1. 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

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

3. 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

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

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

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

7. DR/FATMA AL-THOUBAITY
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DR/FATMA AL-THOUBAITY

8. 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

9. 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.
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DR/FATMA AL-THOUBAITY

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

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

12. DR/FATMA AL-THOUBAITY
Day case surgery
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DR/FATMA AL-THOUBAITY

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

14. 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

15. DR/FATMA AL-THOUBAITY
HAEMORRHAGE
Early
Secondary
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DR/FATMA AL-THOUBAITY

16. 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.
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DR/FATMA AL-THOUBAITY

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

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

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

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

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

22. Urinary tract problems
Acute retension.
Urinary tract infection.
ARF.
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DR/FATMA AL-THOUBAITY

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

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

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

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

27. DR/FATMA AL-THOUBAITY
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DR/FATMA AL-THOUBAITY

28. 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.
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DR/FATMA AL-THOUBAITY

29. 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