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General Surgery Mosul university- College of dentistry-oral & maxillofacial surgery department Dr. Ziad H. Delemi B.D.S, F.I.B.M.S (M.F.) Post-operative care and management
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Mosul university- College of dentistry-oral & maxillofacial surgery department Phases І-Immediate post-anesthetic phase. ІІ-Intermediate phase. ІІІ-Convalescent (recovery) phase.
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Mosul university- College of dentistry-oral & maxillofacial surgery department Immediate post-anesthetic phase 1- monitoring 2- respiratory care 3- cardiovascular system (CVS) care 4- renal & bladder care 5- drainage tubes 6- medication 7- special laboratory tests
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Mosul university- College of dentistry-oral & maxillofacial surgery department 1- monitoring: Observation in recovery room until the patient is conscious & vital sings are stable done by the surgeon & anesthetist then order written on the case sheet & the nursing staff informed. vital signs ( BP, PR, RR, UOP ) recorded every 15-30 min. then 1 hrly on the chart. continuous ECG some times are needed
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Mosul university- College of dentistry-oral & maxillofacial surgery department 2- respiratory care: Maintain open airway by: Side position till gag reflex +ve. Mechanical suction of the blood & mucus secretions. Encourage breathing & cough. Sitting as soon as possible. Turn the patient from side to side every 15-30 min then hourly for first 8-12 hrs to prevent atelectasis & facilitate lung expansion.
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Mosul university- College of dentistry-oral & maxillofacial surgery department 3- cardiovascular system (CVS): to prevent DVT active motion of the lower limb is encourage, in elderly patients we use elastic support stockings or bandages with continuous intra venous fluids (IVF) to prevent circulatory collapse.
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Mosul university- College of dentistry-oral & maxillofacial surgery department 4- renal & bladder: Urinary out put (UOP) kept at least 30 ml /h, low UOP resulted from ↓BP, ↓ blood volume, renal failure, managed by IVF & diuretics. Urinary retention managed by tape water see or Foleys catheter or suprapubic cystostomy.
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Mosul university- College of dentistry-oral & maxillofacial surgery department 5- drainage tubes: Drain : method to prevent fluid accumulation or drainage of pus or fluids or air from plural space. it introduced through a separate incision to ↓wound infections & must fixed to skin to prevent slipping into abdominal cavity Types: 1-soft lax (corrugate) 2-penrose 3-closed drain 4-sump drain
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Mosul university- College of dentistry-oral & maxillofacial surgery department 6- medications: Antibiotic, analgesics, sedation, other drugs. 7- special laboratory tests: PCV & Hb if blood loss during surgery Blood chemistry & blood gases, portable X- ray in critical patient.
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Mosul university- College of dentistry-oral & maxillofacial surgery department Intermediate phase 1- wound care. 2- drains. 3- respiratory care. 4- fluid & electrolytes. 5- gastrointestinal tract ( GIT ). 6- post operative pain.
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Mosul university- College of dentistry-oral & maxillofacial surgery department 1- wound care: Sterile dressing applied in the operative room 4 th post operative day dressing removed & wound inspected. Sutures removed 5-15 days according to site. If the healing is normal, patient allowed to bath in 7 th post operative day. If wound contaminated it is best to leave the skin & subcutaneous tissue open then do delayed primary or secondary suturing. Learn patient how to take care of the wound.
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Mosul university- College of dentistry-oral & maxillofacial surgery department 2- drains: Quantity & quality of drained fluid should be noted. The drain must be removed if there is little or no drainage.
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Mosul university- College of dentistry-oral & maxillofacial surgery department 3- respiratory care: The changes in the pulmonary function observed following general anesthesia & surgery are principley due to ↓ functional residual capacity & ↓ vital capacity with pulmonary edema.
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Mosul university- College of dentistry-oral & maxillofacial surgery department 4- fluid & electrolytes : Daily maintenance :for sensible & insensible loss in adult 1500-2500 cc so give 4-5 pints of glucose saline daily, K+ is not add 1 st 24 hrs. Loss from the drain ( NG tube loss more than 500 ml/day so replace by G/S with K+. Extraneed from systemic factor fever, burn. Loss from 3 rd space sequestration from tissue edema or ileus.
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Mosul university- College of dentistry-oral & maxillofacial surgery department 5- gastrointestinal tract (GIT): Post-operative paralytic ileus (bowel sound – ve) Peristalsis will return within 24 hrs so immediately put NG tube post-op. & connected to suction device with irrigation. Nothing by mouth till bowel sound +ve. Gastrostomy or jejunostomy also attached to succer.
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Mosul university- College of dentistry-oral & maxillofacial surgery department 6- post operative pain: Post-operative pain cause: -↑ stress & this lead to delay recovery. -inability to cough & breath deeply will lead to retention of secretions atelectasis, pneumonia. -immobility lead to venous stasis, DVT, pulmonary embolisim.
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Mosul university- College of dentistry-oral & maxillofacial surgery department Methods of relieving pain 1-Intermittent injection of analgesic drugs: a- morphine ( 3mg IV diluted in 3ml slowly) b- pethidine (75 mg IV infusion) c- pentazocine d- tramadol (100mg), or voltarin (75mg) IM 2- continuous IV infusion. 3- inhalational analgesia. 4- peripheral nerve block. 5- epidural (extradural) block. 6- oral analgesia ( NSAID, pethidine tab, codeine..)
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Mosul university- College of dentistry-oral & maxillofacial surgery department Convalescent(recovery) phase Instruct the patient not to lift heavy weight or to cough heavily or to be constipated for at least 6 months post operative to prevent hernia. Prevent heavy fatty meals & gastric irritants in duodenal ulcer & acute cholycystitis. Prevent chronic constipation & prolonged standing in varicous veins & hemorrhoids.
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Enumerate liver function tests (LFT) Mosul university- College of dentistry-oral & maxillofacial surgery department Quiz
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