Learning Objectives
By the end of this section, you will be able to:
- Relate interventions for the postoperative patient to common postoperative concerns
- Describe the nursing plan of care to prevent complications during the postoperative period
- Discuss the role of the nurse in providing education and psychosocial support to the postoperative patient and their family
Establishing a postoperative care plan is an integral aspect of nursing practice and must include everything a patient needs for optimal recovery while mitigating potential complications. An effective care plan should be customized to the needs of the individual patient. The process begins with an evaluation of a patient’s health status as well as any preexisting health issues or concerns they have. From this information gathered during an assessment, a nurse can identify specific nursing diagnoses, such as reduced mobility, knowledge deficit, risk of infection, or altered comfort that will serve to guide goal setting and intervention strategies (Rao et al., 2021).
Goals set during postoperative care plans aim at meeting both physiological and psychological needs for each patient during recovery, including preventive measures, monitoring protocols, and interventions to address potential complications. Communication is at the center of creating care plans. Communicating key details regarding patient conditions, goals, and interventions between health-care team members, including dietitians and physical therapists, can promote collaborative and cohesive care delivery. Furthermore, postoperative care plans often extend well beyond postsurgical recovery to incorporate education and discharge planning. Nurses provide guidance to both their patient and the patient’s support system about postoperative care, potential complications to monitor for at home, and follow-up appointments. This proactive approach allows and encourages active participation from everyone involved during recovery.
Common Postoperative Concerns
Ongoing assessment includes vital signs, pain levels, respiratory and cardiovascular status, surgical site condition as well as the emotional well-being of a patient. Regular assessments allow the nurse to adapt the care plan as required, keeping up with evolving patient needs and recovery progress. The most serious postoperative complications, as previously discussed, include a DVT or PE. Additionally, hemorrhage from a surgical site can cause hypotension, changes in hemodynamics, and shock. The most common postoperative concerns are typically postoperative nausea and vomiting (PONV), pain, hemodynamic changes, and urinary retention.
Postoperative Nausea and Vomiting
Assessing and treating PONV are integral components of nursing care for surgical recovery patients. Nurse assessments begin by reviewing each patient’s medical history and symptoms to identify potential risk factors of PONV, such as previous episodes of motion sickness or recent surgical procedures that increase PONV risk. After surgery, nurses monitor patients closely for any signs and symptoms of PONV, including patient reports, facial expressions, and physiological indicators like increased salivation or pallor (Jin et al., 2020). There are pharmacological and nonpharmacological interventions the nurse can use to help decrease PONV.
Pain Management
Effective postoperative pain management is key for optimizing patient comfort and supporting recovery. Combining both pharmacological and nonpharmacological interventions tailored to an individual patient’s specific needs and the nature of surgical procedure should be used. Pharmaceutical interventions might include taking analgesics. Nurses carefully assess a patient’s level of pain using validated pain scales and administer analgesics as recommended by health-care providers. As discussed earlier, there are pharmacological and nonpharmacological interventions the nurse can use to help decrease postsurgical pain.
Hemodynamics
Managing postoperative hemodynamics requires vigilant observation and intervention by the nurse to protect the patient’s cardiovascular function and to avoid potential complications. Hemodynamics deals with the flow of blood and the body’s ability to perfuse tissues, which is measured by blood pressure and pulse. Nurses frequently monitor vital signs following surgery to evaluate a patient’s overall hemodynamic status. Continuous electrocardiogram (ECG) monitoring provides real-time information regarding cardiac rhythm, allowing early identification of any arrhythmias or abnormalities that might develop. Hemodynamics reflect tissue perfusion and adequate oxygenation. Central venous pressure or pulmonary artery pressure monitoring may be utilized to assess fluid status and cardiac function more accurately. Nurses may need to administer intravenous fluids and medications to support hemodynamic stability. Fluid management should consider each patient’s individualized needs, surgical factors, and potential comorbidities to avoid both hypovolemia and fluid overload.
Nurses monitor and are prepared to respond to changes of cardiac function, specifically hypotension or hypertension. For hypotension, nurses may give a bolus (a single large dose of fluid) to increase blood pressure per the provider’s order. When electrolytes are increased and blood pressure is low, often a simple bolus of normal saline can restore normal hemodynamics and balance the electrolytes. For hypertension, nurses need to evaluate the cause, which may be from pain, emotional stress or fear, or cardiac overload of fluids. With a provider’s order, interventions may include diuretics to help the body rid excess fluid and avoid peripheral edema and respiratory congestion.
