Post op care Flashcards
What are some questions to ask on a post op ward round?
- are the patients progressing as expected given their operation, comorbidities and age?
- have patients developed complications?
- how can we prevent these cx?
- is the patient feeling well?
- is nutritional and fluid intake adequate?
- is there a return of normal body functioning?
- is the anaglesia adequate?
What are some examples of nutrition post op?
- multivitamins
- high calorie and protein drinks
- nasogastric feeding
- total parental nutrition
What is the traget level for urine output post op?
- UO >30mL/hr
- or >1/2mL/kg/hr
What should you do on day 1 and day 2 regarding a patients fluid balance?
- Day 1: increased ADH but dont give excessive fluids
- day 2: mobilisation shifts fluid form interstitium back into intravascular space therefore in anticipation of this decreased IV fluid rate
What should you do regarding the fluid balance in a patient with low urine output?
- if anuric, check for blocked IDC
- assess patient for hypovolaemia
- ensure patient is not bleeding
- give a fluid challenge (500mL - 1L crystalloid)
What are some strategies to prevent complications post op?
- mobilisation (aim is for out of bed and walking by day 2)
- chest physiotherapy
- VTE prophylaxis: mechanical and chemical
- adequate analgesia
- adequate nutrition and fluids
How can you relate the days post op to the cause of a fever?
- Day 1: usually drug fever
- Day 3: lungs
- Day 5+: infection (UTI, surg site), leaks, DVT/PE
What does a septic screen consist of?
- CXR, MSU, blood cultures
What are some causes of post op confusion?
- hypoxia
- atelectasis
- chest infection
- over sedation/narcotics
- CCF
- MI
- PE sepsis
- chest
- urine
- wound
- intraabdoninal (bile leak)
- meds
- opiates
- sedatives
- DTs
- metabolic
- ureaemia, hyponatraemia
- hypo or hyper glycaemia
What are some causes of post op vomiting?
- post op ileus
- small bowel obstruction
- ischaemic or infarcted segment of bowel
- gastric dilatation
- drugs/narcotics
What are some causes of post op fever?
- wound infection
- pelvic abscess
- UTI
- pneumonia
- DVT/PE
- drip site infection
- transfusion reaction
- meds
- brain stem disease
- MI
- gout
Describe where a PICC line is inserted, how long for and cx of it?
- placed by radiology under US control into basilic vein in upper arm
- can use for total parenteral nutrition or other infusions
- almost equivalent to CVC risk
- venous thombosis of basilic vein
- can be used for weeks
Describe where a central venous catheter is inserted, how long for and cx of it?
- place into IJV or subclavian vein with tip in SVC
- insert in theatre or recovery
- can leave in for 5-21 days (AB impregnated) risk
- immediate=pneumothorax, arterial puncture, haematoma
- later= thrombosis, stenosis, sepsis
Describe where a vascath is inserted, how long for and cx of it?
- vascath= temporary catheter used for haemodialysis
- local anaesthetic needed
- use IJV or femoral vein (NOT SUBCLAVIAN)
- leave in for max 5 days
- US control to insert is optimal
Describe where a permacath is inserted, how long for and cx of it?
- long term catheter for haemodialysis
- has a dual lumen
- place in IJV or EJV
- tunnelled cuffed catheter to prevent infection and displacement risk
- infection
- blockage
- can replace them
