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Fundamentals · chapter 31 · Perioperative Nursing Care

Postoperative Phase

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Postoperative care priorities

    Ongoing nursing management during postoperative care includes maintaining the patient’s airway and ensuring cardiovascular and CNS stability.

  2. PACU complication monitoring

    The PACU nurse must monitor the patient for signs of hypotension and shock, hemorrhage, hypertension, and arrhythmias.

  3. PACU handover purpose

    The handover report during admission to the PACU is crucial to ensure accurate and timely communication of critical details.

  4. Medication reconciliation scope

    This comprehensive review of the patient’s medication history should include medications being taken at home, including ones that the patient should have been taking but may not be, as well as any medications administered in the preoperative area, OR, and PACU.

  5. Immediate assessment importance

    The immediate postoperative assessment holds immense significance for guiding the course of healing and identifying potential complications.

  6. Discharge readiness purpose

    Determining readiness for discharge after a surgical procedure is a critical aspect of postoperative care, ensuring that patients can safely transition from the hospital to home and continue their recovery with minimal complications.

  7. Postdischarge care planning

    The nurse also needs to consider the broader spectrum of postdischarge care options beyond sending a patient home.

  8. Airway patency priority

    Maintaining a patent airway is a critical component of postoperative care, ensuring that patients can breathe effectively and minimizing the risk of respiratory complications.

  9. Atelectasis risk factors

    Postoperatively, patients often experience reduced respiratory effort due to the effects of anesthesia and pain medications, which can lead to shallow breathing and inadequate lung expansion.

  10. Respiratory monitoring documentation

    Continuous monitoring of respiratory parameters (e.g., respiratory rate, oxygen saturation) is important to promptly detect any signs of airway compromise in the postoperative period.

  11. Cardiovascular instability response

    Nurses should be prepared to implement prompt interventions (e.g., administering prescribed medications, titrating vasoactive medications) when cardiovascular instability occurs.

  12. Neurological assessment focus

    Nurses should conduct regular neurological assessments (e.g., level of consciousness, pupillary response, motor function) to promptly identify any signs of CNS dysfunction.

  13. Postoperative hypotension causes

    Typical causes of postoperative hypotension include intraoperative anesthetic medications that were administered or hypovolemia as a result of severe blood or fluid loss.

  14. Hemorrhage intervention steps

    The nurse notifies the charge nurse who reaches out to the surgeon and anesthesia provider while the PACU nurse remains with the patient.

Terms to know

The phase I recovery stage
The phase I recovery stage is the immediate postanesthetic period during which the PACU nurse ensures the patient’s full recovery from anesthesia and return of vital signs to near baseline.
The phase II recovery stage
The phase II recovery stage focuses on preparing patients for discharge from the facility, which includes providing education regarding the postoperative instructions and prescribed discharge medications.
The stage 1—immediate postoperative stage
The stage 1—immediate postoperative stage is the period of time the patient is in the PACU, which may last a few hours or up to a day depending on the type of surgery and the patient’s health and response to surgery and anesthesia.
The stage 2—intermediate postoperative stage
The stage 2—intermediate postoperative stage begins when the patient is transferred out of the PACU, whether it be to another location in the hospital, to the home, or to a convalescent facility.
The stage 3—convalescence postoperative stage
The stage 3—convalescence postoperative stage begins at home, where the focus shifts to gradual rehabilitation and resumption of normal activities, following the surgeon’s instructions for wound care, medication, and activity limitations.
atelectasis
A significant concern following surgery is atelectasis, the partial or complete collapse of one or more areas of the lungs.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

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Every question here, with the answer

  1. A PACU nurse is caring for a patient who has just had major abdominal surgery. The patient becomes alarmed, oxygen saturation is rapidly dropping, and thick secretions appear to be blocking the airway. What is the priority nursing action?

    1. Update the family about the patient’s recovery status.
    2. Begin discharge teaching for postoperative instructions.
    3. Position the patient to maintain airway patency and suction as needed.
    4. Assess bowel sounds and tolerance of oral intake.

    Answer: Position the patient to maintain airway patency and suction as needed.

    The priority is airway management because postoperative patients are at risk for airway compromise. Positioning and suctioning directly address the obstruction; discharge teaching, GI assessment, and family updates are important but do not address the immediate threat.

  2. A patient is being admitted to the PACU after surgery. Which information should the PACU nurse expect in the face-to-face handover report? Select all that apply.

    1. Intraoperative events
    2. The patient’s long-term home exercise schedule
    3. The anesthesia administered
    4. Any immediate postoperative concerns
    5. The surgical procedure performed

    Answer: Intraoperative events, The anesthesia administered, Any immediate postoperative concerns, The surgical procedure performed

    The handover report should include critical perioperative details needed for continuity of care in the PACU. A long-term home exercise schedule may be part of later recovery planning, but it is not listed as a required PACU handover detail.

  3. A patient in the immediate postoperative stage has recovered from anesthesia and vital signs have returned near baseline. The nurse is now focusing on phase II recovery. Which action best matches this phase?

    1. Perform the preoperative baseline neurological assessment.
    2. Provide education about postoperative instructions and prescribed discharge medications.
    3. Begin intensive rehabilitation to restore functional independence and mobility.
    4. Monitor intraoperative blood loss in the operating room.

    Answer: Provide education about postoperative instructions and prescribed discharge medications.

    Phase II recovery focuses on preparing the patient for discharge from the facility. Education about postoperative instructions and prescribed discharge medications is the activity that best fits this phase.

  4. A same-day surgery patient and caregiver are preparing for discharge. Which topics should the nurse include in patient education before the patient leaves? Select all that apply.

    1. Postoperative wound care
    2. How to document assessments in the patient’s chart
    3. Signs of complications
    4. Therapeutic activity
    5. Dietary recommendations, including fluid requirements

    Answer: Postoperative wound care, Signs of complications, Therapeutic activity, Dietary recommendations, including fluid requirements

    Discharge education should prepare the patient or caregiver to manage recovery and recognize concerns after leaving the facility. Chart documentation is a nursing responsibility, not a patient discharge teaching topic listed in the section.

  5. A patient in the PACU has restlessness, increasing heart rate compared with baseline, low-to-normal blood pressure that is dropping, pale cool skin, and fresh bright red blood in the surgical drain. What should the PACU nurse do next?

    1. Provide discharge instructions about activity limitations.
    2. Wait until the next routine wound check to reassess drainage.
    3. Notify the charge nurse while remaining with the patient and anticipate further intervention.
    4. Encourage early ambulation to prevent stagnant circulation.

    Answer: Notify the charge nurse while remaining with the patient and anticipate further intervention.

    These findings are concerning for early hemorrhage, so the nurse should escalate care while staying with the patient. Ambulation, discharge teaching, or waiting for routine reassessment would delay needed intervention.

  6. A PACU nurse is monitoring for early signs of postoperative hypotension. Which findings should concern the nurse? Select all that apply.

    1. Stable oxygen saturation with no distress
    2. Altered consciousness
    3. Tolerance of oral intake
    4. Intact surgical dressings
    5. Cool, clammy skin

    Answer: Altered consciousness, Cool, clammy skin

    Altered consciousness and cool, clammy skin are listed as early signs of impending hypotension. The other findings may be part of postoperative assessment, but they are not identified in the section as early signs of hypotension.

Where every quote comes from

Section 31.4 Postoperative Phase of Fundamentals of Nursing by Christy Bowen, Lindsay Draper, Heather Moore, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.