1. Postoperative Phase 3 Stages Immediate Stage - (1-4hrs) after surgery
Intermediate Stage
- (4 -24hrs) after surgery
Extended Stage
- (1-4days) after surgery/last follow-up visit with
the attending physician
Dr.Karim Shaarawy, MD

2. Immediate Postoperative Period
Respiratory
Position
- left lateral with neck extended and upper arm supported on a pillow.
- supine with head to side and chin extended forward
b) Check presence of gag reflex
c) Maintain artificial airway until gag reflex returned
d) Oxygen
e) Assess rate and depth of respiration
f) Assess breath sounds
g) Monitor for signs of atelectasis, pneumonia, pulmonary embolism
Dr.Karim Shaarawy, MD

3. Assess skin and check capillary refill Assess peripheral edema
Cardiovascular
Assess skin and check capillary refill
Assess peripheral edema
Monitor for bleeding
Assess pulse rate and rhythm
Monitor for hypo/hypertension
Monitor for cardiac dysrhythmias
Dr.Karim Shaarawy, MD

4. Intermediate Post –op Period
Monitor Respiratory Status
- coughing/deep breathing / 1-2 hrs
- turning in bed / 2hrs
- early ambulation
- auscultate lungs / 4hrs
Monitor Cardiovascular Status
- leg exercises / 2hrs
- apply anti-embolic stockings
- vital signs, color, temp of skin
Dr.Karim Shaarawy, MD

5. Promote Fluid and Electrolyte Balance
Promote Optimum Nutrition
- maintain IV infusion as ordered
- Assess return of peristalsis
-Progressive increase in diet
Promote Return of Urinary Function
- Assess ability to urinate/ bladder distention
- Report to surgeon if client has not urinated after 8hrs post-op
Dr.Karim Shaarawy, MD

6. Transferring the patient from the post anesthesia care unit PACU افاقة
Transfer Criteria:
Patient coming out of General Anesthesia
Vital signs are stable for at least 30 mins and are within normal range
Patient is breathing easily
Reflexes has returned to normal
Patient is responsive and oriented to time and place
Dr.Karim Shaarawy, MD

7. Patient who had regional anesthesia
Sensation is restored and circulation is intact
Reflexes has returned
Vital signs have stabilized for at least 30mins 
Adequate urine output
Control of pain
Control or absence of vomiting
Dr.Karim Shaarawy, MD

8. Post-operative Complications
A. Respiratory:
Atelectasis
- a collapse of the alveoli with retained mucus secretions
- Usually develop 1-2days post-op
2. Aspiration
- caused by inhalation of food, gastric contents, water or blood into the tracheobronchial system.
- anesthetics and narcotics depress the CNS, causing inhibition of cough and gag reflex
Dr.Karim Shaarawy, MD

9. 3. Pneumonia
an inflammatory response in which cellular material replaces alveolar gas.
- may develop 3-5 days post-op
Assessment:
Dyspnea, increased Respiratory Rate
Crackles over involved lung area
Elevated temp
Productive cough and chest pain
Hypotension
Decreased breath sounds
Dr.Karim Shaarawy, MD

10. 4. Pulmonary Embolism
-An embolus blocking the pulmonary artery disrupting blood flow to one or more lobes of the lungs
Assessment:
Dyspnea
Sudden sharp chest/upper abdominal pain
Cyanosis
Tachycardia
A drop in blood pressure
Dr.Karim Shaarawy, MD

11. B. Cardiovascular Complications
1. Thrombophlebitis
Inflammation of the vein, often accompanied by clot formation
7-14 days post-op
Assessment:
Vein inflammation
Aching or cramping pain
Vein feels hard and cordlike and is tender to touch
Elevated temperature
Positive Homan’s sign
Dr.Karim Shaarawy, MD

12. Intervention hydrate patient adequately
Avoid massaging to calves or thighs
Avoid standing or sitting in one pace or crossing legs
Avoid inserting IV’s into legs
Assess for Homan’s Sign
Dr.Karim Shaarawy, MD

