After abdominal surgery, patients are often positioned on the side until laryngeal reflexes have started to return. The patient is then placed in a semi-Fowler position to ease the tension on suture lines and to promote respiratory effort. After some procedures on the stomach or esophagus, strict aspiration precautions with the head of the bed elevated to 30 degrees may be required. After hemorrhoidectomy, the patient may assume any position of comfort, which is most likely on the right or left side.

All dressings should be checked. The nurse must know what kind of incision was used and whether any drains are in place. Drains are discussed in more detail in the specific procedure sections. Drainage should be assessed for character, volume, and odor. The nurse should determine who can or should remove the dressing if needed. Some surgeons reinforce the abdominal incision and dressing with a binder; they believe that this gives the incision valuable support. Others, however, believe that binders restrict respiratory effort and that this disadvantage outweighs the limited advantage of incisional support.

Because drainage may be copious after gastrointestinal surgery, frequent reinforcement of dressings may be necessary. Ask the surgeon for anticipated or expected amounts of drainage for the patient and procedure. If drainage becomes excessive (more than expected from the particular procedure), the surgeon should be notified and the incision directly inspected.

All tubes should be connected to the appropriate drainage devices, usually straight-gravity or closed-bulb suction drainage, as the surgeon specifies. Nasogastric tubes will usually be attached to constant or low intermittent wall suction. Maintenance of the patency of these tubes is one of the most important nursing functions after gastrointestinal surgery. Irrigation of nasogastric tubes after esophageal or gastric surgery should be directed by the surgeon’s orders.

The promotion of good respiratory function is a nursing priority for the patient who has had abdominal surgery. Painful abdominal incisions cause the patient to restrict chest expansion voluntarily, which is especially true with high abdominal incisions. The patient must be coached often in sustained maximal inspirations, coughing, and changing position to prevent respiratory complications. Assisting the patient with splinting of the incision and judicious use of pain medications aid in deep breathing and coughing and help to prevent the development of atelectasis. Coughing and incentive spirometry in the PACU setting are valuable in promotion of respiratory function.

Frequent assessment of breath sounds during the postoperative period can alert the nurse to impending respiratory problems. An unrecognized injury to the diaphragm during upper abdominal surgery is possible and can result in respiratory distress. Positive pressure ventilation during anesthesia can also lead to respiratory problems. Breath sounds must be monitored closely to assess for pneumothorax and other respiratory complications.

Patency of the tube must be ensured. The nurse should observe for drainage from the tube. All characteristics of the drainage must be noted: consistency, color, odor, quantity, and any deviations from the expected drainage. After gastrointestinal surgery, initial drainage may be bright red in small volumes but should become dark or thin, watery, cherry pink–colored liquid after 24 hours. Bloody drainage should not be expected from a nasogastric tube placed only for decompression of the stomach after biliary tract, liver, or spleen surgery. If no drainage is present, if the patient’s abdomen becomes distended, or if the patient vomits around the nasogastric tube or has nausea, the tube may be clogged or the suction apparatus may be malfunctioning; check both. For maintenance of the patency of the nasogastric tube, irrigation with 20 to 30 mL of normal saline solution can be performed every hour or more frequently if necessary. Before irrigating the tube, check with the surgeon regarding the permissibility of nasogastric tube irrigation. Plain water in 20-mL amounts can be used to irrigate the tube without creation of electrolyte abnormalities. Larger amounts of plain water should not be used when irrigating for gastric bleeding because of the large volume and the risk of electrolyte alterations. Frequent irrigations increase the loss of electrolytes from the gastrointestinal system. Some surgeons advocate the use of air to irrigate the nasogastric tube to maintain patency. Only air should ever be passed through the second (“sump”) lumen of the double-lumen tube.

The amount of irrigating solution instilled should be recorded as such unless its equivalent is aspirated via syringe. All gastrointestinal drainage should be accurately measured and recorded. If irrigations do not clear the tube, the tubing should be checked for clogs by milking it toward the suction container to dislodge any obstruction. The suction apparatus is checked by disconnecting the nasogastric tube at the junction of the nasogastric tube and the drainage tube that leads to the container. With the suction turned on, the end of the drainage tube is placed in a glass of water; if the water is sucked up, the suction device is functioning. If these measures fail, gastric mucosa may be occluding the lumen of the tube or the tube may be kinked. In this instance, the patient or the tube may need to be repositioned. If the patient has had gastric, pancreatic, or esophageal surgery, the tube should not be manipulated. The surgeon should be notified of the malfunctioning tube. In general, unless ordered by the surgeon, checking with the surgeon before manipulating or replacing a nasogastric tube is always prudent.

The presence of a nasogastric tube is an uncomfortable experience for the patient. However, appropriate nursing care can relieve sore throat, dry mouth, hoarseness, earache, sore nose, and dry lips. The tube should be taped securely and properly (hypoallergenic tape or a specially designed tube-securing device) in a position to prevent pressure on the naris. The tube can be secured to the nose in the position it naturally assumes. The tube should not be taped to the patient’s nose and then to the forehead; this causes pressure on the underside of the nostril and can cause tissue necrosis within minutes. To lessen the pressure and pull on the patient’s nose, the tube can be taped or pinned to the gown.

Petrolatum ointment is applied to the tube where it enters the nose and around the nares. The outside portion of the tube is kept free of mucus or other drainage, which prevents encrustations from forming and reduces irritation of the nostril. Petrolatum ointment, cream, or lip balm is applied to the lips to keep them soft and to prevent cracking. Good and frequent mouth care is essential for the comfort of the patient and prevention of parotitis. Moistened swabs, mouthwash, or even a toothbrush can be used to provide mouth care for the patient. The nurse should ensure that the patient understands not to swallow any of the material used. This, of course, is not fatal but could make assessment of accurate nasogastric tube output difficult.

Gargling with warm tap water or warm saline solution (or with viscous lidocaine or applications of a local anesthetic spray) can relieve the patient’s sore throat. A physician’s order should be provided for these measures. Some surgeons allow patients to suck on isotonic ice chips or hard candy or to chew gum. Anesthetic throat lozenges, if allowed, may be comforting to the patient. All patients with a gastrointestinal tube in place are given essentially nothing by mouth until the tube is removed. The only exception may be certain medications, given orally or through the tube, or ice chips (less than 200 mL every 8 hours). Some surgeons believe that allowing patients to consume ice chips increases comfort and also helps to keep the tube patent by having the melted ice chips frequently sucked out of the stomach by the tube.

Perforation of an ulcer is usually a surgical emergency, and neither the patient nor the family members are adequately prepared, either physically or emotionally, for the surgery. This situation concerns the perianesthesia nurse because complications, especially hypovolemia and shock, may more readily occur in this patient.

Specific care for infants after surgery for pyloric stenosis is detailed in pediatric nursing or medical textbooks. However, the perianesthesia nurse should be aware of general care. Position is important. The infant should be kept either on the right side or on the abdomen until the danger of vomiting and aspiration has subsided and then should be placed in an upright position. Careful placement of the diaper is important to avoid contamination of the wound. Application of a pediatric urine collector may also be helpful to prevent contamination of the wound with urine and to determine accurate output. Feedings are usually begun for these infants 4 to 6 hours after surgery, but the surgeon’s instructions should be strictly followed.