Nurse Eye Roll: Post Operative Nursing Care Basics

You are rocking through your shift, feeling awesome because you kind of know what you’re doing now, and your charge nurse comes up to you to say you are getting a patient from the PACU.  As soon as she finishes that sentence, the phone rings.

They’re calling report.

CRAP!  I’ve never taken care of a fresh post-op!  BAAHHH!

Ok calm down - this is no big deal.  You’ve got this!  Let’s talk about your post-op priorities.

GET YOURSELF TOGETHER, MAN.

Look at their labs, take a look at the post-op orders the physician has put in, and grab everything you’ll need before they roll on the floor.  Once you see them rolling on the floor, meet them in the room.  Complete a quick head to toe assessment and ask them who they want to be their go-to person/emergency contact to be.

I say this because it can get a little dicey if you ask them in front of their family to pick one go-to person.  I also find that this is the best to ask this immediately.  This lets you know whom to ensure to include in post-op teaching, get contact information, and establish communication with the patient and their support system.

Go get the family from the waiting room and introduce yourself.  On the way back, go over your unit rules, contact info, and plan of care.  Drop them off at the door and go chart that beautiful assessment you just did.

PAIN CONTROL.

Make sure you have orders for pain meds, oral and IV.

Please don’t underestimate the importance of Zofran.  It’s a beautiful medication.  Many patients experience post-operative nausea, especially when they are requiring pain medication.

Remember, pain + pain meds + empty stomach = pukes

Once they have kept some crackers/clear liquids down, get some oral pain meds in them.  They last much longer than IV pain medications and the sooner you can get them to oral meds and off IV meds, the better.

Please educate your patients on pain control.  Pain pills don’t kick in for 30-45 minutes, so if they wait to tell you that they’re hurting until it’s unbearable, that little pain pill won’t help near as much if it would have if they had let you know earlier.

My final thought about pain medications post operatively is to not over do it.  Some patients have unrealistic expectations and believe that they should never experience any pain, and after surgery they need to expect some pain and discomfort.  We will not completely take away the pain but our goal is to control it. If they are so out of it that they require a sternal rub to wake them up – they’ve had way too much pain medication!  You need to administer something to reverse it (typically Narcan) because you don’t want them to stop breathing.

Seriously. People stop breathing from being overmedicated with pain meds.  Control their pain appropriately, don’t over do it!

INCISIONS. 

Typically, the surgeon removes the first post-op dressing when they round the next day or whenever they deem appropriate.  Chances are, if there is drainage they’ll only want you to reinforce the dressing, not tear it down and place a new one.  Just assume this unless told otherwise.

When the PACU nurse brings the patient up, look at the dressing together and make sure it looks the same.  If there is drainage on the dressing, outline it with a Sharpie.  Time/date/initial it as well so you know how much is draining.

If their incision is open to air (which isn’t typical but does happen!) – make sure you look at it with the PACU nurse as well.

POOPS + PUKES.

Remember to advance their diet slowly.  Only allowing clear liquids until they start passing gas is always a good rule of thumb.

I’ve had patients say that they are desperately craving a cheeseburger, I tell them no because they’ll throw up, and the family goes and gets them a cheeseburger and fries and guess what?  20 minutes later they’re barfing it up and moaning in pain from their incision.  Now we’re quickly giving anti-nausea meds and pain meds to catch back up.

You also need to make sure they’re getting up as soon the doc allows after surgery.  After a patient gets tons of meds during surgery, pain meds afterwards, and have been laying in bed, their bowels slow down. This is why basically everyone is on Colace (or some other stool softener) postoperatively.

Constipation can be no friggin joke.  Educate your patients on the importance of stool softeners and getting out of bed!

Control pain and nausea, get your patients out of bed, communicate with your patient and their support system, be prepared, assess and chart immediately and you’ll be good to go!