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Postoperative care

introduction

Postoperative care begins immediately after surgery in the recovery room.

As a postoperative care, the care of a patient after (lat: post ) called the OP. It begins immediately after the operation in the so-called recovery room and is then continued at the respective station or at home.

The duration and extent of care are extremely variable and are strongly influenced by the severity of the operation as well as the general condition of the patient. Thus, healthy, fit patients recover from the same procedure more quickly than patients with many underlying diseases whose resources are already being harnessed by these diseases.

In the hospital

In the hospital, postoperative care begins immediately after surgery in the recovery room, which in most cases is directly connected to the operating room. There, a patient usually stays for a few hours before he can be brought back to the ward. Care at this time focuses on monitoring the patient's vital signs and so, as standard, blood pressure, heart rate and respiration are monitored and caregivers take care of necessary infusions and medications, especially painkillers for postoperative pain or even oxygenation the affected person feels shortness of breath. If the condition worsens, it is important that the postoperative care team knows the specific emergency procedures and initiates them in good time. The recovery room staff is usually well prepared for such emergencies. Nursing care postoperative care teams continue to look after nausea and vomiting, which often occurs after anesthesia, and provide for the disposal of urine bottles.

Furthermore, it is important in postoperative care to know different bearings or to perform this according to a doctor's order, because depending on the operation certain postures may not be taken by the patient and are extremely harmful in the worst case. The needs of the patient should also be taken into consideration and the patient should always seek the most comfortable and painless storage possible. These peculiarities of patient positioning must be taken into account throughout the postoperative care beyond the recovery room. The purpose and almost the most important task of the postoperative care in the recovery room is, in addition to the recovery from anesthesia and surgery and general care, the early detection of complications. Here, it is important to detect blood loss early by rebleeding. Above all, the observation of drains and catheters, bandages or other physical signs is in the foreground.

After the time has elapsed, the patient is transferred to his ward or, if the condition worsens, is transferred to an intensive care unit. Depending on the condition of the patient and the doctor's instructions, the newly operated patient is allowed to leave the bed for the first time, but at the beginning usually only in the presence of nurses. When it comes to personal hygiene, nurses should offer oral care and offer washing to the patient in order to increase their well-being and to promote self-employment again. When washing, the surgical area is left out here in most cases. Attending and changing should be supported, whereby always the pain and load limit of the patient must be considered shortly after an operation. In bedridden patients, eg after very severe operations, the development of the so-called pressure ulcer, a dying of the skin and subcutaneous tissue during too long exposure, must be prevented in the postoperative care.

The most common places here are the heels or the buttocks, when they are lying under constant stress when lying down in the absence of movement by the patient. Regular storage changes can prevent the development of decubitus. Furthermore, patients with little proper movement, eg in coma, are often endangered thrombosis and need to be treated with special drugs and the legs are examined for possible thrombosis. If there is no food intake, fungus quickly forms in the oral cavity or gastric contents can enter the lungs through the lying position and trigger pneumonia.

Good oral care by the nursing staff can often prevent the fungal infection. Due to the lying position and the lack of movement, the intestinal movement can quickly come into imbalance and it comes to complete intestinal arrest with constipation (lat: constipation). A lot of drinking, massages or enemas and other medicines must then stimulate the intestinal movements again. In order to have 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 (timing, consistency, smell ...), possible vomiting, amounts of drinking and urine.

In order to further ensure the early detection of complications such as rebleeding, the observation from the recovery room is continued in the postoperative care and the drainage contents and bandages are regularly monitored. Since pain does not only occur directly after the operation, the continuation of the pain control is another building block, which runs through the entire postoperative care.

Patients requiring care at home

The information and instructions on what to look for at home should best be given to nurses in written form to the patient. If a nursing service is necessary, it can be organized with the help of the social service of the hospital. Also, any aids that are necessary, such as a nursing bed, rollator, bedside table, walking aids, etc. can be procured through medical supply stores. Obtaining these tools and finding a suitable nursing service should start early, so that when the patient leaves, everything is ready for his or her life at home. At home, conditions similar to those for postoperative hospital care apply. When warning signs such as fever, a doctor should urgently be informed, as the conditions after surgery easily germs can enter the body, either by the operation itself, but also by the postoperative problems such as long-term ventilation, Urinkathether or pneumonia.

They all cause a fever and have to be treated with antibiotics in a short time. Calfskin, cold drinks or cooling ablutions can bring relief to the nurses. Like nurses in postoperative care in the hospital, patients themselves, relatives, and caregivers must also be alert to bowel movements and urine habits in order to be aware of bowel dysfunction or renal dysfunction early on. The storage must be carried out in a similar way as in the hospital, this should be handed over to a nursing service in difficult cases.

If the relatives or the patient themselves notice signs of a complication of the wound or bleeding, for example, if the drainage is unusually full, the bandage is bled, or dizziness and paleness occur, a doctor should be consulted immediately. Also, the wound control and dressing changes must be continued strictly according to the specifications in order to treat any wound healing disorders or inflammation in time. Since the entire care is a complex topic, especially after major operations, the temporary use of a nursing service should be considered very generous, since it is associated with a considerable effort for relatives and brings them very quickly to their limits.

Non-dependent patients at home

The behavior at home after surgery depends heavily on the procedure. Nevertheless, there are some general principles for body care or wound care. Behavioral guidance is often provided by the wards in written form as leaflets for the patients and is also explained directly by the nurses or doctors. The body care can be resumed, depending on the mobility already in the hospital usually. Only showers or baths usually have to be dispensed with for a few days to weeks. After minor surgery, showers are usually allowed after just a few days, larger operations require a waiver for several weeks and are dependent on the success of wound healing.

However, partial washing with the exception of the operating area is usually always possible. When a dressing may be removed and how often this must be changed, is usually prescribed by the doctor strictly. When dressing changes, the wound should always be viewed briefly. If pus occurs or the wound is extremely red, swollen and sensitive to pain, this may be an indication of invading germs and a doctor should be consulted. When the threads are pulled, is very different depending on the physical region, the time is usually given by the doctor. In order to promote the aesthetically beautiful scar formation, in order to later get as inconspicuous and not discolored scar, direct sunlight on the scar should be avoided for 3-6 months. If a person on a regular basis takes medication, a doctor should discuss when to take it again if it has been discontinued over the period of surgery. For example, special caution should be exercised over blood-thinning medications as they may promote rebleeding.

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