As indicated, inotropic (medications that impact the speed of cardiac contraction) or vasopressor medications may be administered to optimize cardiac output and blood pressure. Assessing peripheral perfusion is important, and nurses need to monitor skin color, temperature, capillary refill time, and peripheral pulses closely in order to spot indicators of inadequate tissue perfusion. Recognizing and taking prompt corrective action upon any deviations from baseline hemodynamic parameters is of vital importance. Nursing interventions for postoperative hemodynamics management may include changing a patient’s position, providing oxygen therapy, or initiating fluid resuscitation/vasopressor support as directed by the health-care provider. Nurses should communicate any concerning findings to the provider immediately to facilitate prompt interventions and modifications of a patient’s care plan. Patient education is important, especially focusing on discharge planning, to help the patient understand the impact of the surgery on their circulatory system and when to call their provider.
If a nurse detects a postoperative patient is experiencing low blood pressure or tachypnea after surgery, immediate action must be taken. Nurses should immediately conduct an ABC assessment to pinpoint potential sources of hemodynamic instability and identify any possible solutions. When there are signs of compromised airway or breathing conditions, interventions such as repositioning, administering additional oxygen therapy, or calling for respiratory support should be implemented immediately. Concurrently, a nurse should assess the surgical site for signs of bleeding or hematoma that might explain any observed decreases in blood pressure. Communication between the nurse and the health-care provider is of utmost importance at this point in order to report findings, discuss possible causes, and get guidance regarding further interventions. Based on the severity of a situation, additional actions could include administering intravenous fluids or medications or prepping for advanced monitoring or interventions. Close monitoring, ongoing assessment, and effective communication with the health-care team are all integral parts of responding effectively to postoperative hemodynamic instability as a nurse.
Urinary Retention
Nursing management of postoperative urinary retention includes proactive assessment, monitoring, and intervention to address potential complications related to impaired urinary elimination. The inability to urinate after surgery even when the bladder is full is called postoperative urinary retention (POUR) (Pomajzl & Siref, 2023). After surgery, nurses regularly assess a patient’s urinary status by tracking intake and output as well as asking the patient about any difficulty or discomfort experienced while urinating. Patients at risk of postoperative urinary retention include those who have undergone lower abdominal or pelvic surgeries, have received epidural anesthesia, or have an established history of urinary issues. Nurses ensure the patient has access to a bedside commode or urinal and should encourage frequent attempts at voiding. When a patient reports difficulty or inability in passing urine postoperatively, nurses can implement various strategies for managing urine retention. These may include providing privacy and an unhurried environment in which to void, aiding with positioning that promotes relaxation of pelvic floor muscles, and providing ample hydration to promote urine production. In certain circumstances, nurses may utilize bladder scanning technology to assess urine volume in the bladder and ascertain the need for intervention.
If noninvasive measures prove ineffective, catheterization might become necessary under medical guidance and the provider’s order. Intermittent straight catheterization may help relieve urine retention and avoid complications such as urinary tract infections or bladder distension. Catheterization should be used only as a last resort due to associated risks with infection. Generally, if an indwelling urinary catheter was placed during surgery, it is removed within six hours postoperatively. Research indicates the quicker a urinary catheter is removed after surgery, the less risks the patient has for long-term infections (Gad & AbdelAziz, 2021).
Patient education plays a vital part in nursing management for POUR. Patients should immediately be assessed if they report any difficulty with voiding and practice strategies to support normal urinary function. Routine evaluation of urinary output, assessment of signs and symptoms of bladder distention, and ongoing communication with patients contribute to effective nursing management of POUR. In many facilities, it is a requirement for the patient to urinate once before being allowed to return home after a same-day surgery.
Prevention of Complications
Prevention of complications is an essential aspect of nursing care for postoperative patients. Nurses need to monitor, assess, and intervene quickly to handle potential complications such as infections, respiratory ailments, or thromboembolic events. Implementation of evidence-based practices like proper wound care, administration of prescribed medications, and early patient ambulation has proven highly successful in mitigating adverse events and improving recovery times. Patient education on warning signs, postoperative care instructions, and follow-up appointments empower individuals to actively take part in their recovery while seeking timely assistance when needed. Nurses’ expertise in anticipating, identifying, and responding to potential complications benefits both patients and health-care delivery systems by decreasing hospital readmission rates, hospital-acquired infections, and their associated costs.
