MISC - Post op care Flashcards
How would you examine a post op pt?
- Vital signs - ABCD
- Fluid balance – including urine output
• Output for any drains
–content and volume
–Can they be removed?
• Examine operative site
– are these findings expected?
• Examine anywhere else of concern – related to operation?
What drugs do you normally expect to see in a post op pt?
• VTE prophylaxis
• Does patient still need these medications?
–Antibiotics
–Analgesia
• Are other medications needed? –Analgesia –Aperients –Antiemetics –Regular medications
How (4) can you treat the inadequate intake of nutrition post op?
- multivitamins
- High-calorie and protein drinks
- Nasogastric feeding
- Total Parenteral Nutrition
How can you examine fluid balance of a patient?
• Urine Output
– measure of tissue perfusion
– maintain UO >30mL/hr or >0.5mL/kg/hr
– beware in CCF and renal impairment
• What fluids are running?
– Replacement vs maintenance fluids (typically 12/24-8/24)
- Critical for major abdominal surgery, especially GI
- Consider total daily balance – does not count insensible losses
What other than urine output can you rely on for fluid balance?
– Consider HR, BP, JVP
• Difficult assessments: use daily weight, compare with preoperative weight
• Be wary of frusemide use
Why should you not give excessive fluids post op day 1?
• Day 1: increased ADH, do not give excessive fluids
What do you anticipate for fluid balance in post op day 2?
• Day 2: mobilisation often shifts fluid from interstitium back into intravascular space
– Decrease IV fluid rate in anticipation
Low urine output
- signs
- Rx
• If anuria, check for blocked IDC • Assess patient for hypovolaemia • Ensure patient is not bleeding • Give fluid challenge –500mL to 1L stat crystalloid
(4) What are the complications of immobilisation due to pain post op etc?
- pneumonia
- DVT/PE
- atrophy
- pressure sores
How would you adequately give analgesia for post op pt?
- WHO analgesia ladder
- Patient-Controlled Analgesia
- Regional
- Spinal
- Epidural
- Acute Pain Service
How can you prevent Cx post op in general?
- Mobilisation: aim for out of bed and walking by day 2
- Chest physiotherapy
- VTE prophylaxis: mechanical and chemical
- Adequate analgesia
- Adequate nutrition and fluids
Give DDx for post op fever causes depending on the days post op.
- Day 1: usually drug fever
- Day 3: lungs (pneumonia)
- Day 5+: infection: urinary tract, surgical site; leaks; DVT/PE
What should you check in a post op fever pt?
– Symptoms
– Vitals – any tachycardia or hypotension?
– lungs, surgical site, all lines, calves, urine dipstick
– inflammatory markers
•Septic Screen: CXR, MSU, Blood cultures
How (3) do you do a septic screen?
CXR, MSU, Blood cultures
How do you treat a wound infection (over closed staples)?
Consider opening suture line over infected area
–Drain underlying abscess
–Swab for MCS
–Heal by secondary intent
–Antibiotics