Delayed Surgical Recovery Nursing Care Plans Diagnosis and Interventions
Delayed Surgical Recovery NCLEX Review and Nursing Care Plans
Delayed surgical recovery is a NANDA nursing diagnosis that is defined as an extension of the number of postoperative days needed by a patient to begin and complete tasks for the sustenance of life, health, and well-being for their benefit.
Postoperative nursing care starts when the patient is admitted to the post-anesthesia care unit (PACU) and concludes when the anesthesia has worn off sufficiently for the patient to be safely transported to the proper nursing unit.
To prevent or manage delayed surgical recovery, the postoperative nurse must be aware of the patient’s potential for complications and be prepared to intervene should the patient’s condition change.
Monitoring vital signs, checking for airway patency and neurologic status, managing pain, examining the surgical site, establishing and preserving fluid and electrolyte balance, and giving a comprehensive update on the patient’s condition to the receiving nurse on the unit as well as the patient’s family are all parts of postoperative nursing care.
The postoperative nurse must carefully assess the patient and act promptly to help them achieve their optimal function as fast, safely, and comfortably as possible to accomplish these responsibilities.
There is no set minimum stay period; instead, the length of stay in the postoperative phase is decided on a case-by-case approach.
The patient must be stable and free from complications to move from the PACU to the clinical unit or home. However, complications can still occur after surgery, thus continuous nursing assessment in the postoperative nursing unit is still critical.
An in-depth understanding of patient sensitivities to anesthetic agents, surgical techniques, pain management, and potential complications should be exhibited by postoperative nurses.
Signs and Symptoms of Delayed Surgical Recovery
The following characteristics can be observed in patients who are exhibiting delayed surgical recovery.
- Signs that a surgical wound is not healing properly, such as tenderness, induration, drainage, and immobility.
- Appetite loss along with or without nausea.
- Difficulty navigating the surroundings.
- The need for assistance with self-care.
- Claims of discomfort or agony.
- A delay in starting up daily tasks.
- The perception that recovery takes longer than it should.
Related Factors to Delayed Surgical Recovery
Some patients need to be treated with greater caution because they are more likely to experience a delayed surgical recovery due to some of the related factors listed below.
- High-risk population. According to research, older people had a slightly greater diagnostic risk for delayed surgical recovery than people of other ages. People who have a history of slow wound healing are also more likely to have a slower recovery after surgery, therefore the medical team must be thoroughly informed of this history.
- Associated conditions or comorbidities. The following conditions are some of the contributing factors to a delayed surgical recovery.
- Physical Status classification score of 2 or less from the American Society of Anesthesiologists (ASA).
- Diabetes Mellitus
- Surgical site swelling/edema
- Prolonged surgical operation
- Mobility limitations
- Infection at the surgical site
- Persistent nausea and vomiting
- Pharmacological substance
- Contamination of the surgical site and psychological disorders in the postoperative phase
- Operation site trauma
- Other causative factors. Other possible related factors of a delayed surgical recovery are exposure to harmful substances, having the surgical wound contaminated, or contracting an infection during or after the procedure.
Complications of Delayed Surgical Recovery
After surgery, complications might occasionally happen. These are the most typical complications that arise from a delayed surgical recovery:
- Shock. Shock is a significant drop in blood pressure that reduces the body’s ability to transport blood adequately. Blood loss, infection, brain damage, or metabolic issues can all result in shock. Stopping any blood loss, assisting with breathing by delivering oxygen or, if necessary, mechanical ventilation, lowering heat loss, giving intravenous (IV) fluids or blood, or prescription medications, such as those to improve blood pressure, are all possible treatments options.
- Hemorrhage. Hemorrhage refers to bleeding or rapid blood loss from the surgical site, which can precipitate shock. Rapid blood loss can be treated with blood transfusions, IV fluids, blood plasma, or additional operations to stop the bleeding.
