The post-anesthesia care unit nurse is caring for 4 clients during the immediate postoperative period. Which client would be the priority for the nurse to see first?

Question

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Immediate postoperative nursing care focuses on management of the airway, breathing, circulation, bleeding, and pain. Although antiemetic medications are typically administered immediately after surgery to control nausea and vomiting, nausea is still a common complication caused by anesthetic side effects and decreased gastrointestinal motility. Clients are at high risk for aspiration (and possible asphyxiation) due to their altered level of consciousness, which is caused by anesthesia. Clients reporting nausea should be placed immediately on their side to prevent aspiration of vomit. (Option B) Mild oozing of blood from the surgical site is normal during the postoperative period. The nurse will note the amount and appearance of the drainage, reinforce the dressings, and continue to monitor the client. This client would be seen third. (Option C) Pain control after surgery is important for client recovery. Because short-acting pain medications are given to minimize respiratory depression, a client's pain can increase quickly. This client would be seen second. (Option D) After transurethral resection of the prostate, continuous bladder irrigation for 24-36 hours flushes out small clots and prevents obstruction. Reddish-pink drainage is expected in the immediate postoperative period. This client would be seen last. Educational objective: Postoperative clients are at an increased risk for vomit aspiration due to nausea and an altered level of consciousness (caused by anesthesia). These clients should be placed on their side and should receive antiemetics to prevent potential airway and breathing complications.

The Post-Anesthesia Care Unit Nurse Is Caring for 4 Clients