GI Post-Op Nursing Flashcards
What are the possible immediate post-op complications (hours)?
Physiological abnormalities worsening (hypothermia etc.)
Pain
Haemorrhage
Drug/anaesthetic reaction
Vomiting/regurgitation
Trauma/increase in abdominal pressure, causing acute wound breakdown
What are the possible long-term post-op complications (days)?
Pain Haemorrhage Aspiration pneumonia Ileus Infection of wound or interference
Describe skin/cutaneous dehiscence.
Seen immediately post-op if trauma occurs, up to several weeks later
Usually 4-5 days post-op
Clinical signs = serosanguinous/prurulent discharge from suture line, swelling and bruising/necrosis of edges
Describe abdominal wall dehiscence.
Dehiscence of abdominal muscles underneath wound, essentially creating a hernia
Overlying skin remains intact but deeper layers have separated
Usually within first 7 days (but can be weeks or years after surgery)
Clinical signs = wound oedema/inflammation, serosanguinous drainage from incision, painless swelling
Describe intestinal dehiscence.
Dehiscence after enteric suture leads to septic peritonitis
Usually occurs within 2-5 days post-op
Clinical signs = depression, anorexia, vomiting, abdominal pain, acute collapse
What are the risk factors for dehiscence?
Surgical technique Self-trauma Underlying neoplasia of area Closure of non-viable skin Systemic factors (endocrine disease, obesity, hypoproteinaemia/hypovolaemia etc.)
How can we prevent dehiscence?
Bandaging to immobilise areas of excessive motion
Elizabethan collar to prevent self-trauma
Animal confined and exercise-restricted for 2 weeks
What are the two types of secondary peritonitis?
Aseptic = mild reaction to surgery itself, or if a sterile object is left in Septic = most common type seen in small animals, contamination during surgery
Why does peritonitis occur?
Dehiscence, ischaemic necrosis, leakage during surgery, insufficient lavage, infection through technique, leaving something in the patient
Emergencies - non-ideal pre-op prep, faecal matter/fluid/food present in intestines resulting in contamination
How does peritonitis present?
Vague history of anorexia, vomiting/lethargy, pyrexia or acute collapse
May adopt prayer position
Rarely large volume of effusion so cannot rely on abdominal distension
3-5 days post-op most likely time to present - close monitoring!
What problems can we see in the oesophagus?
Regurgitation
Oesophagitis
Strictures - post-op due to damage to mucosa that scars as it heals
What problems can we see with the stomach?
Vomiting Anorexia Ulceration Gastric outlet obstruction (e.g. strictures at pylorus) Pancreatitis
What gastric surgeries are common in first opinion?
Gastrotomy - foreign bodies
GDV - gastropexy
What problems can we see with the small intestine?
Excessive handling/rough technique = serosal/peritoneal adhesions Ileus Perforation Stenosis (constriction of lumen) Intestinal strictures (rare) Diarrhoea Anorexia
What small intestinal surgeries are common in first opinion?
Enterotomy - foreign body
Enterectomy - following foreign body or intussusception
What problems can we see with the large intestine?
Haemorrhage and faecal contamination during surgery Leakage Strictures Stenosis Incontinence (rare)
What problems can we see with the perineum, rectum and anus?
Tenesmus Rectal prolapse Temporary/permanent incontinence Anal stricture Urethral obstruction Stenosis
What rectal surgeries are common in first opinion?
Anal sacculectomy (removal of one/both anal sacs)
What are the key things to monitor post-GI surgery?
Depression Pyrexia Abdominal tenderness Vomiting Anorexia Wound
What are the aims of a post-op care plan?
Restore hydration, maintain electrolyte status Resume normal feeding and gut motility Manage GI effects e.g. nausea Manage pain Prevent infection
How do we manage hydration?
Most require fluids post-op until eating/drinking a normal amount
Especially important if biochemical/electrolyte abnormalities or ongoing fluid losses
Monitor for over-hydration - MMs, skin tent, crackles on auscultation
May be necessary to monitor fluid inputs and outputs
How do we manage nutrition?
Intestinal/rectal/anal surgery patients encouraged to eat ASAP
Gastric/oesophageal start with water 2hrs post-op, then food attempted 12hrs later (risk of vomiting)
Bland diet, high calorie, little and often
Encourage patients to be ambulatory to help gut motility
Feeding tube - own complications but great for ensuring nutrition
Cats particularly reluctant to eat!
How do we manage nausea?
Signs = salivation, repeated swallowing, lip-licking
Useful drugs = maropitant, metoclopramide, ranitidine, sucralfate, omeprazole
What drugs may be useful post-GI surgery?
Prokinetic agents (metoclopramide) to manage ileus Probiotics, fibre products useful for diarrhoea Appetite stimulants (mirtazapine) useful in cats
How can we manage pain?
NSAIDs - case basis, can cause ulceration/GI upset
Opioids - often used, may effect gut motility so weigh up when to wean off and move to alternative analgesia for going home
(Codeine, Paracetamol (dogs only!!), Tramadol)
How do we manage infection?
Antibiotics most likely given peri-operatively
Discontinues 6-12hrs post-op, unless contaminated surgery/systemic illness
Broad spectrum e.g. amoxy-clavulanic acid