Decreasing Aspiration Risk
Aspiration can pose serious danger, particularly to postoperative individuals who may experience altered consciousness or compromised protective airway reflexes. Preventing aspiration in postoperative patients is of vital importance, and nurses play a pivotal role in ensuring patient safety during recovery phase. Nurses assess risk factors associated with the effects of anesthesia as well as the presence of comorbidities and employ positioning techniques (e.g., keeping the head of the bed ≥30 degrees) that lower regurgitation risks. Patients must adhere to preoperative fasting guidelines and tolerate the gradual return to oral intake postoperatively, to prevent aspiration during recovery. Nurses should actively watch for any signs of aspiration, such as coughing, choking, or respiratory distress, to identify patients who require emergency intervention such as withholding oral intake until the patient’s protective reflexes and swallowing ability has fully returned.
Decreasing Respiratory Impairment Risk
Nurses bear a responsibility to safeguard postoperative patients’ respiratory function as compromised breathing poses significant health risks during recovery. As part of postoperative patient care, nurses monitor respiratory status by measuring oxygen saturation levels, respiratory rates, and chest movement. Early mobilization, incentive spirometry, and deep breathing exercises are integral parts of nursing interventions to maintain lung expansion and avoid atelectasis. Patients with obstructive sleep apnea are also at risk for postoperative complications. They should be monitored for adequate oxygenation after surgery. Pain management strategies must also be strategically applied in order to provide patient comfort without suppressing respiratory function. Prompt assessment and interventions such as improved positioning, administration of additional oxygen therapy, or collaboration between medical services providers and respiratory therapy services promotes positive patient outcomes. Effective patient education on the significance of good respiratory hygiene practices and early ambulation allows individuals to actively take part in their respiratory health care, reducing the risks of postoperative complications while hastening recovery.
Decreasing Clot Risk
Preventing blood clot formation, particularly DVT and its potentially life-threatening complication of a pulmonary embolism (PE), is an integral component of nursing care for postoperative patients. Nurses play a pivotal role in providing effective thromboprophylaxis strategies such as early mobilization, use of sequential compression devices (SCDs) (Figure 27.4), compression stockings, and anticoagulant medications as part of evidence-based protocols for prevention.
Regular assessments of risk factors associated with blood clot formation such as immobility, type of surgery performed, and any coexisting diseases inform an individualized prevention plan tailored specifically for each patient. With thorough education on the symptoms and prevention measures associated with thromboembolic events, nurses can empower patients to actively take an active part in ensuring their own safety. Nurse work closely with interdisciplinary team members to ensure that prevention plans can be customized as required to minimize risk and enhance postoperative patient well-being.
Decreasing Infection Risk
SSIs or surgical site infections are a quality assurance risk that all members of the health-care team must diligently reduce. Surgical wounds are susceptible to bacterial contamination that can result in life-threatening complications. Preventing infection should always be a priority when caring for postoperative patients. As preventive measures, nurses utilize aseptic practices, and ensure proper hand hygiene, sterile dressing changes, and meticulous wound care. Monitoring for signs of infection at surgical sites, such as redness, swelling, warmth, or drainage, allows for early identification and intervention (Figure 27.5). Administering prescribed antibiotics and promptly removing drains and catheters also help to combat infection. Patient education on wound care, hygiene practices, and reporting any signs of infection helps individuals take an active part in their own recovery while aiding early detection.
Clinical Safety and Procedures (QSEN)
Preventing Postoperative Complications
Preventing postoperative complications is a critical aspect where QSEN competencies are directly applicable. Here’s how nurses observe QSEN competencies to prevent postoperative complications:
- Patient-centered care
Involving patients and families: Nurses involve patients and their families in the care plan, ensuring they understand postoperative care instructions, potential complications, and when to seek help.
Respecting patient preferences: Tailoring pain management and care plans according to the patient’s needs, cultural backgrounds, and preferences enhances recovery and reduces the risk of complications. - Teamwork and collaboration
Effective communication: Nurses communicate clearly and regularly with the surgical team, anesthesiologists, and other health-care providers to ensure a seamless transition of care and address any issues promptly.
Interdisciplinary collaboration: Collaborating with physical therapists, dietitians, and other specialists helps in creating a comprehensive care plan that addresses all aspects of patient recovery and reduces the risk of complications such as deep vein thrombosis (DVT) and pneumonia. - Evidence-based practice
Implementing best practices: Nurses stay informed about the latest evidence-based guidelines for postoperative care, including infection control, pain management, and early mobilization strategies.
