1-33. POSTOPERATIVE CARE
Postoperative care for patients who have had surgery of the heart or great
vessels is generally much the same as that given to other chest surgery patients. A
possible exception to this generalization is care for the patient who has had surgery of
the coronary arteries (see paragraph 1-33d below). The first 48 hours following
cardiovascular surgery are the most critical, and a high degree of alertness and skill in
nursing care are essential if death is to be prevented. Intensified nursing care should
continue for at least the first five postoperative days.
a. Vital Signs. Pulse, blood pressure, and respiration must be taken and
recorded every 15 minutes until they stabilize, usually after 4-8 hours. In addition,
cyanosis must be watched for and its cause corrected. A systolic pressure of only 80 or
90 in cardiovascular (CV) surgical patients is no cause for alarm as these patients
tolerate the lower pressure well. The physician should be called immediately if the
systolic pressure is below 80. The exception is the coronary artery surgical patient,
whose pressure should be not more than 10 mm. below the preoperative pressure. The
apical pulse, taken over the heart with a stethoscope, most immediately reflects the
activity of the heart; however, the arterial pulse should be taken not only from the radial
artery at the wrist, but also from arteries of all limbs to detect the presence of an
embolus as early as possible. Temperatures outside the 97 to 102F range should be
reported. Higher temperatures may be an indication of shock or cardiac
decompensation. The respiratory character as well as the respiratory rate should be
noted. Using the stethoscope aids in detecting changes in character. Changes noted
should be reported promptly.
b. Oxygen Therapy. Oxygen is given by facemask, usually at the rate of 8 liters
per minute. After the patient has fully reacted, a nasal cannula is substituted and
oxygen is continued at 4 to 6 liters per minute until the physician orders discontinuance.
Peripheral signs of cyanosis and ischemia must still be watched for, however. Mottling
or blanching of the skin in an extremity--particularly if it is accompanied by other
phenomena such as pain, numbness, tingling, or loss of motion--may indicate the
presence of an embolus and should be immediately reported.
c. Psychological Considerations. Any signs of disorientation, such as failure
to recognize a member of the family or familiar surroundings, should be reported. A
transient state of depression may be expected in the CV surgical patient. In an
occasional patient, the depression will degenerate into suicidal tendencies.
Postoperative depression may be prevented or its intensity lessened through
preoperative explanation of the upcoming procedure and sympathetic consideration of
the patient's fears and concerns.
d. Positioning and Turning. Usually, the patient is kept in the dorsal
recumbent position until his systolic pressure is more than 100. On specific orders from
the physician, a CV surgical patient, other than one who has had coronary artery
surgery, may be raised to a semi-Fowler position and may be turned from side to side