Post-operative Care
Relieve pain - non-opioid analgesics preferred when paralytic ileus of the intestines are likely.
Epidural catheter if + Pain relieving drugs admininstered as per schedule
ECG immediately after surgery and on days 1 and 2 for those above 40
Administer antibiotics - 3rd 4th or 5th generation cephalosporins
Metronidazole added if needed
Breathing exercises - incentive spirometer
Ventilatory support using small tidal volumes and predefined end-expiratory pressure settings when indicated - reduces inflammatory reaction
Temperature management
Elective surgery - patients kept in their room
High risk patients in ICU
Early mobilization
Measures to prevent DVT (Deep Vein Thrombosis) - elastic crepe bandage, in some patients LMWH; hourly leg exercises, avoid prolonged "dangling" of the lower limbs over the edge of the bed
Early removal of tubes, catheters and drains and nasogastric tubes
Nasogastric tube is only recommended as long as the retrograde fluid delivery of the tube exceeds 100 ml/day.
Early oral nutrition
Nausea and vomiting controlled by appropriate measures (emeset, domperidone)
Expectation & Early detection of complications
For elderly patients, a complication termed postoperative cognitive decline to be recognized
Postoperative delirium, which is defined as confusion and altered consciousness if occurs may last for many days
Fowler's position
Guard against hypotension and shock
Pulmonary embolism to be prevented
Look for dehydration
Large hematomas have to be evacuated removing several sutures and packed light with gauze:
supplemental oxygen during colorectal resection and for 2 hrs postoperatively reduces infection
wound infection - red streaks around wound - wound infection manifests by 5th day
Look for pus discharge, foul odor; dressings kept clean and dry; wet dressings changed
Wound dehiscence looked for - watery brown discharge - an abdominal binder properly applied along with the primary dressing especially in pts with weak or pendulous abdominal walls or when rupture of a wound has occurred
Abdominal girth measurement if needed
Intestinal function monitored
When bowel sounds or passage of flatus start Gradual feeding starting with clear fluids, milk, fruit juices , liquid diet semisolid solid
Look for urnary retention
encourage voiding of urine by early ambulation, applying warmth to the perineum or intermittent catheterization, indwelling catheter is avoided as far as possible. Post voidal volume assesed by palpation or by a portable ultra sound machine
Emotional support, provide an environment to enhance rest and relaxatio by providing privacy, reducing noise, adjusting the lighting, providing enough seating for family members