- Wound infections. Bacteria can cause an infection at the surgical site, which can slow healing. Through the bloodstream, wound infections can travel to nearby organs or tissue as well as to far-off regions of the body. Antibiotics and surgery or other procedures to clean or drain the infected area may be used in the treatment of wound infections.
- Pulmonary embolism (PE) and deep vein thrombosis (DVT). Venous thromboembolism (VTE) is the name given to these conditions collectively. This term refers to the conditions’ close relations to one another as well as to their similar prevention and treatment.
- Pulmonary embolism (PE). The blood flow may be stopped if the clot breaks free from the vein and travels to the lungs, where it can cause a pulmonary embolism. A medical emergency that could result in death. Chest pain, breathing difficulties, coughing that may produce blood, sweating, a rapid heartbeat, and fainting are all symptoms. Depending on where and how big the blood clot is, it may be treated with anticoagulant medications to stop further clotting, thrombolytic medications to dissolve clots, surgery, or other procedures.
- Deep vein thrombosis (DVT). This manifests as pain, swelling, and redness in the affected leg, arm, or other regions of the body, is a blood clot in a large vein deep inside the said body parts.
- Respiratory complications. Lack of deep breathing and coughing exercises within 48 hours following surgery can occasionally result in respiratory complications. Inhaling food, water, or blood into the airways can also cause them, as can pneumonia. Wheezing, chest discomfort, fever, and cough are possible symptoms among others.
- Retention of urine. Following surgery, it is possible to experience temporary urine retention or bladder incontinence. Urinary retention brought on by the anesthesia is typically managed by inserting a catheter to drain the bladder until the patient regains bladder control. Occasionally, bladder-stimulating medications may be administered.
- Anesthesia-related reaction. The symptoms of allergies to anesthetics can be mild to severe, although they are uncommon. To treat allergic responses, some medications that could be the cause of the reaction must be stopped, and the allergy must be treated with additional medications.
Nursing Considerations for Patients with Delayed Surgical Recovery
In order to lower the risks of infection and deterioration, as well as to keep patients informed and comfortable, patients must receive organized, high-quality care immediately following surgery. If this is not accomplished, it may take longer for the patient to recuperate and keep a strain on the surgical team to release the patient before they are fit. All nurses involved in postoperative care should follow best practice recommendations to avoid this.
Pain Management. The kind of surgery done and the demands of the individual will determine the degree and kind of pain control. The following methods of pain management are available: oral, epidural, patient-controlled analgesia (PCA), and opioid continuous infusion. If the patient’s pain is not under control, the effectiveness of the prescription analgesia should be evaluated using a pain tool, and appropriate action should be taken. For major surgery, epidurals, intravenous PCA, and opioid infusion are frequently utilized, and it is crucial to check the ineffective pain management and a higher risk of infection resulting from lines remaining attached to the entrance port. The following signs of discomfort should be watched out for by nurses:
- Facial grimace
- Perfused sweating
- Pale color
- Increased heart rate
- High blood pressure
Proper Wound Care. Every time the nurses observe the surgical site, they should monitor for excessive bleeding because this could be a sign of hemorrhage.
Transfer from the recovery room to the ward.
Complete endorsement, receiving & comprehensive checks. Any area used for postoperative recovery should be staffed by a nurse or other health care provider who can determine if the patient has recovered from the procedure well enough and is stable enough to return to the ward or day unit. Transfer cannot begin unless the following checks have been performed and acceptable results have been recorded:
- ability to keep one’s airway open
- rate, rhythm, and chest breathing movements
- cyanosis and pallor
- oxygen saturation and rate
- pulse rate, rhythm and characteristics
- blood pressure
- more than 36 °C temperature of the body
- a reaction to verbal stimulation
- awareness of one’s environment
- ability to cough and move one’s limbs;
- administered intravenous (IV) fluids whilst in the operating room and continuously infusing
- sufficient fluid intake recommended for 24 hours
- skin quality at the insertion site and cannula patency
- drains, stomas, and urine output
- administered medication/s
- updated medication administration record
- completed theater notes and a list of any particular postoperative directives
Proper Positioning. It is crucial that patients’ beds have been set up for a thorough recovery before they are removed from the recovery room. Typically, they are moved in a semi-prone or lateral position to preserve their airway when they are still semiconscious.
