In addition to checking the blood pressure it is a good practice to check capillary refill and peripheral perfusion.
Always inspect the patient's wound before transferring him to the patient. Heavily blood stained dressings are indicative of severe external bleeding. The surgeon and treatment team must be aware of the patient's condition. Sometimes there is continuous bleeding; at other times the solution may be a simple one. For example: All that is needed is extra padding.
Document the vital signs of the patient when you receive him and also when the patient reaches the ward.
Airway problems are common immediately after the patient has been “reversed” and the endotracheal tube has been removed. When the patient is undergoing surgery an endotracheal tube is used to ventilate the patient with a respirator. After reversal the patient is able to breathe for himself. Initially, the patient may be restless and may cough quite a lot because the ETT causes localized irritation. The patient may cough up sputum or specks of blood. If the patient coughs up food please notify the anesthetist as the patient may have aspirated. Suction the patient's mouth and airway to clear it of foreign particles.
A nurse receiving the report on a patient who is compromised from a respiratory should not agree to transfer the patient to the ward because both operating theater and Intensive Care Units are better able to deal with patients that are compromised or have aspirated.
The nurse caring for the patient will need to attend to the patient immediately if he is wheezing or complains of chest pain. Most often pulmonary (lung) complications arise due to lack of deep breathing during the post operative period. Pain and discomfort after a surgical procedure makes it hard to take deep breaths or cough to clear pulmonary secretions. Deep breathing exercises and use of incentive respirometer are recommended to help clear secretions.
Thirst
Thirst is defined as the desire to have a drink, usually of water. In the post operative stage this is often very severe. As stated earlier the patient has been starved and dried out for the last 20 or so hours. Further, he has had a tube inserted into his dry throat and the cuff inflated in the throat.
When the patient wakes up he is most likely to ask to have a drink of water. Many a times, he is not able to speak. Do anticipate this. Give him a sip of water if not contraindicated. If contraindicated, then allow him to gargle his mouth or moisten it with a small chip of ice.
Listen (auscultate) for abdominal sounds. If present and water is not contraindicated then water may be given. Start of with sips of water. A lot of water, given quickly, will result in vomiting.
Urinary retention
This is another frequent complication of anesthesia particularly in older male patients. This complication will become evident after a few hours when the patient has not passed urine. A number of strategies can be implemented to help the patient void. These include sitting the patient on the side of the bed, running the tap, standing him up and letting him have a shower. If all interventions fail it may me necessary to catheterize the patient. A doctors order will be necessary for this procedure. Urinary Retention has been included in this section because it is due to the effect of an anesthetic gases and lying down for a prolonged period of time.
Picture of an intubated patient. The ETT is connected to a catheter mount. A face mask is ready to be placed on the face as soon as the ETT is removed.
Nausea and vomiting
Patients recovering from anesthesia often complain of nausea and vomiting. Vomiting is defined as forcing the contents of the stomach out through the esophagus to the exterior. Nausea is defined as having the urge to vomit.
The human body has many ways to respond to medications and poisons which have been introduced into it. Sneezing ejects dust / pollen / irritants from the nose. Coughing helps clear the lungs and throat. Diarrhea clears the intestines. Similarly nausea and vomiting clear the stomach.
Vomiting is a forceful action accomplished by a fierce, downward contraction of the diaphragm. At the same time, the abdominal muscles tighten against a relaxed stomach with an open sphincter. The contents of the stomach are propelled up and out. Vomiting is a complex reflex act which is coordinated by the vomiting center of the brain in response to signals from the mouth, stomach, and intestines. This is generally in response to medications (anesthetics and medications) or infections in the blood stream.
Allergic Reactions to Anesthetics and Medications.
An allergic reaction is said to occur when an allergen is introduced into the human body through the skin, inhaled through the lungs, swallowed, or injected.
