The hours after surgery are a period of high risk. Patients are recovering from anaesthesia, may be bleeding, are in pain, and are vulnerable to breathing problems, clots and infection. Ward nurses are the first line of defence. This guide covers what to check when receiving a patient from theatre and over the first day.
Receiving the patient: the handover
Take a structured handover from the recovery nurse (SBAR works well). Make sure you know:
- The operation performed and type of anaesthesia (general, spinal, regional block).
- Any complications during surgery and estimated blood loss.
- Observations in recovery; any concerns.
- Drains, catheters, IV lines, dressings, and their contents so far.
- Pain relief and antiemetics given; post-op prescriptions (analgesia, fluids, antibiotics, VTE prophylaxis).
- Specific instructions: positioning, eating and drinking, mobility, when to review.
Observations
A common pattern (follow your local policy and the surgeon’s instructions): on arrival, then every 15–30 minutes for the first 1–2 hours, then hourly for several hours, then 4-hourly once stable. Each set includes respiratory rate, SpO₂, pulse, BP, temperature, conscious level, pain score, nausea, wound and drain checks, and the early warning score. See our NEWS2 guide.
Pain
- Assess pain at rest and on movement and coughing, using a pain scale.
- Give regular analgesia as prescribed (often paracetamol plus an NSAID if suitable, with opioids for breakthrough pain), and reassess.
- Uncontrolled pain stops patients breathing deeply, coughing and moving, which increases complications.
- For opioids, PCA (patient-controlled analgesia) or epidurals: monitor sedation and respiratory rate closely.
Complications to watch for
| Complication | Timing | Signs | Action |
|---|---|---|---|
| Haemorrhage | First 24 hours (and later) | Rising pulse, falling BP, pallor, restlessness, blood-soaked dressing, filling drain, abdominal swelling | Pressure on visible bleeding, A–E, escalate urgently, IV access and bloods |
| Respiratory depression | Early | Drowsiness, slow breathing, low SpOâ‚‚ | Stimulate, oxygen, stop opioids, naloxone as prescribed, call for help |
| Nausea and vomiting | Early | Retching, aspiration risk | Antiemetics as prescribed, position on side if drowsy |
| Urinary retention | First 6–12 hours | No urine, lower abdominal discomfort, distended bladder | Bladder scan, encourage voiding, catheter if needed |
| Chest infection / atelectasis | Days 1–3 | Fever, rising RR, low SpO₂, cough | Deep breathing, early mobilisation, escalate |
| Wound infection | Days 3–7+ | Redness, heat, swelling, discharge, fever | Swab, escalate, antibiotics as prescribed |
| DVT / pulmonary embolism | Any time, often days later | Calf pain and swelling; sudden breathlessness, chest pain | Emergency escalation for suspected PE |
| Anastomotic leak / ileus (abdominal surgery) | Days 3–7 | Increasing pain, fever, distension, vomiting, no bowel sounds | Escalate |
| Delirium | Days 1–3, especially older adults | New confusion, agitation or drowsiness | Look for causes, escalate |
Fluids, eating and drinking
- Accurate fluid balance chart, including drains, NG output and urine.
- Aim for at least 0.5 mL/kg/hr urine output.
- Enhanced recovery (ERAS) programmes encourage early eating and drinking when safe, and stopping IV fluids early.
Wound and drain care
- Leave the original dressing in place for 48 hours unless leaking, as per local policy.
- Check drains are secure and patent, and record the volume and type of output each shift.
- Report sudden large increases in drain output, especially fresh blood.
Getting patients moving
Early mobilisation (sitting out and walking on the day of or day after surgery, where appropriate) reduces chest infections, clots, muscle loss and length of stay. Give VTE prophylaxis (anticoagulant injections, stockings or compression devices) as prescribed, and encourage leg exercises.
Related: SBAR handover · Sepsis Six · Catheter care
Based on NICE NG180 (Perioperative care in adults), Enhanced Recovery After Surgery (ERAS) principles and WHO surgical safety guidance. Educational content: follow surgical instructions and local policy.