Care of Surgical Patient 2 Flashcards
What are the 4A’s for postoperative care?
anticoagulants
analgesia
antiemetics
antibiotics
How can VTE be prevented?
LMWH
- treatment dose
-LMWH for 10days followed by aspirin (75or 150mg) for a further 28days.
- LMWH for 28days combined with anti-embolism stockings (until discharge).
Ted stockings
pneumatic compression devices - intermittent pneumatic compression (IPC) devices are used to help prevent blood clots in the deep veins of the legs. The devices use cuffs around the legs that fill with air and squeeze your legs. This increases blood flow through the veins of your legs and helps prevent blood clots.
mobilisation and hydration - the earlier the better
What is extended prophylaxis? When is it used?
Thromboprophylaxis extended after hospital discharge is effective for reducing the composite of major or fatal thromboembolic outcomes
total hip replacement
- LMWH for 10 days then aspirin for 28 days
- LMWH for 28 days with antiembolism stockings
- DOACs = rivaroxaban, apixaban
What is the aim of post operative pain management?
facilitate recovery
reduce morbidity
early hospital discharge
improve quality of life
What is the analgesia ladder for surgery?
start at the top and de-escalate
Step 3 - opioids for moderate to severe pain + non-opioids +/- adjuvant analgesic
Step 2 - opioid for mild to moderate pain + non-opioids +/- adjuvant analgesic
Step 1 - non-opioid +/- adjacent analgesic
What are the side effects of opioids and how can they be managed?
constipation - proactive laxative use = Senna or macrogol
nausea/vomiting - antiemetic = ondansetron
itch/rash - antihistamine = chlorphenamine
dry mouth - increase fluid intake or artificial saliva
drowsiness/sedation - dose adjustment or opioid rotation
respiratory depression - administer naloxone
What are adjuvant analgesics?
weak/non-analgesic action when administered alone
- enhances analgesics action when administered along with other analgesics
- used for pain poorly responsive to opioids (neuropathic) or for an opioid sparing effect
amitriptyline, gabapentin, pregabalin, ketamine
Why does nausea and vomiting occur post operative?
opioid side effects
anaesthetic side effects
What are the risk factors for post op nausea and vomiting?
being female
being a non-smoker
use of peri-operative analgesia
inhalation anaesthetics
Who should not take metoclopramide and why?
patients on Parkinson’s medicines
young people
pregnant people
can cause extrapyramidal disorders and tar dive dyskinesia
When are antibiotics needed for surgery?
to prevent surgical site infections when implants are being inserted - pacemaker or total hip replacement
in MRSA colonisation, add vancomycin
What is enhanced recovery?
Recovery is an evidence-based approach that helps people recover more quickly after having major surgery
Research shows that the earlier a person gets out of bed and starts walking, eating and drinking after an operation, the shorter their recovery time will be.
What are the reactive triggers for a structure medicine reviews?
crisis or incident
- unplanned hospital admission with the medicine regimen being a possible contributing factor
personal concerns
- about the amount of medicines or what medicine being taken
professional referral
- a health care professional is concerned about the number of medicines being taken
request for a monitored dosage system as an aid for managing multiple medicines
What is an alternative post operative analgesia? What are its side effects? What can its use impact?
epidural infusions
- Hypotension
- Urinary retention
- Motor weakness
impacts the use of anticoagulants
What are common side effects of opioids?
sedation
respiratory depression
nausea and vomiting
ileus
urinary retention
pruritus
