Caring for the Surgical Patient

Atmosphere

Certified nurse’s assistants assigned to medical/surgical floors will often be tasked with a variety of responsibilities. These floors are usually busy, and you will sometimes need to keep track of patients and their records as they come and go from the floor. This will help to inform the doctors and nursing staff regarding the patient’s location and condition. Consider yourself the eyes and ears of the floor.

Being able to multitask is an essential skill for the nurse’s assistant in this type of atmosphere. Unlike a nursing home environment, medical/surgical units will frequently see a wide variety of patients of various ages that may have a whole multitude of different conditions.

Surgical Care Concerns

The goal of the surgical healthcare team is to make the patient’s hospital stay comfortable, safe and as short as possible. Surgical patients are classified into both pre-operative and post-operative care. During pre-operative care, patients are prepped for surgery and all relevant notes regarding the require blood test and possible patient allergies are noted on the patient identification bracelets and in their file.

During post-operative care, patient’s vital signs are closely monitored for signs of shock or infection. The nursing staff also must tend to the patient’s wounds, surgical drains and any other postsurgical concerns.

In your role as a nurse’s aide, you will assist the nursing staff in the following surgical care procedures during this time:

Vital Signs

You will be responsible for measuring and documenting patient’s vital signs. The four basic signs are temperature, blood pressure, heart rate and respiratory rate. You should immediately inform the nursing staff of any abnormal findings.

Post- Operative Pain

Pain is common after surgery. If the patient is complaining of pain, let them know that you are there to help and notify the nursing staff of the patient’s pain level. Offer emotional support and do your best to keep the patient comfortable during this time of physical pain.

Moving the Patient

When the patient is ready, they will need to get up and move as soon as possible after surgery. This helps with circulation. You will be called to help the nursing staff move the patient in bed at least every two hours. This helps to prevent bed sores and also helps to keep the patient comfortable.

Prior to moving the patient, make sure that their pain is under control. If the patient seems to be in too much pain, inform the nurse and try again later after their pain is under control.

When dealing with surgical patients, they often have tubes/drains that need to be unhooked from the bed and moved with the patient. If this is overlooked, it can lead to a tube or drained being pulled out of the wound and may result in additional pain to the patient.

The patient will also be encouraged to perform leg exercises to assist with circulation. This will help prevent blood clots in the legs. Walking, leg exercises, compression stockings and movement are all preventative measures against clots.

Fluid Intake/Output

Patients are often on intravenous fluids after surgery.  During this time, it is important to monitor the patients to make sure that their output is adequate and that they aren’t retaining fluid.

Once the patient begins oral fluids, you will need to document how much they consume during your shift. You will also be responsible for emptying the urine containers and documenting the output during your shift.

After the IV fluids stop, the patient needs to be monitored for signs of dehydration. If you notice any adverse signs in the patient, report them to the nursing staff.

The signs are often poor skin elasticity, dry mucous membranes, thirst, and small amounts of constant urine. After the IV fluids end, patients will start with small sips of water and gradually move onto additional fluids.

Daily Living

Patients under surgical care will often require assistance performing activities of daily living. Be prepared to help them eat, brush their teeth, comb their hair and dress if necessary.

Use caution when initially getting the patient out of bed. Have them sit on the side of the bed for a while, and then slowly get them up.  If the patient appears pale or dizzy, check their blood pressure and pulse to make sure they are alright to move.

QNA’S

Q.  What are some of the types of post-surgical care that a nursing assistant can be asked to provide for patients?

A.  Nursing assistants who work on a surgical floor provide a range of post-surgical care services.  Some of these services include the monitoring and recording of vital signs.  Nursing assistants help to keep an eye out for signs of infection, shock and other complications.

Explanation:  CNAs provide many different care services when working with patients who have had surgery.  They will help to monitor a patient’s condition and to obtain assistance from the appropriate healthcare team members when there are concerns.   Assistance with daily activities while a patient recovers will also be provided.

Q.  What are some special considerations when moving patients who have recently had surgery?

A.  Great care must always be taken when moving patients. A nursing assistant must carefully move patients. This will often require the nursing assistant to move the patient with the help of other nursing assistants or nurses.  Nurses must be careful of a patients dressing.  They must also cautiously move patients who have tubes and other medical equipment attached.

Explanation:   There can be some additional considerations when moving patients in bed or to other locations that have recently had surgery.  Patients who have had surgery often have a lot of tubes, drainage equipment and other medical equipment attached to them. They can also have wounds from their incisions.  Patients can be weak from just having had surgery and can be having after effects of anesthesia.

Q. True or False:  The monitoring of a patient’s input and output of foods and drinks is very important after surgery?

A.  True:  The monitoring of a patient’s input and output of food and fluids is important after surgery.  Many patients will have IV fluids at first and then will move on to a bland diet before progressing to solid foods.  The input and out can show how well a patient is progressing in their recovery.

Explanation:  The input and output of liquids (and food) can help the medical staff to monitor for signs of infection or complications.  Doctors often want to see that a person is able to void before they are released from the hospital (this can depend on a person’s surgery and medical condition as some people will have catheters or other special care for a awhile).  Doctors typically like to see that a patient can begin tolerating food as well.  The monitoring and documenting of input and output by the CNA is very important.