Post OP care and complications Flashcards
What are the phases of postoperative care
Post Anesthesthetic Observation
Intermediate Phase
Convalescent Phase
Post Anesthesthetic Observation
taken to recovery room to make sure that everything is ok
What is the intermediate phase?
Hospitalization period
amount of time at the hospital
Primary Goal of the first 2 phases (post anestehsia and observatino)
Hemostasis
Pain Control
Prevention & early detection of complications
Convalescent Phase
Time from hospital discharge to full recovery
Time varies
Who is in charge of the patient from when they are asleep to awake?
anesthesiologists
monitor:
Vital Signs (HR, BP, RR, Temp)
Monitoring of EKG
O2 sat - maintain on supplemental oxygen as needed
Fluid monitoring (I&O ins and outs)
Mental status and neuro checks
Pain assessment (how would you rate your pain? You give meds based on pain level)
Usually ready for d/c from recovery room within an hour or 2
Unstable/intubated pts are transferred to the ICU for management
what happens from immediate to intermediate period?
Discharge from Recovery Room and transfer to hospital floor
Admit Orders
PostOp Note (Procedure Note)
Operative Report
What goes into admit orders?
Explains if you are admitted or under observation
Dx
Condition (stable/critical/guarded)
activity
vitals (how often you want them to be checked)
Diet (patient-dependent, any restrictions, liquids only)
IV Fluids (what type, typically NS)
Drains (surgical drain stuck in skin and pulled through how often you check it and what is in it)
I&O
Meds (patient dependent - often pain meds, DVT prophylaxis, GI prohpylaxis, chronic meds)
Allergies
Labs/imaging (typically trending - WBC and H&H)
monitors (based on patient presentation)
respiratory care (COPD, sleep apnea, respiratory therapist help)
Wound/dressing care and how often
Special instructions (if temp above X call me. If pain above X call me)
explain a drain
cut off scary sharp end
push air out
let go and it will pull out the blood/fluid in that area
Who dictates the POST-OP note
physician
What is in a post-op note?
Patient Name
Date/Time
Pre-op Dx (pelvic pain)
Post-op Dx (stage 2 endometriosis
Procedure
Surgeon
Assistant (PA)
Anesthesia (type)
Est. Blood Loss (EBL)
Urine Output
IVF
Findings (what we found)
Specimens
Drains (what kind of drain and how it was secured)
Complications
Disposition (to be admitted to the floor in satisfactory condition - all surgical counts were correct)
What is included in intermediate stage
wound care
drains
pulm care
fluid replacement
blood loss
pain control
GI tract
DVT prophylaxis
what do you do if a wound cannot be closed?
Use a wound back
During intermediate phase, what do you look at for drains?
Orders include how often to check drains and record output (typically every shift change)
Look for signs of infection, appearance of drain output
Typically removed in 3-5 days, once output diminishes (shows that there is not much more fluid to get rid of)
When does pulm function come back after surgery?
Remains markedly diminished for 12-14 hours postop
Slowly increases over next 5-7 days
Typically returns to baseline after 7 days
MC pulmonary risk of surgery and how to prevent
Atelectasis
Minimize risk with - incentive spirometry and early mobilization
When do yo uneed fluids?
Maintenance requirements
Extra needs due to systemic factors (fever, D/V, burns, etc.)
Losses resulting from drains, operative blood/fluid loss
Third space losses
How much maintanence fluids do you need during intermediate phase for a 75 kg?
4:2:1 rule for maintenance fluids
4x10 for the first 10kg
2x10 for the second 10kg
1x remain kg
example: 75kg
4x10 + 2x10 + 1x55 = 115mL/h x 24h =2,760mL
Fluid needs over the first 24 hours postoperatively are greater
What hemoglobins do you give packed RBCs for?
A Hemoglobin < 7 (in any patient) or < 8 in patients with cardiac, pulmonary, or cerebrovascular disease require blood transfusion
What is the conversion of 1 unit of RBCs for Hct and Hg?
General rule: 1 unit of RBC’s increase Hg by 1g/dL and Hct by 3%
how is pain managed for surgery?
subjective based on patient
MC post op pain control
Opioids, but others worse
IV and then switch to oral
NSAIDs also work (toradol MC)
What can be used for breakthrough pain (high pain)
IV morphine
What non-opioids can be used for surgery pain?
Avoid opiods if possible with:
Toradol
CElebrex
Tylenol
Gabapentin
Do we just use one pain med after surgery?
NO
can give based on location as well
wanna decrease the use of nacrotics
What can be used for local anesthesia?
Local Anesthesia
Intraoperative injection
Patches
Pain-ball (2 days of a numbing agent like lidocaine)
When are spinal/epidurals typically used?
If surgery led to >5 rib fractures
for big surgeries
When are nerve blocks typically used?
typically in extremeties
What is often given for GI tract?
Stool softener (Miralax or Colace) to minimize constipation
Zofran for antiemeics
What mechanical methods do you use for DVT prophylaxis?
compression stockings/ SCDs
early ambulation
What chemical prophylaxis do you use for DVT?
Lovenox (LMWH) or SQ Heparin
If a patient has an immediate fever (<24 hours), what do you do?
Evaluate and look at wound (can be normal)
transfusion reaction?
infection?
If a patient has an fever in a week what is it?
Acute
Subacute fever
1-4 weeks
Delayed fever
> 1 month, likely a viral infection
5 W’s of acute fever
Wind (PNA, CXR)
Water (UTI)
Wound (look at the wound with CT scan)
Walking (is there a clot? DVT/PE?, depends on how they present)
Wonder drugs (medications, blood products, dx of exclusion)
