2. ABCDE Assessment and Vital SignsABCDE Assessment and Vital Signs
Airway – clear & patent? May require an airway adjunct whileAirway – clear & patent? May require an airway adjunct while
unconscious.unconscious.
Breathing – Monitor respirations for rate, character and symmetry. OBreathing – Monitor respirations for rate, character and symmetry. O22
therapy until fully conscious and target saturations reached.therapy until fully conscious and target saturations reached.
Circulation – Monitor pulse for rate, volume, character. Monitor bloodCirculation – Monitor pulse for rate, volume, character. Monitor blood
pressure.pressure.
Disability – Level of Consciousness will initially be low but should riseDisability – Level of Consciousness will initially be low but should rise
as anaesthetic dissipates. Monitor blood glucose in diabetic patients.as anaesthetic dissipates. Monitor blood glucose in diabetic patients.
Exposure – Monitor temperature for signs of infection. Monitor woundExposure – Monitor temperature for signs of infection. Monitor wound
sites (usually not disturbed for first 24hrs) and drain sites. Regularsites (usually not disturbed for first 24hrs) and drain sites. Regular
pain scoring and analgesia, may also require anti-emetics. Maintainpain scoring and analgesia, may also require anti-emetics. Maintain
comfort.comfort.
COMMUNICATION WITH THE PATIENT IS KEY THROUGHOUT!COMMUNICATION WITH THE PATIENT IS KEY THROUGHOUT!
3. Oxygen TherapyOxygen Therapy
► Oxygen is considered a drug – it must beOxygen is considered a drug – it must be
prescribed.prescribed.
► Oxygen is usually delivered around 4-6l byOxygen is usually delivered around 4-6l by
Hudson mask post-op until anaesthetic hasHudson mask post-op until anaesthetic has
dissipated and saturations recover.dissipated and saturations recover.
► Care must be taken to maintain moist mucousCare must be taken to maintain moist mucous
membranes and avoid pressure around the maskmembranes and avoid pressure around the mask
and elastic.and elastic.
► Fire precautions must be taken as Oxygen isFire precautions must be taken as Oxygen is
flammable.flammable.
4. Specifics of SurgerySpecifics of Surgery
► Each surgery has its own considerations:Each surgery has its own considerations:
A range of drains may be used e.g. T-tube drains in gallA range of drains may be used e.g. T-tube drains in gall
bladder surgery; multiple drains in head and neck orbladder surgery; multiple drains in head and neck or
breast surgery.breast surgery.
Stoma care may be required after bowel surgery –Stoma care may be required after bowel surgery –
colour, size, surrounding skin and activity must becolour, size, surrounding skin and activity must be
considered.considered.
Orthopaedic surgery may require extensive physioOrthopaedic surgery may require extensive physio
input.input.
Cardiac surgery involves transfer to ITU for 24 hours.Cardiac surgery involves transfer to ITU for 24 hours.
Body image may be affected esp in head and neck,Body image may be affected esp in head and neck,
breast, genito-urinary or bowel surgery.breast, genito-urinary or bowel surgery.
5. IV InfusionsIV Infusions
►IV infusions may be used to replace fluidsIV infusions may be used to replace fluids
while patient is NBM.while patient is NBM.
►Additional constituents may be GKI forAdditional constituents may be GKI for
diabetics, Potassium or antibiotics.diabetics, Potassium or antibiotics.
►Fluids must be prescribed and charted andFluids must be prescribed and charted and
care taken esp with patients with heartcare taken esp with patients with heart
failure who may suffer overload.failure who may suffer overload.
6. Blood TransfusionsBlood Transfusions
► Student Nurses may not take part in bloodStudent Nurses may not take part in blood
transfusions except for monitoring vital signs.transfusions except for monitoring vital signs.
► Blood transfusions are usually given when Hb < 8Blood transfusions are usually given when Hb < 8
or blood loss over 30% (approx 1500mls)or blood loss over 30% (approx 1500mls)
► Blood must be appropriate to the individual toBlood must be appropriate to the individual to
avoid reactions and ‘group and save’ must beavoid reactions and ‘group and save’ must be
within a week or redone.within a week or redone.
► Transfusion reactions usually take place within 15Transfusion reactions usually take place within 15
minutes of start.minutes of start.
7. Pain AssessmentPain Assessment
► Assessment of pain is fundamental to managing painAssessment of pain is fundamental to managing pain
successfully. It is a crucial part of nursing care and shouldsuccessfully. It is a crucial part of nursing care and should
be carried out at regular intervals following surgery.be carried out at regular intervals following surgery.
► Pain assessment can involve:Pain assessment can involve:
Observation- looking for non-verbal signs such as guarding,Observation- looking for non-verbal signs such as guarding,
bracing or even lying perfectly still. Non-verbal clues are importantbracing or even lying perfectly still. Non-verbal clues are important
when nursing unconscious patients.when nursing unconscious patients.
Communication- talking to the patient and asking them questionsCommunication- talking to the patient and asking them questions
like where is your pain? What makes it worse? Describe the type oflike where is your pain? What makes it worse? Describe the type of
pain- sharp, dull, stabbing etc.pain- sharp, dull, stabbing etc.
