Hi all! Quick question! So, I work on a surgical floor and I am almost at the two year mark. I had an interesting discussion with a colleague the other day about how she never, ever ambulates her patient's post op day zero because of their increased risk for bleeding. She said it does not matter what the procedure was it is a big no-no.
But, I have used my nursing discretion all this time and if the patient is ordered "activity as tolerated", pain is well controlled, and what not then I get them to ambulate. Usually just a few steps or even standing up at the side of the bed. And I take into consideration their procedure, if it was something like a TURP, then yeah get walking. A cystectomy, well no I will probably wait until POD 1 to ambulate.
Yes, we get them OOB on POD0 unless there's some contraindication - doctor's orders, vital signs, or like my patient recently who went into a junctional rhythm with their HR in the 40s every time they stood up for a couple of days post-surgery.
We get our c/section mamas up and out of bed POD0 on a regular basis. Occasionally we'll get one who begs us to pull the foley at 6h postop & wants to at least get up and stand at the sink for a few minutes to brush teeth if nothing else. Those folks tend to do very very well and feel better much more quickly.
When I was a brand new nurse 17 years ago on a gen surg floor we generally got our pts up to at least sit on the side of the bed POD0. Some wanted to sit in the chair. They usually weren't traipsing the hallways til POD 2-3 but most of them didn't stay in bed all that time, either.
As others have said, there is too much variation between patients and situations to make an all-or-nothing rule.
Specializes in Critical Care; Cardiac; Professional Development.
For many to most routine surgeries it is best practice to get the patient up as soon as possible on POD0. Naturally a nursing assessment for appropriateness and safety should be performed as well as a thorough check of the postop orders regarding ambulation.
Thank you for all replies everyone! I am glad to know that I have been doing the right thing based on the situation!
And my colleague who told me this has been an LPN longer than I have been alive, so this is why I was having second thoughts about everything. You guys are great!
Also, just pulled up an article on the ERAS protocol on cystectomies, which are one of the more intense surgeries I see, so that was fantastic.
Yeah, get those guts grumbling, gases moving, blood churning, and lungs expanding, coughing, deep-breathing, and all that good stuff that just happens naturally quicker, easier, and better if we get up and move, the sooner the better if not contraindicated.
Our order set for post op hearts is 1. Dangle one hour post extubation 2. Up in chair 4 hours post extubation. Keep on keeping on! I remember a stat somewhere that said in our older patients each day in bed is equal to an extra week to baseline recovery, unable to source that quote, but anecdotally it seems true.
Specializes in icu,prime care,mri,ct, cardiology, pacu,.
I recently had surgery. Was walking around a couple hours after getting to the floor. My 02 sat was in the toilet until I walked and opened up my lungs. I was even out getting my pain med at 3 am at the nurses station. I never saw another patient ambulating in my stay.
Depends on the surgery, and my floor sees the gamut. Lap chole, appy, or thyroidectomy? Yup, you're getting up on POD #0, because you're probably going home in the morning. Liver transplant? You're possibly/likely still intubated in the SICU until the morning of POD #1 so not until then. Really just depends.
Our thoracic surgeons are huge advocates of early ambulation. Those patients get woken up in the middle of the night to ambulate the night of their surgery. Seems cruel but low complication rates and the patients are informed ahead of time.
So many of these laparoscopic surgeries go home the same day (lap choley, lap appy, tubal ligation done laparoscopically, Lap hernia repairs). And they have to get up and walk before they are discharged home.
And ERAS protocols such as drinking Gatorade up to 4 hours before surgery (some say 6 or 8 hours) or chewing gum after surgery, helps the bowels to start moving again sooner, helping decrease lillius, but doesn't help get the gas out of the abdominal cavity and back into the bowels.
With laparoscopic surgeries there is considerable gas pain, must of which will not be relieved with meds... but walking helps immensely. They place gas in the abdominal cavity to lift the skin and muscle up so the scope can visualize the surgical area better. And after, they remove as much as they can, but can't get all the gas out. The gas causes pressure, distention and pain. Gas bubbles can rise to the underneath of the diaphragm and stimulate nerve pain that is most commonly felt as right shoulder pain.
Gas pain is relieved when the gas moves back into the GI system and the patient has flatulence or eructation (burping). Ambulation moves this process along. I start explaining early ambulation to patients in phase I PACU. I explain that although they hurt and moving seems counter intuitive, it's actually what will help them the most. The discharge nurses in phase II love it when the patient has already been educated, that when when they re-educate and start to get the patient moving, the patient feels like they have the advice of more then one nurse and is more mentally ready to get moving. IF the patient is not safe to ambulate, transferring into a recliner where they are sitting up as much as possible can help.
Yeah, get those guts grumbling, gases moving, blood churning,
BlueShoes12, BSN, RN
131 Posts
Yes, we get them OOB on POD0 unless there's some contraindication - doctor's orders, vital signs, or like my patient recently who went into a junctional rhythm with their HR in the 40s every time they stood up for a couple of days post-surgery.