20.) Preoperative And Postoperative Cares In Gynecology Flashcards
What are the main goals of preoperative evaluation in gynecology?
The primary goals are to:
- Assess the patient’s overall health status.
- Identify and mitigate risks associated with surgery.
- Prepare the patient’s body to handle the physiological stress of surgery.
What is the General Adaptation Syndrome, and what are its stages in response to surgical stress?
General Adaptation Syndrome describes the body’s response to stress, including surgery.
Stages:
- Alarm stage: Initial response with increased cortisol, aldosterone, and ADH, leading to higher blood glucose, water/sodium reabsorption, decreased urine output, and lowered potassium.
- Resistance stage: Stabilization, where heart rate, blood pressure, and hormone levels normalize.
- Exhaustion stage: The body’s resources are depleted, potentially leading to severe complications, especially in high-risk patients (elderly, smokers, obese, etc.).
What components are included in the preoperative evaluation?
Preoperative evaluation consists of:
- Medical history: Current illness, past medical history etc
- Physical examination: Head-to-toe check, local examination, hemodynamic assessment, respiratory and neurologic evaluation, and a pelvic exam.
- Laboratory tests: Complete blood count, blood chemistry (RFT, LFT), urinalysis, X-ray, ECG.
What is the purpose of antibiotic prophylaxis and anticoagulant management preoperatively?
Antibiotic prophylaxis reduces the risk of surgical site infections, while managing anticoagulants helps prevent excessive bleeding during and after surgery.
Examples : 1st gen cephalosporin (Cefazolin)
Also Low mol weight heparin
What are the primary post-operative care steps immediately after surgery?
Key post-operative assessments include:
- Airway: Ensure it is clear and patent.
- Breathing: Monitor respiratory rate, rhythm, and oxygen levels.
- Mental status: Assess level of consciousness and orientation.
- Surgical site: Check dressing, drains, and incision for bleeding or infection.
- Vital signs: Regularly monitor blood pressure, heart rate, and temperature.
- Intravenous fluids: Maintain hydration and monitor IV site.
- Other tubes: Assess Foley catheter, NG tube, and other devices for proper function.
What are common complications after gynecological surgery?
Common post-op complications include:
- Respiratory issues: Atelectasis, pneumonia.
- Cardiovascular complications: Hypotension, arrhythmias.
- Skin complications: Infection, poor wound healing.
- Gastrointestinal issues: Ileus, constipation.
- Neuromuscular complications: Weakness, nerve damage.
- Renal/urinary problems: Urinary retention, electrolyte imbalances, acute renal failure.
What is hemoperitoneum, and why is it significant post-operatively?
Hemoperitoneum is bleeding into the peritoneal cavity, a leading cause of shock within 24 hours post-surgery. It may result from poor wound closure, suture issues, or intra-abdominal pressure increases. It requires prompt detection and management to prevent shock and organ failure.
What causes urinary retention post-operatively, and how is it managed?
Post-operative urinary retention can result from anesthesia, decreased renal function, or pain. It is managed with catheterization to relieve retention and monitor output until normal function resumes.
Normal urine output per day = 800-2000ml
What criteria indicate a patient is ready for discharge after gynecological surgery?
Discharge criteria include:
- Controlled pain.
- Stable vital signs.
- No excessive bleeding or drainage.
- Adequate oral intake.
- Ability to ambulate ( walk)
- Understanding of emergency instructions, follow-up care, hygiene, wound care, and medications.
What are the essential follow-up instructions for a patient after gynecological surgery?
Key instructions include:
- Pain management: Take prescribed pain medications as directed.
- Wound care: Keep the incision site clean and dry.
- Activity limitations: Avoid heavy lifting and strenuous activities.
- Diet and hydration: Maintain a balanced diet and adequate hydration.
- Signs of complications: Look out for symptoms of infection, excessive pain, or unusual discharge, and seek medical help if they occur.