Emergency Care. The surgical ward/day unit nurse will receive information about the patient’s status throughout surgery and the recovery period from the nurse in the recovery area. With the systematic “ABCDE” strategy outlined below, both nurses should be able to identify and respond to an emergency or a patient who is deteriorating.
- Airway: Search for indications of airway blockage
- Breathing: Look, listen, and feel for indications of respiratory issues
- Circulation: Watch for tachycardia, hypotension, and decreased urine output
- Disability: Using the AVPU scale, determine the level of consciousness
- Exposure: thorough patient examination
Caregiver Support. Patients should always be notified when they return to the ward or day unit, and once it is safe for them to be there, people with learning disabilities should be allowed to bring their parents or caregivers with them. The correct route and rate for oxygen therapy and infusions should be checked before being transferred to the patient’s bed.
Postoperative Care on the ward
Gradual position change. Patients can be helped into a more upright position and supported by pillows when they are more responsive, observations are stable, and it is suitable.
Deep breathing and coughing exercises. Patients should be instructed on how to support an incision and encouraged to take deep breaths and cough. For instance, they could use their arms or pillows to support an abdominal wound. For patients to be able to cough, pain must be effectively managed.
Fluids. If it is not contraindicated, small amounts of fluid can be introduced. Since fasting and anesthesia can produce a dry mouth, ice cubes or icy water might be refreshing.
Bladder care. The bladder muscle may become weak as a result of anesthesia, which could make it challenging for the patient to urinate. Catheterization should only be done as a last option when bladder discomfort and distension are present, and then intermittent catheterization should be used to reduce the risk of infection from an indwelling catheter. When feasible, help the patient get out of bed, and give them as much privacy as they need to urinate.
Prevent embolism and pressure ulcers. To lower the risk of embolism, patients should be instructed to flex, extend, and rotate their feet. If the peripheral vascular disease does not make anti-embolism stockings inappropriate, they should be worn and shouldn’t be rolled up or wrinkled.
Patients who have previously undergone anticoagulation will need a continuous anticoagulant infusion, and all patients should be watched for dyspnea or a hot, swelling, or sore calf. On the other hand, the risk of pressure ulcers should be reevaluated following local policies, and patients should be assisted in changing positions; proper pain management is necessary to make this possible.
Delayed Surgical Recovery Nursing Diagnosis
Delayed Surgical Recovery Nursing Care Plan 1
Nursing Diagnosis: Delayed Surgical Recovery related to postoperative wound dehiscence secondary to laminectomy as evidenced by limited range of motion, decreased muscle control, restlessness and episodes of shortness of breath.
Desired Outcome: The affected body part will become stronger and more functional, and the patient will display strategies and behaviors that allow them to resume their usual tasks.
|Delayed Surgical Recovery Nursing Interventions||Rationale|
|Provide and/or assist with passive and active ROM exercises based on the surgical procedure performed on the patient.||Improves body mechanics while strengthening the flexors of the spine and the abdominal muscles.|
|Help the patient move about and gradually ambulate.||Activity is restricted and increased gradually under each person’s tolerance up until healing takes place.|
|Evaluate the patient’s proper body mechanics and activity participation techniques.||Increases the likelihood that the patient will engage in increasing activity while minimizing the chance of muscle strain, injury, and pain.|
|Maintain strong connections with the patient’s physical therapy team.||To maintain a regular schedule of exercises that are suitable for the patient and strengthen their legs and back.|
|Plan rest periods between patient activities and procedures, and promote participation in ADLs within personal boundaries.||Patient involvement fosters independence and a sense of control while rest periods between tasks improve healing and constructing muscle strength and endurance.|
|Check for wheezes or rhonchi by auscultating the patient’s breath sounds.||Suggests secretions are building up and that more intensive therapeutic measures are necessary to clear the airway.|
|Monitor the patient’s ABGs or pulse oximetry results.||Evaluates the efficacy of a breathing technique or treatment.|
|Provide supplemental oxygen if necessary.||Periods of breathing difficulty or signs of hypoxia might necessitate the use of oxygen.|
Delayed Surgical Recovery Nursing Care Plan 2
Nursing Diagnosis: Delayed Surgical Recovery related to bladder tone loss as a result of preoperative overdistension or ongoing decompression secondary to prostatectomy as evidenced by difficulty and hesitancy in urinating, urinary incontinence and retention, and bladder discomfort.
