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Nurses' Strategies for Managing Pain in the Postoperative

   

Added on  2021-04-17

11 Pages3012 Words69 Views
Healthcare and Research
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Nursing strategies 1Post-operative Nursing Strategies by Course Tutor University City and State Date
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Nursing strategies 2IntroductionCardiac surgery is among the most hectic areas in acute nursing care (Clark, et al 2015). Some of the common surgical operations include Aortal-coronary bypass graft, valve repair and replacements, the repair of aortic root and removal of intracardiac tumors though less common. For cardiovascular surgical patients such as the arterial bypass grafts, there is need for immediatepost-operative care practices such as warming, physical examination and assessments and tests among others. Other post-operative managements include hemodynamic management, transfusion of RBC’s and treating of medical bleeding. This paper focuses on the major post-operative nursing strategies that help to minimize challenges in patient management such as intravenous fluid management. Immediate post-operative strategies. The immediate post-operative care includes the examination of the patient from the surgical room, transportation to the ICU and recording of patient information. The end of the surgery is marked by the preparation of moving the patient from the operation room to the post-operative recovery room. This may also include the ICU or any other high unit that enables and supports a patient’s recovery. In transporting the patient from the surgical room to the ICU, several measures must be observed including; hemodynamic monitoring. Special attention must be given to intravascular volume status and systemic arterial blood pressure to ensure it is consistent with the health guidelines and does not pose a bursting of blood vessels or a clot in a major blood vessel (Mann and Carr, 2018). Management of the airway is another major post-operative care that is necessary to ensure that the anatomic airway is maintained for a patient who has been extubated during the
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Nursing strategies 3surgery. The endotracheal tube patency and security is also key in ensuring effective management of the airway most especially if the patient is to remain intubated. Meissner, (2015) sufficient ventilation is a key factor that has to be addressed positive pressure ventilation which in turn ensures that the patient is able to effortlessly maintain enough tidal volume and respiratory rate. Assessment of any internal bleeding should also be done again at this point and all the chest tubes carefully examined to prevent a pneumothorax. After all these precautionary measures, the patient is prepared to be transported to the ICU for further post-operative care. Arachchi, et al (2016) transportation of the patient to the ICU should ensure a constant high rate of vigilance and care. Efficient routine systems of patient transportation need to be adhered to. Some of these include continuous hemodynamic monitoring and continued intravenous infusions. The transport time and method is not distinct but varies depending on the conditions of the patient and the environment. In very critical conditions, the surgical room can be modified to fit and support intensive care of the patient. Failure to conduct the movement carefully and efficiently may cause arrhythmias due to fluid shifts that arise as a result of hemodynamic instability. Supplemental oxygen is also considered as very important to the patient. It is therefore advised that the anesthesia provider to ensure enough oxygen and ventilation to the patient throughout the transportation process all the way to the intensive care unit. Insufficient ventilation and lack of oxygen has been observed to cause post-operative hypoxia. Neuromuscular blocking agents and anesthetics have also been found to cause hypoventilation which may in turn cause atelectasis. In cases of inadequate ventilation, Egerod, (2015) it is not advisable to use BPAP or CPAP but a bag valve mask device or a transport ventilator. It is highly recommended to use
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Nursing strategies 4compact ventilators which ensure adequate positive pressure ventilation it also ensures suitable amounts of positive end expiratory pressure where it is necessitated. Portable ventilators connected to enough oxygen supply are increasingly important since this prevents hypoxic prevalence to the patient. It is important to monitor sufficiency of ventilation using esophageal stethoscope, physical examination of a chest rise. Oxygen sufficiency can also be efficiently monitored using a portable pulse oximeter. Transport beds that do not have positive end expiratory pressure (PEEP) should be improvised to account for it if need arises. Shewale, et al 2015 explains that uninterrupted hemodynamic monitoring is necessary to be made possible due to the fact that transducers and transfer cables can be added to the transportbed. This allows an uninterrupted monitoring until the patient reaches the recovery area. Infusions and fluids that were previously being administered to the patient should be maintained.This may include drug infusions. However, if a patient is in a stable condition, some of these infusions one may halt them after flushing in order to reduce the complexity of transportation. Before considering to halt the infusions, it is also considerably important to consider and explore all other available alternatives. For instance, pacemakers and intra-aortic balloon pumps, ventricular assist devices among others may form part of the primary solutions if they are feasible. Upon successful transportation of the patient to the ICU, the surgical team if expected to pass on information about the patient. A review of the patient’s cardiac health, anesthetic condition, heart rate and rhythm should be conducted. The nurses at the ICU should first collect the history information from the patient chart and the surgeon. The main details should include the patient age and sex, the condition of the operation result such as any difficulties or complications encountered and not withholding the success of the whole procedure. The type and
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