Postoperative Care and Wound Management
Immediate postoperative assessment
In the PACU, prioritize airway, breathing, circulation, and level of consciousness. Use Aldrete-type criteria for discharge readiness: activity, respiration, circulation, consciousness, and oxygen saturation. Monitor temperature, urine output, pain, nausea, and the surgical site. Early hypothermia and shivering increase oxygen demand; apply warm blankets and treat per orders. Report hypotension, tachycardia, oliguria, or expanding dressings promptly.
Wound assessment and classification
Classify wounds as clean, clean-contaminated, contaminated, or dirty/infected; this guides antibiotic and dressing decisions. Assess for bleeding, hematoma, seroma, dehiscence, and infection (redness, warmth, purulence, fever). Healing by primary intention occurs with clean apposed edges; secondary intention heals by granulation; tertiary intention is delayed closure. Dehiscence with evisceration is an emergency: cover with a sterile saline-moistened dressing, position with knees flexed, keep the patient NPO, and notify the surgeon. Do not remove sutures or drains without an order.
Trap: fever timing. Malignant hyperthermia occurs intraoperatively or early; atelectasis day 1–2; surgical site infection day 3–5; DVT day 5–7; abscess day 7 or later. A question may incorrectly attribute early fever to infection.
Rule of thumb: “look, listen, and lay flat”-assess the whole patient before focusing on the wound; when evisceration is suspected, cover and call.