Desired Outcome: The patient will exhibit efforts to restore bladder and urinary control.
|Delayed Surgical Recovery Nursing Interventions||Rationale|
|Check the patient’s urine output and drainage system while the bladder is being irrigated.||Blood clots, bladder spasms, and surgery site inflammation can all result in retention.|
|Encourage the patient to stand and go to the bathroom frequently after the catheter is removed to help the patient assume the appropriate position when voiding.||It facilitates urine flow and fosters a sense of normalcy.|
|Check the patient’s dressing, incision, and drainage frequently for heavy bleeding, and keep an eye out for any infections or symptoms of bleeding.||It is possible for the patient’s sutures to reopen.|
|After the catheter is removed, note the duration, volume, and size of the stream while also taking note of any reports of urgency or bladder fullness.||The catheter is often withdrawn 2–5 days following surgery, but urethral edema and loss of bladder tone may make it difficult to urinate for a while.|
|Encourage the patient to void when needed, but no more frequently than once every 2-4 hours in accordance with the protocol.||Urinary retention is avoided by voiding when needed. If acceptable, limiting voids to every 4 hours improves bladder tone and helps with bladder retraining.|
|Encourage the patient to drink up to 3000 mL per day as tolerated, and once the catheter is out, restrict fluid intake in the evening.||Keeps the kidneys adequately hydrated and perfused for urine flow. The desire to empty frequently during the night and disrupt sleep is reduced when fluid consumption is reduced on the appropriate schedule.|
|Give the patient instructions to do perineal exercises, such as tightening the buttocks and halting and beginning the urine flow.||Lessens incontinence and aids in the bladder, sphincter, or urinary control recovery.|
Delayed Surgical Recovery Nursing Care Plan 3
Nursing Diagnosis: Delayed Surgical Recovery related to intestinal tissue swelling brought on by inflammation secondary to appendectomy as evidenced by restlessness, facial grimacing, guarding behavior, and verbalized pain reports.
Desired Outcome: The patient will demonstrate how to control pain brought about by delayed surgical recovery by using relaxation techniques and distractions.
|Delayed Surgical Recovery Nursing Interventions||Rationale|
|Evaluate pain, taking note of its characteristics (0–10 scale), location, and intensity. If necessary, look into and report changes in pain.||Useful for tracking the efficiency of treatments and the development of healing. A growing abscess or peritonitis may be indicated by changes in the features of pain, necessitating an immediate medical evaluation and treatment.|
|Maintain the patient’s semi-position Fowler’s when at rest.||The inflammatory exudate is localized into the lower abdomen or pelvis by gravity in this posture, reducing the abdominal strain that is aggravated by lying on one’s back.|
|Give the patient a list of distraction-enhancing activities.||Relaxation is encouraged, attention is refocused, and coping skills may be improved.|
|Promote early ambulation.||Reduces stomach discomfort and stimulates peristalsis, which helps organ function return to normal.|
|Keep a tight eye out for any other serious surgical problems in the patient.||An abscess may be detected by persistent discomfort and fever.|
|Examine the dressings and incisions. Keep an eye out for erythema and discharge from the wound if present.||Enables the early diagnosis of infectious processes in progress and keeps track of the healing of existing peritonitis.|
|Monitor the patient’s vital signs and keep an eye out for the beginning of a fever, chills, diaphoresis, mentation changes, and symptoms of growing abdominal pain.||Suggests an infection or the onset of sepsis, an abscess, or peritonitis.|
Delayed Surgical Recovery Nursing Care Plan 4
Nursing Diagnosis: Delayed Surgical Recovery related to pain and discomfort secondary to mastectomy as evidenced by hesitation when trying to move, reduced muscle strength and mass, and restricted range of motion.
