DR/FATMA AL-THUBAITY SURGICAL CONSULTANT ASSISSTANT PROFESSOR POSTOPERATIVE CARE DR/FATMA AL-THUBAITY SURGICAL CONSULTANT ASSISSTANT PROFESSOR 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY Objectives Understand the principles of patient management in the recovery phase immediately after surgery. Understand the general management of the surgical patient on the ward. Consider the initial management of common acute complications during the postoperative period. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY Immediate postoperative care (recovery phase). Care on the word until discharge from hospital. Continuing care after discharge. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY The Recovery Phase Airway and breathing. Circulation. Fluid balance. Core temperature. Blood sugar monitoring. ECG monitor. Distal perfusion monitoring. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY Neurological observation. Catheter output. Pulse oximeter versus arterial blood gas. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY CARE ON THE WARD Monitor the patient progress at least daily postoperative & more frequently if indicated.record in the notes at least daily. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY Detailed operation note. Monitoring of vital signs. Early mobilization. Diet. Intravenous fluids. Intake/output chart. Urinary output. Medication. Laboratory tests. Radiographs & ECG. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY progress General condition. Vital signs. Mobility. Chest. Abdomen. Legs. Wounds. Intake/output. Diet. Result of any laboratory tests. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY Surgical drains Nasogastric tube. Chest drain. Drains at the operative site. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY Day case surgery 02/04/2019 DR/FATMA AL-THOUBAITY

Postoperative complication Haemorrhage. Wound. Cardiovascular. Lung. Cerebral. Urinary. Gastrointestinal. Others. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY Airway obstruction Obstruction by the tongue. Obstruction by foreign bodies. Laryngeal spasm. Laryngeal oedema. Tracheal compression. Bronchospasm. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY HAEMORRHAGE Early Secondary 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY HYPOVOLEMIA Unreplaced blood loss. Loss of fluid into the gastrointestinal tract. Loss of plasma into the wound or abdomen. Sequestration of extracellular fluid into the third space. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY Wound problems Infection. Wound breakdown. Burst abdomen. Incisional hernia. Anastomotic breakdown. Haematoma. Seroma. Stitch sinus. 02/04/2019 DR/FATMA AL-THOUBAITY

Cardiovascular problems Cardiac arrest. MI. Pulmonary oedema. Arrhythmias. DVT. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY Lung problems Atelactasis. Aspiration pneumonitis (Mendelson s syndrome. Pneumonia. Pulmonary oedema. Pulmonary embolus. Pneumothorax. ARDS. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY Causes of ARDS Infection. Inhalation. Embolism. Cerebral. Drugs. Others. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY Cerebral problems Confusion(sepsis,hypoglycemia,hypoxia & alcohol withdrawal). Stroke 02/04/2019 DR/FATMA AL-THOUBAITY

Urinary tract problems Acute retension. Urinary tract infection. ARF. 02/04/2019 DR/FATMA AL-THOUBAITY

Gastrointestinal problems Paralytic ileus. Mechanical obstruction. Gastric dilatation. Constipation. 02/04/2019 DR/FATMA AL-THOUBAITY

Postoperative pain relief Parenteral analgesia. Spinal opioids. Intercostal nerve blocks. Direct infiltration. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY Parenteral analgesia Intermittent intramuscular opiates. Continuous subcutaneous of opiates. Continuous I.V.infusion of opiates. PCA pump. 02/04/2019 DR/FATMA AL-THOUBAITY

Complications of blood transfusion Incompatibility. Febrile reactions. Allergic reactions. Infection. Massive transfusions. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY SUMMARY Postoperative care is divided into three phases. The recovery phase is the immediate care of patients after surgery until they can maintain all vital functions independently. The second phase is care on the word,during which the three most important general considerations are pain control,fluid balance management and nutrition. The third phase of care follows discharge from hospital. 02/04/2019 DR/FATMA AL-THOUBAITY

DR/FATMA AL-THOUBAITY The intensity of monitoring in the postoperative phase depends on the severity of disease or the nature of surgery. Good communication is essential throughout postoperative care to ensure the best outcome. 02/04/2019 DR/FATMA AL-THOUBAITY