Post-op patients

[username33]

I am a new hire on med-surg floor. I know I need to be alert and monitor many things during my shift. I would like to hear from the seasoned nurses their opinion regarding monitoring patients' status on med-surg floor. What are my top priorities r/t monitoring post-op patients?

Thanks!

[Aurora77]

I'm not seasoned (8 months in), but I was taught to do a thorough initial assessment, then do focused assessments r/t the particular surgery. It really depends on the type of surgery, anesthesia, etc. Your facility will have guidelines for vital sign monitoring. I'm on a general surg/ortho floor.

For ortho:

Check pulses, cap refill, dressings, pain, urine output, vitals, IV site.

General surg:

Dressings, pain, output, vitals, IV site

Don't forget to look under a patient to check for bleeding--the dressing could have a bit of blood on it, but more could've pooled behind them. Whenever you're in just checking on a patient, you can tell a lot quickly--skin color, LOC, changes that could mean you need to do a more thorough assessment.

I've also found that I have to check to make sure that patient's home meds are restarted after surgery. Sometimes the docs aren't great about sending the med reconciliation form to pharmacy.

[cocojnel]

I'm not a seasoned nurse... new grad here but I've also been taught that positioning is key to prevent any pressure on suture lines.

[username33]

Thank you!

[ninja-nurse, BSN]

Not greatly seasoned - 2 years of med/surg - but priorities are:

neuro assessment/changes, VS, dressings/incision, distal circulation, urine output and IV.

On arrival to floor, the PACU nurse shouldn't leave until a set of stable VS have been taken (and report given, of course).

For any surgery, check LOC, incision, IV and urine output (if foley in place, GREAT. If not, ask when pt voided/had foley removed and monitor from that time)

For abd surgeries, check bowel sounds/distention. For limb surgeries, check pulse/cap refill/feeling and movement.

The neuro is baseline - not unusual to have some confusion/lethargy or even distal numbness and decreased ROM. But it should get better over time.

Hope that helps!

[Morainey, BSN, RN]

My rapid head-to-toe for post-ops:

Very first thing: check ID band and have pt tell me name and DOB. I can size up pretty quickly if they're confused or out of it.

Listen to LS

Listen to bowel sounds, ask about nausea, vomiting, passing gas, and BMs

Look at the foley bag, if they have one, or the urinal or just ask if they are peeing ok.

Look at incision or bandage, any drains

Assess pain

Check distal pulses, color, sensation, mobility

I look at VS, I&Os, and labs, too. I try to scope out how they're feeling, in general. Are they mentating ok? Falling asleep in the middle of sentences? Fidgety and restless? White as a sheet? When was the last time they were medicated for pain? Are they doing their incentive spirometer? Becoming confused? All good things to look at, I'm sure I can think of a lot more!

[Anna Flaxis, BSN, RN]

Not a med/surg nurse, but keep in mind that when assessing for oversedation r/t opioid pain meds, don't rely on respiratory rate alone. Decreased level of consciousness is a far more accurate indicator of oversedation, and is usually the precursor to respiratory depression.

[rgroyer1RNBSN, BSN, RN]

Stargazer is right, level of conc. is the better indicator of oversedation, and I do this all the time when I work in sicu, also in er when we do a procedure.Rod RN, BSN, CEN, CCRN, CFRN, TNCC, EMT-P, MICN, like I have said before its amazing how many letters you can get behind your name I also have med-surg, and CRNI.