Desired Outcome: The patient will demonstrate strategies that allow the body parts affected to resume their normal activities and gain strength.
|Delayed Surgical Recovery Nursing Interventions||Rationale|
|Elevate the patient’s affected arm as necessary.||Reduces the likelihood of lymphedema by enhancing venous return.|
|Move the patient’s fingers as they observe their feelings and the color of their affected hand.||Discoloration can signify poor circulation, and lack of mobility may imply issues with the intercostal brachial nerve.|
|Encourage the patient to perform personal hygiene with the afflicted arm.||Maintains the strength and functionality of the arm and hand while increasing circulation and reducing edema. The arm is used in these activities without being abducted, which might put stress on the suture line in the initial postoperative stage.|
|Encourage good posture and assist the patient with movement.||The patient may require assistance while getting used to the shift since they will feel off-balance. Maintaining a straight back stops the shoulder from advancing, preventing a long-term restriction in mobility and posture.|
|Exercise in advance as directed, including active arm extension and shoulder rotation while lying in bed, pendulum swings, rope turns, and raising arms to meet fingertips behind the head.||Preserves muscular tone in the shoulders and arm, prevents joint stiffness, and improves circulation.|
|Teach the patient how to take slow, deep breaths while exercising.||When the abdominal muscles contract, lymphatic fluid is forced through the thoracic duct and out of the cisterna chyli, improving drainage by creating a vacuum effect.|
Delayed Surgical Recovery Nursing Care Plan
Nursing Diagnosis: Delayed Surgical Recovery related to multiple comorbidities secondary to TAHBSO as evidenced by unstable vital signs, bladder distention, urinary incontinence, irregular bowel movement, limited range of motion, and facial grimace when moving.
Desired Outcome: The patient will continue to urinate and eliminate according to the usual pattern, and exhibit adequate perfusion as shown by stable vital signs.
|Delayed Surgical Recovery Nursing Interventions||Rationale|
|Observe the patient’s vital signs frequently, check for peripheral pulses, check capillary refill, evaluate the patient’s urine flow and characteristics, and analyze changes in the level of consciousness.||Indicators of the systemic perfusion’s sufficiency, fluid and blood requirements, and emerging problems.|
|Examine the dressings and perineal pads, noting any drainage’s color, volume, and smell. If the patient is bleeding heavily, weigh the pads and compare them to the dry weight.||The risk of postoperative hemorrhage is increased by the presence of big blood vessels close to the surgical site and/or by the possibility that the clotting mechanism will be disrupted.|
|Reposition the patient as indicated ad urge frequent coughing and deep breathing techniques.||Frequent repositioning of the patient prevents respiratory problems and secretion stasis.|
|Exercise the patient’s legs and feet with assistance, and help them get up as quickly as possible.||Circulation is improved by movement, and consequences from stasis are avoided.|
|Note any stomach distension, nausea, or vomiting when auscultating for bowel sounds.||Indicators of ileus, either present or resolved may influence the selection of therapies.|
|6. Encourage the patient to drink sufficient fluids, including fruit juices, after oral intake has restarted.||Softens the stools and may help to stimulate peristalsis.|
|Make note of the patient’s urine flow and voiding patterns, and gradually let the bladder expand.||If the patient frequently voiding in small, insufficient amounts, this could be a sign of urine retention. Rapid bladder decompression, which occurs when there has been an excessive buildup of urine, relieves pressure on the pelvic arteries and encourages venous pooling.|
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