Post-op colic care Flashcards
1
Q
What basic requirements. post colic surgery?
A
- Analgesia - fluxinin
- Fluid therapy - isotonic fluids CRI
- Monitor c/v status Hr PCV TP membranes
- Protect surgical site :belly bandage
- Manage iv catheters
- Gut motility
2
Q
How to monitor for signs of gut motility?
A
- US
- HR & PCV
- Gastric reflux
- Auscultation
- Faeces
3
Q
How do we restore gut motility?
A
- Mov, gentle walking
- Oral fluids & food (fluids by mouth after 12 hrs & offer small amounts of feed early 12-24hrs post op
- BEWARE: average time to onset of ileus is 24hrs
4
Q
Why are post-op complications important?
A
- Discomfort
- Prolonged hospitalisation
- Expense
5
Q
Causes of post-op colic (50% of complications) ?
A
- Blockage of anastomosis
- Ileus
- Adhesions
- Displacement
- Failure of adaptation?
- INC risk following large colon volvulus
6
Q
Describe surgical site infections?
A
- Painful
- Inc risk of hernia formation
- Prolonged hospitalisation
7
Q
incisional herniation risk factors?
A
- Wound suppuration
- HR at admission
8
Q
How to avoid incisional hernias?
A
- Avoid wound infection
- Box rest 8 weeks
- Paddock rest 8 weeks
- Use belly band
- Use hernia belt
9
Q
Post op ileus epidemiology?
A
- Prevalence 10-20%
- 80% of cases survive
- Average time to onset 24hrs
10
Q
CLS of ileus?
A
- Dull & depressed
- Inc HR, PCV, TP
- Gastric reflux
11
Q
US of SI?
A
goof to see gut motility
12
Q
Risk factors to post-op ileus?
A
- PCV (endotox, fluid into SI leading to distention)
- Pedunculated lipoma strangulation
13
Q
Management of post-op ileus?
A
- Decompression
- i/v fluids
- walk out in hand
- Prokinetic drugs?
14
Q
What prokinetic agent can we use?
A
MEtaclopramide
15
Q
Describe metaclopramide
A
- 5-HT receptor agonist and dopaminergic antagonist
- Experimental and pharmacological rationale
- Narrow therapeutic window -> if you give too much starts circling (neuro signs)
