Postoperative care on the ward: the first 24–48 hours
- Safe practice
On the ward the nurse helps the patient breathe deeply, move early, control pain and eat again, while watching for early signs of complications.
What it is
When the patient arrives from the recovery unit, the ward nurse continues monitoring and starts active recovery. The first 24–48 hours combine regular observation (vital signs, saturation, consciousness, pain, wound, drains, intake and output) with actions that prevent complications: deep breathing, coughing and incentive spirometry, getting out of bed and walking as soon as possible, early drinking and eating when ordered, removing urinary catheters early, and multimodal pain control that allows the patient to move. Older adults also need prevention of delirium. Deterioration is escalated early using the early warning score.
What it requires
- Early mobilisation is a strong recommendation of enhanced recovery guidelines.
- Bed rest brings muscle loss, poorer lung function and a higher risk of thromboembolism.
- Atelectasis after abdominal or chest surgery is mainly caused by shallow breathing due to pain and immobility.
- Routine urinary catheters are avoided or removed as soon as the patient can void, ideally within 24 hours in the hip and knee consensus.
Components
- Monitoring: vital signs and early warning score, saturation, consciousness, pain, wound and drains, intake and output.
- Prevention: breathing exercises, mobilisation, mechanical and drug VTE prevention as ordered, skin care.
- Comfort: pain and nausea control, rest and sleep.
- Recovery: early nutrition, catheter and drain removal as ordered, discharge teaching.
How it is applied (and why)
- Receive the handover and check airway, breathing, saturation and consciousness on arrival: the ward sets its own baseline.
- Measure vital signs and score the early warning scale at the ordered interval: trends show deterioration early.
- Assess pain with a scale and give ordered analgesia before activity: controlled pain allows breathing and moving.
- Help with deep breathing, supported coughing and incentive spirometry each hour while awake: this prevents atelectasis.
- Sit the patient up and walk them as soon as allowed, with help: mobility prevents clots, pneumonia and weakness.
- Apply the ordered VTE prevention (stockings, compression, medicines): surgery and immobility raise clot risk.
- Check the dressing and drains and record output: bleeding or leaks are found early.
- Record intake and output and the first void; remove the catheter early as ordered: this prevents retention and infection.
- Restart drinking and eating as ordered and watch for nausea: early feeding supports recovery and bowel function.
- Keep the patient oriented, with glasses, hearing aids, sleep and family: this helps prevent delirium in older adults.
In nursing practice
- A patient who will not move because of pain needs a pain review, not more bed rest.
- Drowsiness with slow breathing after opioids is an emergency: stimulate, check saturation and call.
- Teach before discharge: wound care, warning signs, activity limits and who to contact.
- Escalate early with the early warning score; see the page on postoperative complications.
Common mistakes
- Keeping the patient in bed «to rest» without a medical reason.
- Giving incentive spirometry to the patient without checking that it is used.
- Measuring pain without acting on the result.
- Leaving the urinary catheter in place «just in case».
- Missing quiet, sleepy confusion in an older adult (hypoactive delirium).
Test yourself
Think of the answer, then tap the question to see it.
Why is early mobilisation encouraged after surgery?
Because bed rest causes muscle loss, poorer lung function and a higher risk of thromboembolism; walking early helps prevent these problems.
How often is incentive spirometry usually done after surgery?
About 10 breaths an hour while the patient is awake, as ordered, with the nurse checking that it is done correctly.
Why is pain treated before mobilising or doing breathing exercises?
Because uncontrolled pain causes shallow breathing and stops the patient from moving, which favours atelectasis and other complications.
Which measures help prevent postoperative delirium?
Early mobilisation, adequate sleep, orientation with glasses and hearing aids, family support and a calm, familiar environment.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations (Acta Orthopaedica, open access (Europe PMC), 2020); Nursing Skills, 11.2: Basic concepts of oxygenation (Open RN, Wisconsin Technical College System (LibreTexts copy), 2021); Postoperative pulmonary complications: clinical and imaging insights (Balkan Medical Journal, open access (Europe PMC), 2025); Postoperative delirium in elderly orthopedic patients: a narrative review of prevention and multidisciplinary nursing intervention (Frontiers in Psychiatry, open access (Europe PMC), 2026).
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Representative model, for educational purposes only.