Recovery Room Equipment

• heart monitoring
• suction equipment measure output (Yankeur suction for nose & mouth, has larger bore catheter (wider & shorter)
• Oxygen nasal canula, ventilator, try to wean off O2 if healthy & before they leave recovery, note O2 sat
• pulse oximeter
• V/S equipment: dynamap checks BP, pt can have it check every minute, print out recording
• SCD (hose that intermittently decompress & compress) & TED hose put on pre-op to ↑circulation to legs to prevent DVT, and ↑return to heart from legs
• PCA pump (initiated by anesthesiologist), monitored by nurse

Complications Cardiovascular Complications

• Hemorrhage
• Shock
• Thrombophlebitis
• Deep vein thrombosis
• Pulmonary embolus
• Leg Exercises to Increase Venous Return nurse should teach pre-op (↑venous return, ↓DVT. use of SCD & TED hose also
• Respiratory Complications pg. 83 LeMone
• Pneumonia
• Atelectasis collapse of alveoli, collapse or incomplete expansion of lung tissue due to inadequate lung ventilation
• Interventions to Prevent (pg 72 L)

Respiratory Complications (atelectasis & pneumonia)

• Monitoring vital signs
• Implementing deep breathing*
• Coughing* (cough every 1-2 hrs = deep cough x4)
• Incentive spirometry* 1-2 hrs
• Turning in bed
• Ambulating
• Maintaining hydration
• Avoiding positioning that decreases ventilation
• Monitoring responses to narcotic analgesics

Urinary Complications (causes: Foleys & anesthesia)

• Urinary retention note output in recovery room chart
• Urinary tract infection

Gastrointestinal Complications

• (avoid gas foods)
• Nausea and vomiting
• Postoperative ileus assess bowel sounds (gut goes to sleep with anesthesia, no solid food until bowel sounds heard. listen for 5 minutes if not heard), Ask pt about flatulence (normal to have some)

Wound Complications

• Infection (S & Sx: swelling, redness, warmth, & drainage) teach pt and family
• Dehiscence separation of suture line
• partial surgeon may leave or may decide to resuture
• complete back to surgery
• concern for morbidly obese needs to be packed*
• Evisceration extrusion of body organs out of wound

Managing pain

• Prior to transfer from recovery room the client's pain should be stabilized
• It is not expected the client be pain free.
• Pain control regimen initiated
• Document level prior to transfer
• Assess for nonverbal pain cues: restlessness, in vitals, ↑heart rate, BP, & respirations

Other expectations prior to transfer

• Stable vital signs & gag reflex present
• Alert and awake easily aroused, understands instructions
• Communicating
• Adequate output
• Toleration of some clear liquids/decrease in N&V
• Stable CV and respiratory system
• Postoperative orders obtained and on chart give report at transfer
• can have orthostatic hypotension when stand up, have pt dangle legs a few mins.
• * don't use nurse's name in chart

Outcomes for the Surgical Patient

• Be free from injury and adverse effects
• Be free from infection
• Maintain fluid and electrolyte balance; skin integrity
• Demonstrate understanding of physiologic and psychological responses to surgery
• Participate in rehabilitation process: can be simple, ie. coughing

Common nursing diagnoses see T. 913, 30-1 skill related to hazards of immobility

• Acute pain risk for falls
• Risk for infection risk for constipation
• Risk for altered skin integrity ineffective coping
• Disturbed body image knowledge deficit
• Risk for urinary retention
• Risk for constipation
• Risk for injury

Developmental / Cultural Considerations Children

• use short simple explanations
• give mini tour of facility, explain what to expect.
• Pay careful attention to parents of infants & children, include them in education, plan of care & procedure as much as possible

Adolescents

• protect privacy
• remember actual age & developmental level of all clients
• be culturally competent
• keep family members informed to ↓anxiety & feeling of being left out, answer family & client questions
• Evaluate teaching & learning during recovery / postop phase.
• ie. coughing & deep breathing, use of ICS, diet, etc. taught before surgery