Postoperative period of the child in general surgery. It is the time elapsed since the patient is operated on until discharge. It can be immediate and mediate; the first occurs in the first 72 hours after surgery and the second after this time. Let’s point out that these time limits are not absolute.
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- 1 Objectives and characteristics of this period
- 2 Immediate postoperative
- 3 Possible postoperative complications
- 4 Immediate postoperative care
- 5 Source
Objectives and characteristics of this period
Post-operative care involves intensive care in order to:
- Appreciate the patient’s condition, psychologically and physically, and intervene effectively to promote recovery.
- Prevent and timely appreciate complications.
- Protect the patient from injury during the period of unconsciousness, and relieve discomfort.
- Help the patient regain his independence.
Factors such as the patient’s age, nutritional status, or disease states, which require more intensive therapy, will affect the length of the postoperative period. The type of surgical intervention will influence the duration of continuous surveillance required by the patient after the immediate post-anesthetic period.
During this period, the patient is located in the Recovery Room or the Intensive Care Unit, services specially created for this type of patient that requires close observation and quick action in the event of a sudden complication. Patients arriving at the Intensive Care Unit are sent there for risk factors that lead to greater postoperative care, while patients in the recovery room remain there only as long as necessary to recover from the effects of anesthesia.
The intervention of the intensivist nurse during the postoperative period is based on the patient’s deep knowledge, the pathophysiology of the specific surgical procedure and the organism that fights. The uninterrupted appreciation of the parameters that indicate the state of the patient at all times enables the nurse’s judgment and communication with the doctor; Another important factor that the nurse must take into account in the postoperative period is full identification with the pathology presented by the patient, since not only is the notion of the operation performed in these cases sufficient, but also knowledge of the history of the disease, including the antecedents, symptoms and important signs and other elements that motivated the surgical intervention.
Immediate interest is intravenous fluids, cures and drains, nausea and vomiting, pain experienced and monitoring of vital signs, as the postoperative period progresses, careful attention is required to the patient’s activity, while recording early signs. of complications.
Possible postoperative complications
In the first 24 hours after the intervention, great attention needs to be paid to the prevention or possible diagnosis of 5 important complications in the immediate postoperative period:
- Hemorrhage: it can be internal or external; If it is internal, it will be appreciated not by visible blood, but by paleness, low blood pressure, tachycardia, restlessness and dehydration, externally, the dressings must be regularly inspected for any sign of bleeding, an observation that will also cover clothing. bed and the dressings that have been left under the patient because the blood can escape and the stain on the bedding is more evident than on the dressing; in the event that it occurs it may be necessary to take the patient back to the Operating Room. Frequently, blood transfusion is ordered to correct the loss. When reporting bleeding to the doctor, always assess the color of the blood: bright red blood indicates recent bleeding, dark brownish blood indicates that the bleeding is not recent.
- Shock: fluid and electrolyte loss, trauma, anesthetics, premedication drugs, and sepsis may be involved in triggering shock.
Symptoms include paleness, hypotension, rapid (tachycardia) and weak pulse, cold extremities, decreased urine output. Narcotics will never be administered to the patient in shock or if shock appears imminent. They are placed with the head lower than the feet to maintain good cerebral irrigation. Patients undergoing brain surgery or spinal anesthesia remain horizontal and the foot bed area does not rise (if done, the spinal anesthetic may rise and cause respiratory arrest; place the head lower than the rest of the body after brain surgery may cause increased cerebral edema). Treatment of shock includes administering fluids parenterally, such as plasma expanders, blood cells, plasma, hydrocortisone, inotropic drugs, etc.
