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PRE-OPERATIVE & POST- OPERATIVE CARE Begashaw M (MD)

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Presentation on theme: "PRE-OPERATIVE & POST- OPERATIVE CARE Begashaw M (MD)"— Presentation transcript:

1 PRE-OPERATIVE & POST- OPERATIVE CARE Begashaw M (MD)

2 General consideration General medical & surgical history Complete P/E  Lab: _Complete blood count _Blood typing & Rh-factor, crossmach _Urinalysis _Chest x-ray

3 Assessment Cardiovascular System Pulmonary system Renal system Hematologic system Endocrine system

4 Cardiovascular System  Heart disease  high-risk chest pain, dyspnea, pretibial edema or orthopnea Recent history of CHF Recent MI Severe hypertension DVT

5 Pulmonary system  High risk: Upper airway infections Pulmonary infections Chronic obstructive pulmonary diseases  chronic bronchitis, emphysema, asthma  Elective surgery should be postponed

6 Renal system  Renal function test: -history of kidney disease -diabetes mellitus -hypertension -over 60 years of age -proteinuria, casts or red cells  creatinine clearance, blood urea nitrogen and electrolyte

7 Haematological system  Anemia affects the oxygen carrying capacity of the blood Iron deficiency Megaloblastic Hemolytic Aplastic anemia  Patients with iron deficiency anemia respond to oral or parenteral iron therapy

8 Thrombocytopenia  Normal platelet  150,000 to 450,000/ml  Manifestations: Petechia Epistaxis Menorhagia Uncontrolled bleeding  Treatment -treat the underlying cause -support with platelet transfusions & clotting factors

9 Diabetes mellitus  poorly controlled DM -susceptible to post- operative sepsis In type - II patients-avoid hypoglycemia not use longer acting oral hypoglycemic agents -2 days before operation Insulin dependent diabetics with good control- sliding scale Chronic cxs - Hypertension, myocardial ischemia which may be silent-proper workup & treatment

10 Thyroid disease Elective surgery should be postponed when thyroid function is either excessive or inadequate In Hyperthyroidism, the patient should be rendered euthyroid before surgery  may take up to 2 months with anti-thyroid medications

11 Post-operative care is care given to patients after an operation in order to minimize postoperative complications Early detection & treatment of post operative complications

12 Post-operative care Aims: Comfortable, pain free recovery from operation – Immediate  recovery room – Intermediate  ward – Long term  home

13 Immediate care a. Vital sign b. Chest auscultation c. Input and output monitoring d. Checking for bladder & abdominal distention e. Potent analgesics for pain relief

14 On subsequent post-operative days a. Oral intake can be started b. Patients encouraged to ambulate

15 Post Op Complications General Immediate 1. Primary hemorrhage 2. Reactive hemorrhage 3. Basal Atelectasis 4. Minor lung collapse 5. Shock 6. Blood loss 7. MI, Pulmonary Embolism 8. Low Urine Output

16 Cardiac complications 1. Abnormal ECG 2. Acute MI 3. Arrhythmia 4. Pulmonary embolus

17 Shock Postoperative efficiency of circulation depends on blood volume, cardiac function, neurovascular tone Shock:  Excessive blood loss  Third spacing  Marked peripheral vasodilatations  Sepsis  Pain or emotional stress

18 Treatment  Arresting hemorrhage  Restore fluid & electrolyte balance  Correct cardiac dysfunction  Establish adequate ventilation  Control pain & relief apprehension  Blood transfusion if required

19 Thrombophlebitis  Superficial thrombophlebitis -within the first few days after operation  Clinical features A segment of superficial saphenous vein becomes inflamed manifested by: Redness Localized heat Swelling Tenderness

20 Treatment  Warm moist packs  Elevation of the extremity  Analgesics  Anticoagulants

21 Thrombophlebitis of the deep veins  Occurs most often in the calf Clinical features  asymptomatic  dull ache  tender & spasm  swelling of calf  Dorsiflexion of the foot may elicit pain in the calf  Homan’s sign  pulmonary embolism