Continuous education: Engaging in lifelong learning ensures that nurses are up-to-date with the latest research and techniques to prevent postoperative complications effectively. - Quality improvement
Monitoring outcomes: Nurses participate in quality improvement initiatives by tracking postoperative outcomes, identifying trends, and contributing to the development of strategies to improve patient care.
Feedback and reflection: Regularly reflecting on care practices and outcomes allows nurses to identify areas for improvement and implement changes to prevent future complications. - Safety
Preventing infections: Adhering to strict aseptic techniques and protocols for wound care, catheter care, and hand hygiene minimizes the risk of postoperative infections.
Medication safety: Carefully managing and administering medications, including anticoagulants and antibiotics, to prevent complications such as DVT and surgical site infections.
Fall prevention: Implementing safety measures such as ensuring the patient’s environment is free of hazards and assisting with ambulation to prevent falls during the postoperative period. - Informatics
Electronic health records (EHR): Utilizing EHRs to document and track patient information accurately, ensuring that all members of the health-care team have access to up-to-date patient data.
Decision support systems: Using clinical decision support systems to identify potential risks and alert health-care providers to implement preventive measures promptly.
By integrating QSEN competencies into daily practice, nurses play a crucial role in preventing postoperative complications and ensuring high-quality, safe patient care. This holistic approach not only improves patient outcomes but also enhances overall health-care quality and safety.
Decreasing Hemorrhage Risk
Nurses caring for postoperative patients must prioritize preventing hemorrhage as an essential goal, given that surgical procedures carry inherent risks of bleeding complications. Nurses monitor vital signs closely, assess surgical sites for signs of excessive bleeding, and educate patients to recognize abnormal blood loss or hemorrhage symptoms. Administration of prescribed hemostatic medications on an optimal schedule and close monitoring of drainage and blood loss help prevent hemorrhages. Furthermore, early intervention when abnormal bleeding occurs is also essential to preventing complications. Patient education on activity restrictions, adhering to postoperative care guidelines, and being alert for signs of bleeding help facilitate active patient participation in their healing journey. Nurses play an invaluable role in mitigating hemorrhagic risks and encouraging safe postoperative recovery for their patients through vigilant monitoring, effective communication with the interdisciplinary team, and proactive patient education.
Patient and Family-Centered Care
The focus of all health practice is patient-centered care. Including the patient’s family and support network is paramount to successful outcomes. Family members and close friends provide emotional support, comfort, and encouragement that contribute significantly to the patient’s overall well-being and mental health during recovery periods. Their involvement can also improve continuity of care by knowing and reinforcing the patient’s postoperative instructions, medication schedules, and rehabilitation exercises. Family members can provide invaluable advocacy on behalf of their loved one by communicating any changes or concerns with health-care staff. Encouraging open dialogue and collaboration between nurses and the families of patients generates an atmosphere of support that enhances the recovery journey, provides a sense of safety, and creates more positive postoperative experiences.
Patient Education
Patient education after surgical treatment involves many crucial elements to ensure successful healing and a good recovery. Nurses should offer the patient guidance in pain management strategies, emphasizing the need to quickly report a change in pain levels to enable timely interventions that meet the patient’s needs. Wound care instructions, including signs of infection and proper dressing changes, are provided to the patient to minimize complications at surgical sites. Mobility exercises and ambulation techniques, medication education, and respiratory exercises are all included as part of a postoperative education plan, along with instructions regarding potential complications. Educating patients and family members about the importance of follow-up appointments and when to notify their health-care provider if concerns or complications develop, along with the rest of the postoperative plan, create an informed and empowered patient who experiences a smoother postoperative recovery process.
Providing Emotional Support
Nurses can offer postoperative patients emotional and spiritual support by cultivating open communication and showing genuine care and empathy. Acknowledging any worries, fears, or anxiety around surgical experiences and recovery processes as soon as they arise is helpful for proper healing and wellness. Nurses should strive to create an atmosphere in which a patient feels free to express themselves without the fear of judgment. This is key to building trusting and therapeutic relationships with patients. Nurses can offer assurance and realistic expectations regarding recovery processes while clearing up any misconceptions or uncertainties patients may have. Providing information to the patient about their progress, including the patient in decision making where applicable, and encouraging the patient to express their feelings all foster an atmosphere of control and empowerment. Nurses work collaboratively with other interdisciplinary team members, such as social workers or counselors, to provide additional emotional support as needed, further strengthening postoperative patients’ overall well-being and resilience during recovery.