Surg Med - Post Op Care - Exam 1

Hospital Day

number of days patient has been admitted to the hospital, with HD 1 as the day of admission

Post Operative Day

number of days that have passed since the surgery date, with POD 0 as the day of surgery

Immediate/Post Anesthesia Phase

PACU

Anesthesiologist in charge of cardiopulmonary function, Surgeon/PA in charge of operative site & all other aspects of care not directly related to anesthesia effects

Brief Op note

Post-op admission orders placed

Discharged from PACU once patient is at baseline

Check vitals, neuro function, cardiovascular function, pulmonary function, dressing & drains

Diet Options - Post Op

NPO, full liquid, soft, thick, full/regular, cardiac, diabetic, renal, high/low protein

Maintenance Fluids - Post Op

For 0-10 kg: 4 mL/kg/hr

For > 10-20 kg: 40 mL +2 mL/kg/hr for every kg > 10 kg

For > 20 kg: 60 mL + 1 mL/kg/hr for every kg > 20 kg

Ambulation/Positioning - Post Op

Turning side to side every 30 min until conscious then hourly for 1st 8-12 hours

Ambulate to reduce venous stasis

Upright positioning to increase diaphragmatic excursion

Post Op Pain Control

Parenteral opioids

non-opioids

oral analgesics such as NSAIDs

continuous epidural anesthesia

nerve block

direct infiltration

PO Medications - Post Op

Improve patient's ADLs

Shortens time to discharge

More cost effective

Tube and Drain Care

Used to prevent or treat unwanted fluid accumulation

Used to evacuate air from pleural cavity so that lungs can re-expand

Drain Care Orders

Type of pressure/suction

Irrigation fluid/frequency, stripping

Exit site care

Record output separately

Tube and Drain Removal

Surgeon specific, but remove as soon as it is no longer useful

Use aseptic technique and apply occlusive dressing to cover

Wound Vac/NPWT

Helps remove fluid

Helps promote granulation tissue formation

Can reduce infection risk

Less dressing changes

Diagnostic tests - Post Op

CBC

CMP/BMP/Renal chem

coag studies

blood/sputum cultures

OR cultures

UA

X-rays

CT scans

MRI

Pulmonary Care - Post Op

Admin oxygen

Incentive spirometry

Respiratory treatments

PT

Mechanical ventilation (tracheal suctioning)

PT/OT - Post Op

Dependent on type of surgery

Ambulation/ROM

Condition of patient

Crutch training

ADLs

Wound Care - Post Op

Monitor for bleeding, purulent drainage, erythema, warmth, malodor, swelling, pain, wound dehiscence

Social Work - Post Op

Eval and manage: mental status, ability to perform ADLs, financial concerns, support system, ability to return to work/normal activities, long-term care

Convalescent Phase

Medication reconciliation

Follow up appointments

Transportation

Patient education

Patient instructions, caretaker instructions, home health/facility instructions

Need for in home services

Destination and approvals

Prescriptions or delivery of supplies arranged

Durable medical equipment: walker, CPAP, wound care supplies

Important Info For PACU Receiving Team

Patient name/age

Pertinent history to the case and pertinent PMH

Procedure and notable findings/occurrences

Estimated blood loss

Drains/dressings/lines

Specific orders: activity, ABX, labs, positioning

Disposition: floor, ICU, observation, home, facility

Post-Op Eval After PACU

Eval again 4-6 hours post-op

-Patient subjective and exam

-Review orders and appropriateness

-Any signs of complication of procedure or anesthesia

Proper documentation is important

Presenting on Rounds - One Liner

Name

Hospital day or post-op day

Diagnosis/procedure performed

Presenting on Rounds - Subjective

Significant events in last 24 hours

Adequacy of pain control

Passing of flatus or BM

N/V, etc

Presenting on Rounds - Meds

ABX and day of

Pain control

Presenting on Rounds - Objective

Vitals

I/Os

Pertinent changes in exam

Surgical site: any warmth, erythema, dehiscence, induration, fluctuance

Labs/imaging

Presenting on Rounds - A&P

Name, age, diagnosis, procedure, POD#

Status

Plan - think about discharge

talking with patient - post op

Discuss overnight condition - Pain, N/V, eating/appetite, passing flatus, BM, urination if had Foley, sleep, any chest pain/SOB

Physical exam - Assess surgical site, Dressing changes, Assess drains/wound vac

Discuss chart review 

Discuss discharge planning

Post Op Care Goals

Maintenance of homeostasis

Treatment of pain

Prevention and early detection of complications

Promote Healing

Prepare patient for discharge

Total parenteral nutrition

Admin through a central line and supplies a person's daily nutritional requirements

-Can be done in hospital or at home

-Patient evaluated by pharmacist and registered dietician

DO NOT use in patient with intact GI tract

5-8 days

when should sutures be removed from head and face?

10-14 days

when should sutures be removed from the chest?

10-14 days

when should sutures be removed from the abdomen?

10-14 days

when should sutures be removed from the spine?

10-14 days

when should sutures be removed from the extremities?

Respiratory Therapy - Post Op Care

Admin Oxygen

Incentive spirometry

Resp Treatments - Nebulizer, Inhalers, Steroids

Respiratory PT

Mechanical ventilation

Tracheal suctioning