Assessment tools- Pain scales, Smiley faces etc.Assessment tools- Pain scales, Smiley faces etc.
10. Pain ManagementPain Management
► Effective pain management rely’s on a good nurse/ patient relationship.Effective pain management rely’s on a good nurse/ patient relationship.
► Pain can be managed with the use of medication e.g. Weak/ StrongPain can be managed with the use of medication e.g. Weak/ Strong
Opioids, paracetamol etc. It very much depends on the type of surgery.Opioids, paracetamol etc. It very much depends on the type of surgery.
The route of administration needs to be considered, as you cannot giveThe route of administration needs to be considered, as you cannot give
oral meds to an unconscious patient.oral meds to an unconscious patient.
► Certain surgeries use PCA, which allows the patient to have moreCertain surgeries use PCA, which allows the patient to have more
control. This is not suitable for all surgeries and needs to be monitoredcontrol. This is not suitable for all surgeries and needs to be monitored
very closely.very closely.
► Patient’s pain may be managed with positional changes; getting themPatient’s pain may be managed with positional changes; getting them
up to sit when appropriate may help.up to sit when appropriate may help.
► There is a specialised pain services team which can offer advice aboutThere is a specialised pain services team which can offer advice about
the best way to manage a patients’ pain. They also offer educationalthe best way to manage a patients’ pain. They also offer educational
services to health professionals and audit and evaluate the care that isservices to health professionals and audit and evaluate the care that is
given.given.
11. Pain ManagementPain Management
► There are alternative methods regarding pain managementThere are alternative methods regarding pain management
that may be used after discharge-that may be used after discharge-
► * Relaxation (in/out patient)* Relaxation (in/out patient)
► * Massage* Massage
► * Heat/ cold packs* Heat/ cold packs
► * Hypnosis* Hypnosis
► * Acupuncture* Acupuncture
► Post-operative pain is managed by nurses, surgeons,Post-operative pain is managed by nurses, surgeons,
anaesthetists and physio’s, it is very much a team effort. Itanaesthetists and physio’s, it is very much a team effort. It
should also be noted that treatment must be tailored to theshould also be noted that treatment must be tailored to the
individual and preventing pain should be the main goal.individual and preventing pain should be the main goal.
12. MobilityMobility
► If the patient is on bed rest as first you would be looking atIf the patient is on bed rest as first you would be looking at
positional changes and pressure relieving devices, with the usepositional changes and pressure relieving devices, with the use
of passive exercise ie. lifting and bending patients legs.of passive exercise ie. lifting and bending patients legs.
► Encourage early mobilisation as this prevents complicationsEncourage early mobilisation as this prevents complications
such as pressure damage and deep vein thrombosis, alsosuch as pressure damage and deep vein thrombosis, also
promoting the patient’s independence again as well.promoting the patient’s independence again as well. HoweverHowever
only if their overall medical condition allows.only if their overall medical condition allows.
► Mobilisation and multi-disciplinary team rehab should beginMobilisation and multi-disciplinary team rehab should begin
within 24 hours.within 24 hours.
► Initial emphasis should be on walking and the activities of dailyInitial emphasis should be on walking and the activities of daily
living such as transferring, washing, dressing and toileting.living such as transferring, washing, dressing and toileting.
► You should be assessing a patient’s balance and gait and if anyYou should be assessing a patient’s balance and gait and if any
pain on movement.pain on movement.
13. MobilityMobility
► Since the patient’s condition has changed you would needSince the patient’s condition has changed you would need
to update appropriate risk assessments.to update appropriate risk assessments.
► You should bear in mind a patient’s previous mobilityYou should bear in mind a patient’s previous mobility
before the operation. Such as the use of walking aids andbefore the operation. Such as the use of walking aids and
make them available for use.make them available for use.
► The physiotherapist would be involved with active dailyThe physiotherapist would be involved with active daily
exercises, strengthening muscles and joints and canexercises, strengthening muscles and joints and can
devise a patient rehab plan - giving advice and patientdevise a patient rehab plan - giving advice and patient
education.education.
► The occupational therapist could also be involved toThe occupational therapist could also be involved to
provide aids and prepare the patient for discharge home.provide aids and prepare the patient for discharge home.
14. Psychological IssuesPsychological Issues
► Easily tiredEasily tired
► Inability to concentrate e.g. unable to concentrate effectively whilstInability to concentrate e.g. unable to concentrate effectively whilst
reading a book or newspaper.reading a book or newspaper.
► Memory dysfunction e.g. reduced ability to remember things recentlyMemory dysfunction e.g. reduced ability to remember things recently
said or done.said or done.
► Reduced ability to perform arithmeticReduced ability to perform arithmetic
► Highly confused e.g. hallucinations due to medication on for painHighly confused e.g. hallucinations due to medication on for pain
management.management.
► Behavioural problems- more aggression due to increased confusionBehavioural problems- more aggression due to increased confusion
after surgery.after surgery.
► Self-esteem issuesSelf-esteem issues
► Body image issuesBody image issues
► DepressionDepression
► Sexuality issuesSexuality issues
