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POSTOPERATIVE CARE

POSTOPERATIVE CARE. DR/FATMA AL-THUBAITY SURGICAL CONSULTANT ASSISSTANT PROFESSOR. Objectives. Understand the principles of patient management in the recovery phase immediately after surgery. Understand the general management of the surgical patient on the ward.

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POSTOPERATIVE CARE

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  1. POSTOPERATIVE CARE DR/FATMA AL-THUBAITY SURGICAL CONSULTANT ASSISSTANT PROFESSOR DR/FATMA AL-THOUBAITY

  2. DR/FATMA AL-THOUBAITY

  3. Objectives • Understand the principles of patient management in the recovery phase immediately after surgery. • Understand the general management of the surgical patient on the ward. • Consider the initial management of common acute complications during the postoperative period. DR/FATMA AL-THOUBAITY

  4. Immediate postoperative care (recovery phase). • Care on the word until discharge from hospital. • Continuing care after discharge. DR/FATMA AL-THOUBAITY

  5. The Recovery Phase • Airway and breathing. • Circulation. • Fluid balance. • Core temperature. • Blood sugar monitoring. • ECG monitor. • Distal perfusion monitoring. DR/FATMA AL-THOUBAITY

  6. Neurological observation. • Catheter output. • Pulse oximeter versus arterial blood gas. DR/FATMA AL-THOUBAITY

  7. DR/FATMA AL-THOUBAITY

  8. CARE ON THE WARD • Monitor the patient progress at least daily postoperative & more frequently if indicated.record in the notes at least daily. DR/FATMA AL-THOUBAITY

  9. Detailed operation note. • Monitoring of vital signs. • Early mobilization. • Diet. • Intravenous fluids. • Intake/output chart. • Urinary output. • Medication. • Laboratory tests. • Radiographs & ECG. DR/FATMA AL-THOUBAITY

  10. progress • General condition. • Vital signs. • Mobility. • Chest. • Abdomen. • Legs. • Wounds. • Intake/output. • Diet. • Result of any laboratory tests. DR/FATMA AL-THOUBAITY

  11. Surgical drains • Nasogastric tube. • Chest drain. • Drains at the operative site. DR/FATMA AL-THOUBAITY

  12. Day case surgery DR/FATMA AL-THOUBAITY

  13. Postoperative complication • Haemorrhage. • Wound. • Cardiovascular. • Lung. • Cerebral. • Urinary. • Gastrointestinal. • Others. DR/FATMA AL-THOUBAITY

  14. Airway obstruction • Obstruction by the tongue. • Obstruction by foreign bodies. • Laryngeal spasm. • Laryngeal oedema. • Tracheal compression. • Bronchospasm. DR/FATMA AL-THOUBAITY

  15. HAEMORRHAGE • Early • Secondary DR/FATMA AL-THOUBAITY

  16. HYPOVOLEMIA • Unreplaced blood loss. • Loss of fluid into the gastrointestinal tract. • Loss of plasma into the wound or abdomen. • Sequestration of extracellular fluid into the third space. DR/FATMA AL-THOUBAITY

  17. Wound problems • Infection. • Wound breakdown. • Burst abdomen. • Incisional hernia. • Anastomotic breakdown. • Haematoma. • Seroma. • Stitch sinus. DR/FATMA AL-THOUBAITY

  18. Cardiovascular problems • Cardiac arrest. • MI. • Pulmonary oedema. • Arrhythmias. • DVT. DR/FATMA AL-THOUBAITY

  19. Lung problems • Atelactasis. • Aspiration pneumonitis (Mendelson s syndrome. • Pneumonia. • Pulmonary oedema. • Pulmonary embolus. • Pneumothorax. • ARDS. DR/FATMA AL-THOUBAITY

  20. Causes of ARDS • Infection. • Inhalation. • Embolism. • Cerebral. • Drugs. • Others. DR/FATMA AL-THOUBAITY

  21. Cerebral problems • Confusion(sepsis,hypoglycemia,hypoxia & alcohol withdrawal). • Stroke DR/FATMA AL-THOUBAITY

  22. Urinary tract problems • Acute retension. • Urinary tract infection. • ARF. DR/FATMA AL-THOUBAITY

  23. Gastrointestinal problems • Paralytic ileus. • Mechanical obstruction. • Gastric dilatation. • Constipation. DR/FATMA AL-THOUBAITY

  24. Postoperative pain relief • Parenteral analgesia. • Spinal opioids. • Intercostal nerve blocks. • Direct infiltration. DR/FATMA AL-THOUBAITY

  25. Parenteral analgesia • Intermittent intramuscular opiates. • Continuous subcutaneous of opiates. • Continuous I.V.infusion of opiates. • PCA pump. DR/FATMA AL-THOUBAITY

  26. Complications of blood transfusion • Incompatibility. • Febrile reactions. • Allergic reactions. • Infection. • Massive transfusions. DR/FATMA AL-THOUBAITY

  27. DR/FATMA AL-THOUBAITY

  28. SUMMARY • Postoperative care is divided into three phases. • The recovery phase is the immediate care of patients after surgery until they can maintain all vital functions independently. • The second phase is care on the word,during which the three most important general considerations are pain control,fluid balance management and nutrition. • The third phase of care follows discharge from hospital. DR/FATMA AL-THOUBAITY

  29. The intensity of monitoring in the postoperative phase depends on the severity of disease or the nature of surgery. • Good communication is essential throughout postoperative care to ensure the best outcome. DR/FATMA AL-THOUBAITY

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