- Hypoxia: oxygen deficiency can complicate postoperative recovery; sometimes preoperative anesthetics and medications depress breathing; the mucus can block the airways making it difficult for air to enter, which decreases the pulmonary gas exchange. The oxygenation and aspiration equipment must be kept ready for use and will be carefully monitored for cyanosis and / or dyspnea. Other factors such as excessive doses of drugs or their side effects, pain, inadequate position, extensive and comprehensive bandages that restrict movements of the rib cage as well as obstruction of the airways also cause hypoxia. Signs of restlessness, increased respiratory rate, circulation, nasal flutter, warn of shortness of breath, implying oxygen administration,
- Vomiting: occurs in patients who come from the classroom without a nasogastric tube, although it is not frequent; most have nausea and anorexia. If she vomits, gastric rest is imposed, suspending the oral route; if they are frequent or abundant, a nasogastric tube is placed and gastric rest is maintained by sucking periodically and feeding will be done intravenously, according to a medical order. Many patients begin to eat food and liquids hours after having undergone the operation, except for the one performed on the digestive system; The presence of a nasogastric tube allows measurement of gastric aspirations until intestinal peristalsis is restored. The shrewd nurse will always be aware of this postoperative situation and must keep the head lateralized if the patient is in the supine position, since if he vomits suddenly, it could cause bronchoaspiration. If she vomits even with the Levin in place, her position and TIMEcy must be rectified.
- Pain: after any surgical operation, the appearance of pain can be expected, so it will be indicated to administer analgesics and try to make the patient as comfortable as possible. The pain becomes intense in the first 48 hours and triggers various degrees of anxiety, some endure it, others fear it so much that their tension increases. The pain experienced by the patient when recovering from anesthesia is relatively strong and is often increased by feelings of helplessness and bewilderment due to being in a strange environment and due to the fact that the administration of analgesics has to be deferred until vital signs stabilize; in such circumstances the animating presence of the nurse is of the utmost importance,
Other care measures should be attempted to relieve pain and pain relievers should never be administered as substitutes for nursing care. Sometimes helping the patient change position, gently massaging her back, or allowing her to express her concerns about her condition will be enough to relieve her. More than one nurse after practicing these measures mentioned, usually leaves the patient asleep. If an analgesic is needed, its effect will be more effective if the patient is placed as comfortably as it can rest satisfactorily and receive the full benefit of the medication.
Immediate postoperative care
- Drains: It should be known whether drains were placed and the type of fluid that should be expected to drain. Dressings with drainage material can be readjusted or changed according to medical needs or indications. If the exit of drainage material is foreseen, it will be explained to the patient that this is a normal result of the operation and does not indicate any complication. The color and volume of the drainage material will be accurately noted in the patient’s medical record.
- IV Therapeutics: After major surgery, intravenous solutions are usually administered to restore lost fluids and electrolytes. Blood transfusions may be necessary to replace blood loss. It is important to assess the rate of perfusion and infiltration of the administration area appears. Check your doctor’s order to see if IV fluids will be continued or discontinued. Basic acid imbalances are important in patients and will be corrected according to the results of the blood gas.
- State of consciousness: the nurse will observe the state of consciousness of the recently operated patient; if general anesthesia was administered, the patient will be unconscious, but gradually begin to show concern and then open his eyes, he will complain and make some movements before regaining consciousness, when he begins to react, he will speak quietly to instill confidence.
- Fluid ingestion: the beginning of the oral route will be ordered by the doctor; As long as it is not allowed, the oral cavity can be moistened with a little water or some ice chips to relieve dryness. Once it is ordered to start it, it must be in small quantities to avoid vomiting.
- Diuresis: its measurement is important in all operated patients (especially in major surgery) since it is necessary to calculate the hydromineral balance, in addition to being an important index of kidney function. In those without a bladder catheter, the volume emitted spontaneously will be measured, and the collector will be used in young children.
The nurse will record the hours and volume of each urination. You will have to follow the specific instructions that the doctor leaves to measure the discharges (diuresis, gastric content, drains). Likewise, it must record what was administered (venoclysis, medications, plasma, blood, etc.) during the immediate postoperative period. If the patient does not have a bladder catheter and delays urinating, bear in mind the possibility of urinary retention; You should look for the “bladder balloon” by feeling the suprapubic region where the increased bladder volume can be found . The doctor should be consulted.