22 Treatment  Elevation  Application of full leg gradient pressure elastic hose  Anticoagulants  Prevention: Early ambulation

23 Pulmonary embolism  Pre-disposing factors -Pelvic surgery -Sepsis -Obesity -Malignancy History of pulmonary embolism or deep vein thrombosis  7 th to 10 th post-operative day  cardiac or pulmonary symptoms occur abruptly

24 Clinical features  chest pain; severe dyspnea, cyanosis, tachycardia, hypotension or shock, restlessness and anxiety  pleuritic chest pain  blood-streaked sputum, and dry cough  pleural friction rub

25 Investigation  Chest X-ray=pulmonary opacity in the periphery- triangular in shape with the base on pleural surface, enlargement of pulmonary artery, small pleural effusion and elevated diaphragm  ECG Treatment Cardiopulmonary resuscitation measures Treatment of acid-base abnormality Treatment of shock Immediate therapy with Heparin

26 Respiratory complications 1. Atelectasis 2. Aspiration pneumonitis/Pneumonia 3. Pulmonary edema 4. Pneumonia 5. Respiratory failure

27 Atelectasis early postoperative period-48 hrs airway collapse distal to an occlusion  Predisposing factors chronic bronchitis, asthma, smoking and respiratory infection Inadequate immediate postoperative deep breathing and delayed ambulation

28 Clinical features  Fever  Increased pulse, respiratory rate  Cyanosis  Shortness of breath  Dull with absent breath sounds

29 Investigation and Treatment  CXR - patchy opacity - mediastinal shift Prevention and treatment stop smoking Treat chronic lung diseases Postpone elective surgery encourage sitting, early ambulation Adminster analgesics Supplemental oxygen

30 Pneumonia and aspiration pneumonitis Pneumonia -atelectasis or aspiration Preexisting bronchitis  Clinical features Fever Respiratory difficulty Cough becomes productive pulmonary consolidation

31  Chest-x-ray _diffuse patchy infiltrates or lobar consolidation  Prevention and treatment minimized by - Fasting - Naso-gastric tube decompression  Treatment Deep breathing and coughing Change position Broad spectrum antibiotics

32 Paralytic Ileus  functional intestinal obstruction usually noted within the first hours Clinical features Abdominal distention Absent bowel sounds Generalized tympanicity on percussion Investigation Plain x-ray-generalized dilatation and gaseous distention of the bowel loops Treatment NGT decompression Fluid and electrolyte balance

33 Post operative intestinal obstruction  Causes _Peritonitis,Peritoneal irritation, Fibrinous adhesion  Clinical features between the 5th and 6th POD vomiting Crampy abdominal pain Focal typmpanicity Exaggerated bowel sounds  Investigation Plain film _distension of small bowel with air fluid levels  Treatment Hydration & electrolyte keet NPO NGT After hours, reoperation

34 Urinary and renal complications Urinary retention Acute renal failure Urinary tract infection

35 Urinary retention  pelvic operations  spinal anesthesia  Pain Mx  encouraged to get out of bed  Bladder drainage _a urethral catheter

36 Urinary tract infection  Predisposing factor contamination of the urinary tract Catheterization  Clinical presentation Fever Suprapubic or flank tenderness Nausea and vomiting  Investigation Urine analysis  Treatment Increase hydration Encourage activity appropriate antibiotic therapy

37 Wound infections  Pre disposing factors Age General health Nutritional status hygiene Malignancy Poor surgical technique Diagnosis: clinical Fever during the 4th to 5th POD Redness or induration

38  Treatment Sutures _remove wound exploration and culture drainage wound care antibiotics if systemic manifestations like fever

39 Hematoma, Abscess and Seromas may occur in the pelvis or under the fascia of abdominal rectus muscle falling of hematocrit low-grade fever Small hematoma or seroma _resolve spontaneously Ultrasonography Drainage of infected hematoma


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