Post operative care Flashcards
What is the aim of post operative care?
To get the patient back to pre operative state as quickly as possible
What are the principles of enhanced recovery?
Good pre op preparation e.g. good nutrition Minimally invasive procedures Adequate analgesia Good nutritional support around surgery Early oral intake Early mobilisation Early removal of NG tubes/ drains and catheters Early discharge
What analgesia is normally given post op?
Paracetamol and NSAIDs normally given in theatre with opioids if deemed necessary
Surgeons often inject LA into wound site to help with initial pain
What is patient controlled analgesia?
Continuous infusion where patient presses a button for administration
Button is then locked for a period of time before patient can re-administer again
What monitoring do patients with PCA need?
Close monitoring required with easy access to naloxone, anti emetics, laxatives and atropine if required
What are risk factors for post op N&V?
Female Young age Non smokers Previous motion sickness or PONV Opiate use Volatile anaesthetic
How is PONV prevented or treated?
Ondanestron- avoid in pts with risk of prolonged QT
Prochloperazine- avoid in Parkinsons
Cyclizine- caution in elderly and HF
When should the different tubes be removed?
Drains- when draining minimal or no blood/fluid
NG tubes when feeding or drainage no longer required
Catheters- when able to mobilise can lead to retention
What nutritional support is there?
Aim to give food via GI system
- oral
- NG
- PEGG
If not parenteral nutrition can be given where solution of carbs, proteins and fats is given via veins
Can cause thrombophlebitis so given via central vein
What are post op complications?
Anaemia AKI Infection Ileus Urinary retention DVT/PE Wound dishesiance Delirium Shock ACS Arrythmias Haemorrhage
