Post-op vital signs and assessments - page 2

just a quick question. I just came back from a staff meeting and we were discussing our protocol for post op pts. We do vital signs and full head to toe assessments q1hr x4, then q4 for 24hr and... Read More

  1. by   SmilingBluEyes
    I would look at AORN standards. (any AORN-cert nurses here?). I believe there, you will find outlined the standard of care for post-op, post- anesthesia patients. I know we recover our Csection patients according to those standards, no exceptions.Be sure you are up to standards in case something untoward should happen in recovery; you butt will be covered that way. Otherwise....well you know.......
  2. by   Tweety
    PACU does the frequent monitoring of vitals immediately post-op. Unless there's a problem when they come to the med-surg unit they are q4h for at least 24 , hours. We skip the q1h x 4 that you do and I can't remember in 11 years a major problem with that.
  3. by   blue280
    Thanks to all for their replies! I think monitoring vital signs frequently is a good thing and a complete head to toe on arrival to the unit is appropriate. We were wondering if a complete assessment is necessary as often as we were doing it. We wanted to do a focused assessment instead and our CNS told us to find out how its done else where. Thanks again for the valuable info.
  4. by   moonshadeau
    Complete assessment. Q15x4 then Q30x2 then Q4 in a perfect world for vitals. Heart caths get vitals, groin check and CMS check as above. The thing I hate the most, especially on night shift is the urine output monitoring which ends up being q1 hour.
  5. by   peaceful2100
    I just started this past week on a Post-op surgical care floor and here is what I was told yesterday and I did not like this attitude at all. The preceptor told me that they are suppose to do a full head to toe right away including checking the post op site, then vital signs Q15x4. then Q30x2 then Q4 for 72 hours post op and then after 72 hours if they are still there then it is routine but my preceptor asked me do you think that really happens, I said yes I do because it should and she told me think again when you get so many post ops back then you will probably rarely have time to do ALL that on everyone with all the number of patients you have. She said the first hour is definitely most important and most critical.
  6. by   stella123 rn
    We do q1/2 hour x 4, q 1hour x4, then q4 hour for 24 hours. Head to toe assessments. Sometimes I do think this is overkill for a stable patient. Especially when they do not get any sleep if it was a late surgery. I do wish sometimes that we could some more discretion.
  7. by   gwenith
    Was browsing the Joanna Briggs Institute website. The JBI is a big Australian Evidence Based Practice website. They have done an EBP report on vital sign assessments that is well worth the read.

    here is the link

    Hope this helps