CARE ON SURGICAL FLOOR

1. Monitor respiratory status and promote optimal functioning. 
     1. Encourage client to cough (if not contraindicated) and deep breathe every 1-2 hours. 
     2. Instruct client to splint incision while coughing. 
     3. Assist client to turn in bed every 2 hours. 
     4. Encourage early ambulation. 
     5. Encourage use of incentive spirometer every 2 hours: causes sustained, maximal inspiration
         that inflates the alveoli. 
     6. Assess respiratory status and auscultate lungs every 4 hours; be alert for any signs of
         respiratory complications.

2. Monitor cardiovascular status and avoid post-op complications. 
     1. Encourage leg exercises every 2 hours while in bed. 
     2. Encourage early ambulation. 
     3. Apply antiembolism stockings as ordered. 
     4. Assess vital signs, color and temperature of skin every 4 hours.

3. Promote adequate fluid and electrolyte balance. 
     1. Monitor IV and ensure adequate intake. 
     2. Measure I&O. 
     3. Irrigate NG tube properly, using normal saline solution. 
     4. Observe for signs of fluid and electrolyte imbalances.

4. Promote optimum nutrition. 
     1. Maintain IV infusion as ordered. 
     2. Assess for return of peristalsis (presence of bowel sounds and flatus). 
     3. Add progressively to diet as ordered and note tolerance.

5. Monitor and promote return of urinary function. 
     1. Measure I&O. 
     2. Assess client's ability to void. 
     3. Report to surgeon if client has not voided within 8 hours after surgery. 
     4. Check for bladder distention. 
     5. Use measures to promote urination (e.g., assist male to sit on side of bed, pour warm water
         over female's perineum).

6. Promote bowel elimination. 
     1. Encourage ambulation. 
     2. Provide adequate food and fluid intake when tolerated. 
     3. Keep stool record and note any difficulties with bowel elimination.

7. Administer post-op analgesics as ordered; provide additional comfort measures.
8. Encourage optimal activity, turning in bed every 2 hours, early ambulation if allowed (generally
    client will be out of bed within 24 hours; have client dangle legs before getting out of bed).
9. Provide wound care.

1. Check dressings frequently to ensure they are clean, dry, and intact.  
2. Observe aseptic technique when changing dressings.  
3. Encourage diet high in protein and vitamin C.  
4. Report any signs of infection: redness, drainage, odor, fever.

10. Provide adequate psychologic support to client/significant others.
11. Provide appropriate discharge teaching: dietary restrictions, medication regimen, activity
      limitations, wound care, and possible complications.