are thosewho require treatment for fractures, deformities, anddiseases or injuries of some part of the musculoskeletalsystem. Some patients will require surgery,immobilization, or both to correct their condition.General CareThe basic principles and concepts of care for thesurgical patient will apply to orthopedic patients. Themajority of patients not requiring surgical intervention2-19
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