Ambulating post op day zero

Nurses General Nursing

Published

  1. Do you ambulate your patients POD 0 or 1?

    • 19
      POD 0
    • 2
      POD 1
    • 44
      Depends on the situation
    • 0
      Neither

65 members have participated

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.

Any thoughts?

I used to do work on an ortho surg unit and we did about 200 spinal instrumentations a summer. Every developmentally appropriate patient was expected to stand at the side of the bed on POD 0 and we had them ambulating QID on POD 1 no questions asked. These kids had drains and sometimes had to get infusions, we routinely checked H&H's on POD 1&3 and they usually were discharged in good condition by POD 4 or 5.

In contrast I worked at another hospital who did spinal tetherings which are supposed to be substantially "less invasive" because they require less bone grafting and hardware. The staff only asked the patients if they wanted to get out of bed (their teenagers guess what they said) so some kids didn't even get out of bed till after POD3, They had less infusions but they also had less chisels and hammers taken to their spines. Most of them ended up with pneumonia, got chest tubes, and had hospital stays of 7-14 days.

Trust your instincts. Ambulating a patient is a pain in the ass, there's always going to be some kind of excuse not to do it. But it is a foundation of surgical recovery.

Fun fact I also give them stickers to decorate their IS and have them give it a name. If they aren't sure when the last time they did it was it's time to do it. If it isn't within arms reach of them I tell them they left behind thier life vest. .... Probably wouldn't work on all adults but laughing helps with pulmonary toilet too.

I had a gastric bypass in December and was keen to mobilise while still in recovery.

If I had of had a nurse who told me i couldnt mobilise when i get back to the ward I would have quite happily told them where to stick it

Among other things it was one of the only things that helped combat the nasty shoulder tip pain from the gas

We wouldn't let our bariatric patients back in bed until they had walked enough times and they had to be sitting at bedside until 9pm

Ambulating post op day zero for a patient who has well controlled pain and activity as tolerated orders if the best thing for the patient. This decreases their likelihood for post procedure thrombus and atelectasis.

We have one thoracic surgeon who comes in the evening day 0 and orders the patient to be stood at bedside. He watches you do it!

I've worked ortho/neuro/bariatric with some general surgery mixed in. The only time we definetly didn't ambulate a patient POD 0 was if they had a suspected or at high risk for a CSF leak or if they had hip/knee surgery and were numb from a spinal block. I've taken care of patients with knee/hip replacements who walk a few hours after surgery and there are a few "stragglers" who we can barely get out of bed POD 1. All bariatric surgery patients were required to start walking the halls within 4 hours of getting to the floor. For spine, cervical, and brain surgery & general surgery it depends on the time/length of the procedure, how involved it is, and how the patient was doing medically.

Specializes in Oncology.
We have one thoracic surgeon who comes in the evening day 0 and orders the patient to be stood at bedside. He watches you do it!

We have one urology surgeon who comes and walks his patients himself!

Specializes in Critical Care.

Gastric bypass/sleeve patients walk day 0 when they come to the floor. Most colorectal patients also ambulate. Some of the pancreatic resections make it up but the majority are in too much pain, they have foley, ngt, epidural, pca, multiple drains, etc. Most lose the foley and ngt after pod 1 morning rounds so then it's time to get moving if they haven't yet

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.

Any thoughts?

I think it depends upon the patient's baseline as well as on the type of surgery they had. I had an intensivist write orders to "Ambulate at 0900, 1100, 1400, 1700 & 2000." When questioned, he said that "You nurses don't ambulate patients often enough -- this guy hasn't been ambulated since his surgery two days ago!" And he hadn't actually ambulated since his surgery two YEARS ago, either. This guy wasn't going to be ambulating early -- or at all.

I not only ambulated on POD 0 after my bilateral lumpectomy and reconstruction, I was discharged. After my bilateral knee replacements -- POD #1 I TRIED to ambulate, but the nerve block was still active and it didn't go very well. So yeah -- depends upon patient baseline as well as the surgery they had.

Specializes in Mental Health, Gerontology, Palliative.
We wouldn't let our bariatric patients back in bed until they had walked enough times and they had to be sitting at bedside until 9pm

That wouldnt have worked for me. Unfortunately because I was on the table so long i have aggravated an old tail bone injury and the only positions that didnt leave me in alot of pain were lying down or walking, sitting up in a chair required large amounts of pain relief. Not only that while I was more active than most between walking I still slept alot

I get that there needs to be protocols however there is a danger not every patient is the same and its important to use clinical judgement in each individual is very different.

We get all total joint and spine patients up day zero and the majority of all other surgical patients.

Most ortho we ambulatory pod 1. Large and I surgeries might get a day or two off depending on Dr's orders and pain control. Turns are generally bed rest until pod 1. It's generally better to bullet sooner but I find you need to assess the patient and go from there

And in English - I surgery? Bullet? Eagerly awaiting translation.

As tolerated is a magical phrase. I'm on stroke/tele, so we don't do a ton of surgery, but generally, I follow the surgeon's lead. If the surgeon thinks it's safe to ambulate the patient on POD 0, so do I. PT at our hospital may wait until POD 1 to see patients after a craniotomy or other surgery, but unless I have bedrest orders or my patient's unable, they're UP.

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