Post-operative instructions Flashcards
ILO 1.14a: have knowledge of the causes of infection, mechanisms and routes of spread of infection and principles of treatment (17 cards)
what should be expected after an extraction?
- pain
- bleeding
- swelling
- bruising
- infection
- jaw stiffness
what post-operative instructions should you give about pain?
- expect pain
- can be significant for some people and some experience no pain - varying degrees of normal
- likely will peak around 48 hours
- should gradually improve after next few days but can be occasionally painful after 1-2 weeks
- can take analgesia before anaesthetic wears off
- take analgesia regularly for first couple of days
- after first few days, use analgesia when required
what is ibuprofen? what doses can be taken? what is the max dose?
ibuprofen is an NSAID (non-steroidal anti-inflammatory drug) and is a painkiller for dentoalveoar pain
* 200mg or 400mg tablet
* 1200mg - 1800mg daily in 3-4 divided doses preferably after food
* max dose: 2400mg daily
* children: reduced dose, depends on age/weight
when should you be cautious when prescribing ibuprofen?
- previous/active peptic ulceration/GORD
- elderly
- pregnant and lactation
- renal, cardiac or hepatic impairment
- history of hypersensitivity to aspirin and other NSAIDs
- asthma - unless taken before with no problems
- patient taking other NSAIDs
- patient on long term systemic steroids
what is paracetamol? what doses can be taken?
paracetamol is a painkiller with a different mode of action to NSAIDs
* 500mg tablets
* 1-2 tablets every 4-6 hours
* max dose: 4000mg (8 tablets) daily
* children: depends on age/weight
* warn all patients of maximum dose and do not exceed - send to A&E immediately
when should you be cautious when prescribing paracetamol?
- hepatic impairment
- renal impairment
- alcohol dependency
what is co-codamol? what doses can be taken? when should you not take co-codamol?
co-codamol is a painkiller of paracetamol and codeine combined
* 8/500 (8mg codeine 500mg paracetamol)
* 30/500 (30mg codeine 500mg paracetamol)
* do not take if taking other paracetamol products
what is the suggested analgesia regimen?
- ibuprofen and paracetamol interspread
- dont exceed recommended dose - 3 doses ibuprofen, 4 doses paracetamol
- e.g. 400mg Ibuprofen, then 2 hours later take 1g Paracetamol, then around 4 hours after this take 400mg Ibuprofen, then 2-4 hours later another 1g Paracetamol and so on
what post-operative instructions should you give about bleeding?
- a little bleeding post-operatively should be expected
- blood-stained saliva for up to 72 hours post-op is normal
- can bleed in response to **LA wearing off, agitating socket, changes in BP and eating and drinking **
ensure bleeding has stopped before pt leaves surgery
how can a patient mange bleeding at home?
- roll up some damp gauze and bite on it for 20-30 mins - repeat if not effective
- if bleeding persists, pt. should contact practice/out of hours
- make sure pt has contact details before they leave surgery
- if they cannot get bleeding to stop and cannot get a hold of dental emergency team, go to A&E
what post-operative instructions should you give about swelling?
- normal reaction to trauma
- variable in different people
- more common after a difficult extraction/surgical procedure
- reaches peak after around 2 days, can persist up to 2 weeks - ice pack 5 min at a time
- if swelling continues to increase after 2 days or worried about infection, get in touch with you
what post-operative instructions should you give about bruising?
- variable in different people
- can be more marked with more difficult procedures/more difficult extractions/surgical extractions
- always worn patients to expect it
what post-operative instructions should you give about infection?
- uncommon
- antibiotics not required unless signs of infection:
- increase in pain / swelling after 2 days
- discharge / bad taste from socket
what post-operative instructions should you give about jaw stiffness?
- pain and stiffness associated with TMJ/muscles of mastication is to be expected
- can result in a limitation in mouth opening
- can take up to 2 weeks to settle
- soft diet is helpful
what are some general instructions to give post-operatively?
- avoid smoking for min 48 hours (delays healing, dry socket)
- avoid alcohol for min 24 hours (increased risk of bleeding)
- avoid increasing blood pressure (heavy lifting, exercise)
- tooth brushing (soft brushes, warm water)
- mouth rinsing with HSMW - hot salty mouth wash (sterilisation 3-4 times a day)
- discomfort in adjacent teeth is to be expected (new parts of teeth exposed so can be sensitive (M,D))
what post-operative instructions can you give after surgical extractions?
- pain, swelling and bruising is likely to be increased
- likely to have stitches placed - advise if resorbable or not and when they are likely to fall out (if change in gum, or starts significantly bleeding, or causes pain - get in touch )
- sutures can become uncomfortable as the area heals
- may recommend CHX mouthwash
what is important when giving written instructions?
- follow up verbal instructions with written instructions
- should reinforce verbal instructions
- should not replace verbal instructions
- include emergency contact details
- should be available in different languages
