Postoperative patient management Flashcards
- Patients have more — concerns about the sequelae of surgery (pain,
swelling) than about the procedure itself
preoperative
- Give adequate and complete post-operative instructions to patient and patient’s ride (if
present)
(3)
- Verbal & Written forms
- In lay terms (easier understood)
- Give most common post-op sequelae and how to manage
- Regarding IV sedation patients: instructions given
prior to appointment, and also given to
ride/escort (should have one since patient is receiving sedation)
CONTROL OF POSTOPERATIVE HEMORRHAGE
* Placement of gauze over socket (4 cm x 4 cm rolled into 1cm x 1cm x 2 cm shape)
- Do not cover occlusal surface of adjacent teeth
- No pressure applied to extraction site
- Slightly moistened
- Coagulated blood can adhere to dry gauze
- When gauze is removed it will remove clot
- Firm pressure for at least 30-45 min (I tell pts one hour)
- Take advantage of patient being numb, once local wears off it will be painful to bite on gauze
- Remove and throw away after 1 hour, if pack is pink in color
CONTROL OF POSTOPERATIVE HEMORRHAGE
* Patients should be told they might expect mild continual oozing over next 24 hours
- A small blood spot on the pillow is normal (~ size of a quarter)
- Warn the patient that a small amount of blood will mix with saliva and appear to be a lot
more - If continued oozing after removal of gauze (45min – 1 hour later), patient should reapply gauze
that is provided to them on discharge (advising to use slightly wet gauze) - Again bite firm pressure for another 1 hour
- If still oozing after removal of second gauze pack, patient can bite on tea bag for another 1
hour - Directions: boil tea bag, remove from hot water to cool, wrap in gauze, bite hard 1 hour
- Tannic acid is a local vasoconstrictor and pro-coagulant
CONTROL OF POSTOPERATIVE HEMORRHAGE
* Patients should avoid things that aggravate bleeding
(2)
- Smoking (avoid for at least 24 hours if possible)
- Nicotine interferes with wound healing
- The pull of the cigarette/pipe/cigar causes negative pressure, potentially pulling the clot
out of the socket
CONTROL OF POSTOPERATIVE HEMORRHAGE
* No other changes in pressure inside the mouth
(4)
- No sucking through straw → negative pressure change
- No spitting → negative pressure change
- No blowing nose against closed mouth → positive pressure change can push clot out
- No stopping sneeze → positive pressure change
- Okay to sneeze, but keep mouth open to allow air escape
- When should patients get concerned?
(3)
- If bright red blood fills the mouth in matter of minutes
- If there is a large liver clot present over socket
- Most often darker in color, but can be bright red
- What should patients do if concerned?
(2)
- Call surgeon to schedule return visit as soon as possible
- If no ability to contact someone affiliated with the clinic, might
need to go to Emergency Room
All patients will experience some sort of — after any surgical procedure
discomfort
It is the job of the surgeon to:
(2)
- Give the patient a realistic expectation of what type of pain may occur
- Correct misconceptions of how much pain is likely to occur
Amount of pain after extraction is highly variable, and depends in part on the patient’s
preoperative expectations
* Thus, surgeons who spend time — to the procedure to discuss these issues can create the most
appropriate analgesic regimen
* Also, can catch potential problems after
prior
extraction → think about the opioid addiction patient population
ALL patients receive instructions concerning analgesics before they are discharged
- Even if no narcotics are written for patient, they should be advised to take Ibuprofen and
Tylenol (!! if they are able, remember patients with gastric ulcers as well as kidney and liver disease patients !!), and
how the patient is to take each medication as well as the amount in milligrams.
Higher expected levels of pain might necessitate
narcotic prescriptions
* i.e. - surgical extraction or entire quadrant extraction
Advise the patient that complete resolution of pain is not the goal,
the reduction of
pain to be able to perform ADLs (activities of daily living) is the goal
* About 3-5 out of 10 on the pain scale