13. C. Circulatory Complications
1. Hemorrhage
-The loss of a large amount of blood externally/internally for a short period of time
2. Shock
-Loss of circulatory fluid volume caused by hemorrhage 
Assessment:
Restlessness
Weak rapid pulse
Hypotension
Tachypnea
Cool skin
Reduced urine output
Dr.Karim Shaarawy, MD

14. E. Paralytic Ileus توقف حركة الامعاء
D. Constipation
E. Paralytic Ileus توقف حركة الامعاء
- paralysis of intestinal peristalsis
F. Wound Infection
- occurs 3-6 days post op
G. Wound Dehiscence
- Separation of wound edges on the suture line
- occurs between 5th and 8th day post op
H. Wound Evisceration
- Protrusion of the internal organs and tissues through an opening in the wound edges
Dr.Karim Shaarawy, MD

15. I- Urinary Retention
-Involuntary accumulation of urine in the bladder as a result of loss of muscle tone
- Due to effects of anesthetics/narcotics
Assessment:
Inability to urinate
Restlessness
Lower abdominal pain, distended bladder
Elevated BP
Dr.Karim Shaarawy, MD

16. Postoperative Discharge Teaching
Focus on:
Proper wound dressing
Medications
Diet
Follow-up visit – removal of sutures in (7-10 days Abdomen), / removal of staples in7-14 days
Activity levels-no lifting for 6 weeks not to lift anything (>10lbs)
Return to work in 6-8 weeks
Signs and symptoms of complications
Dr.Karim Shaarawy, MD

17. Drains
placed in wounds only when abnormal fluid collections are present/expected
Are placed near the incision site:
In compartments that are intolerant to fluid accumulation
In areas with large blood supply
In infected draining wounds
Areas that have sustained large superficial tissue dissection
Greatest accumulation is expected during the first 24 hrs
removed when amount of drainage decreases < 50 ml/day
Dr.Karim Shaarawy, MD

18. Types of Drains A.Gravity B.Mechanic 1. Penrose Drain 2. T-Tube
1. Jackson-Pratt Drain 2. Hemovac
Dr. K. Shaarawy
Penrose Drain
T-Tube
Jackson -Pratt
Dr.Karim Shaarawy, MD

19. B. Mechanical
- these are portable self contained closed wound mechanical devices that suction fluid after collapsing them and closing the valve thus forcing the fluid to be pulled into the collection chamber. examples: Hemovac, Jackson- Pratt
Dr. K. Shaarawy
Hemovac drain
Dr.Karim Shaarawy, MD

20. Other types: Negative pressure drain (VAC)
Nelaton drain
Corrugated Rubber drain
Pigtail drain
Davol
Dr.Karim Shaarawy, MD
Rubber drain

21. Care and Handling of Surgical Specimens
Types of Surgical Specimen
Routine specimen
specimen that doesn’t require immediate attention
placed in a preservation fluid
labeled and sent to Pathology Department feat. conclusion of the procedure
scrub nurse should separate like specimens from different locations
specimens not immediately passed off the field should be kept moist in saline
calculi should not be placed in formalin, same with foreign bodies
amputated extremities are wrapped before sending them to the pathology/morgue للدفن
Dr.Karim Shaarawy, MD

22. 2.Diagnostic Specimen Frozen Section
Requires special handling and immediate examination by the pathologist
With verbal report of the findings communicated to the surgeon during the surgical procedure
Examples include breast biopsy/any organ, tumor or lesion
Specimen is sent dry and is properly labeled.
Dr.Karim Shaarawy, MD

23. Cultures
Are taken on a patient who comes to the OR with a known/suspected infection
2 types: aerobic and anaerobic, requires different medium for growth
This will determine the antibiotic that will specifically affect the microbes
Are obtained under sterile condition, using appropriate collection tube.
Exact procedure for collecting cultures for specific test will vary from each institution
Must be sent to the lab immediately for accurate processing
Dr.Karim Shaarawy, MD

24. Thank you God Bless You All!
Dr.Karim Shaarawy, MD