Postoperative care is the care of a patient after (lat. : post) surgery. It begins immediately after the operation in the so-called recovery room and is then continued on the respective ward or at home. The duration and extent of care is extremely variable and is strongly influenced by the severity of the operation but also by the general condition of the patient. Thus, healthy, fit patients will recover from the same operation more quickly than patients with many underlying diseases, whose resources are already taken up by these diseases.
In hospital
In the hospital, post-operative care begins immediately after the operation in the recovery room, which in most cases is directly connected to the operating rooms. A patient usually stays there for a few hours before he can be brought back to the ward. The care at this time focuses on monitoring the patient’s vital signs and so the standard of care is to monitor blood pressure, heart rate and respiration, and the nursing staff take care of necessary infusions and medication, especially painkillers for post-operative pain or also give oxygen if the patient feels breathlessness.
If the condition worsens, it is important that the post-operative care team knows the special emergency measures and initiates them in good time. The staff in the recovery room is usually very well prepared for such emergencies. The post-operative care teams in the recovery room also continue to deal with nausea and vomiting, which often occurs after anesthesia, and ensure that urine bottles are disposed of.
Furthermore, it is important in post-operative care to know different postures or to carry them out according to the doctor’s orders, because depending on the operation, certain postures may not be adopted by the patient and are extremely harmful in the worst case. The needs of the patient must also be considered and the most comfortable and least painful position for the patient should always be aimed for. These special features of patient positioning must be taken into account in all postoperative care beyond the recovery room.
The purpose and almost most important task of postoperative care in the recovery room is, in addition to recovery from anesthesia and surgery and general care, the early detection of complications. In this case, it is particularly important to detect blood loss due to post-operative bleeding at an early stage. The main focus here is on the observation of drains and catheters, bandages or other physical signs.
Furthermore, it is important in postoperative care to know different positions or to carry them out according to the doctor’s instructions, because depending on the operation, certain postures may not be adopted by the patient and in the worst case are extremely harmful. The needs of the patient must also be considered and the most comfortable and least painful position for the patient should always be aimed for. These special features of patient positioning must be taken into account in all postoperative care beyond the recovery room.
The purpose and almost most important task of postoperative care in the recovery room is, in addition to recovery from anesthesia and surgery and general care, the early detection of complications. In this case, it is particularly important to detect blood loss due to post-operative bleeding at an early stage. The main focus here is on the observation of drains and catheters, bandages or other physical signs.
At the end of this period, the patient is transferred to his ward or, if his condition worsens, he is transferred to an intensive care unit. Depending on the patient’s condition and the doctor’s instructions, the newly operated patient may also leave the bed for the first time, but at the beginning usually only in the presence of nursing staff. As far as personal hygiene is concerned, the nursing staff should offer oral hygiene as well as offer the patient washing in order to increase his or her well-being and to promote independence again.
When washing, the surgical area is usually left out in most cases. Dressing and changing should be supported, whereby the patient’s pain and stress limits must always be considered shortly after an operation. For bedridden patients, e.g. after very serious operations, the development of the so-called decubitus, a dying off of skin and subcutaneous tissue after too long a period of stress, must be prevented in postoperative care.The most common areas here are the heels or buttocks, if they are under constant stress when lying down in the absence of movement by the patient.
Regular changes of position can prevent the development of a decubitus. Furthermore, patients with little movement of their own, e.g. in a coma, are often at risk of developing a thrombosis and must be treated with special medication and their legs examined for possible thromboses. Fungal infections can develop quickly in the mouth if food is not consumed or stomach contents can enter the lungs through the lying position and cause pneumonia.
Good oral hygiene by nursing staff can often prevent fungal infestation. Due to the lying position and the lack of movement, the intestinal movement can also quickly become imbalanced, resulting in complete intestinal arrest with constipation (lat. : constipation).
A lot of drinking, massages or enemas and other medication must then stimulate the intestinal movements again. In order to keep a close eye on the condition of the gastrointestinal tract, so-called balancing plays a role in postoperative care. This describes the exact documentation of bowel movements (time, consistency, smell…), possible vomiting, drinking and urine quantities.
In order to ensure early detection of complications such as post-operative bleeding, post-operative care continues with observation from the recovery room and regular checks of the contents of the drain and bandages. Since pain does not only occur immediately after surgery, the continuation of pain control is another component that is part of the entire postoperative care. The nursing staff should provide the patient with information and instructions on what to observe at home, preferably in writing.
If a nursing service is necessary, it can be organized with the help of the hospital’s social services. Any aids that may be necessary, such as a nursing bed, rollator, night chair, walking aids, etc. can also be obtained from medical supply stores.
The procurement of these aids and the search for a suitable nursing service should begin at an early stage so that everything is ready for the patient’s life at home when he or she is discharged. At home, similar conditions apply as for postoperative care in hospital. In case of warning signs such as fever, a doctor should be urgently notified, since the conditions after an operation can easily allow germs to enter the body, whether through the operation itself or through post-operative problems such as prolonged ventilation, urinary catheters or even pneumonia.
They all cause fever and have to be treated with antibiotics within a short time. The first measures to be taken by the nursing staff are calf compresses, cold drinks or cooling ablutions. Like the nursing staff in post-operative care in the hospital, the patients themselves, their relatives and the nursing staff must also pay attention to bowel movements and urine behavior in order to become aware of intestinal or kidney dysfunction at an early stage.
The positioning must be carried out similarly to hospital, although in difficult cases this should be handed over to a nursing service. Should the relatives or the patient himself notice signs of a complication of the wound or post-bleeding, for example if the drainage is unusually full, the dressing is perfused with blood or if dizziness and paleness also occur, a doctor should be consulted immediately. Wound control and dressing changes must also be continued strictly according to the instructions in order to be able to treat any wound healing disorders or inflammation in good time. As the entire care process is a complex issue, especially after major operations, the temporary deployment of a nursing service should be considered very generously, as it involves considerable effort for relatives alone and brings them to their limits very quickly.
