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CHAPTER 42: Postoperative Considerations

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INTRODUCTION

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Many problems following surgery can be avoided by the preoperative risk assessment and prevention strategies described in Chapter 39. However, despite ideal preparation, complications may still develop, and vigilance for these adverse events can help ensure successful convalescence for most patients.

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POSTOPERATIVE ORDERS

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These written instructions address support of each organ system, while normal function is gradually reestablished. Although orders are customized for each woman, goals are common among all surgical patients—resuscitation, pain control, and resumption of daily activities. Table 42-1 offers a template for both inpatient and outpatient postoperative orders.

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TABLE 42-1Typical Postoperative Orders (Inpatient and Outpatient)
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TABLE 42-1 Typical Postoperative Orders (Inpatient and Outpatient)
Postoperative Orders (Inpatient) Postoperative Orders (Outpatient)
Admit to: recovery room/assigned hospital floor/attending physician’s name Admit to: recovery room; transfer to DSU when cleared by anesthesia
Diagnosis: s/p what surgical procedure Diagnosis: s/p what surgical procedure
Condition: stable Condition: stable
Vital signs: q1h × 4, q2h × 2, then q4h VS per routine
Activity: bed rest Allergies: NKDA
Allergies: NKDA Bed rest until A&A, then activity ad lib
Notify MD for: T >101°F; BP >160/110, < 90/60; P >130; RR >30, <10; UOP < 120 mL/4 hr; acute changes NPO until A&A, then clear liquids
IV fluids: LR at 125 mL/hr until tolerating PO, then D/C IV
Diet: NPO except ice chips
IV fluids: LR at 125/hr		 Notify MD for: T >101°F; BP >160/110, <90/60; P >130; RR >30, <10; acute changes
Special:

  • Strict I/Os

  • Turn, cough, deep breath q1h while awake

  • IS to BS, q1h while awake

  • Foley to gravity

  • SCD hose to pump

 D/C patient home when A&A, cleared by anesthesia, taking PO, ambulating, and able to void

F/U at ___________ clinic in _____ weeks

Write any necessary prescriptions
Medications:

  1. PCA orders: mix 30 mg MSO4 in 30 mL NS; load 4–6 mg, then IV q6min on demand; lockout 20 mg in 4 hours

  2. Phenergan 25 mg IV q6h prn N/V

  3. ±Toradol 30 mg IM q6h × 24 h (only if Cr is okay)
Labs: H & H in AM (or that afternoon if necessary)

A&A = awake and alert; BS = bedside; Cr = creatinine; D/C = discontinue, discharge; DSU = day surgery unit; F/U = follow-up; H&H = hemoglobin and hematocrit; I/Os = input and output; IM = intramuscular; IS = incentive spirometry; IV = intravenous; LR = lactated Ringer; MSO4= morphine sulfate; NKDA = no known drug allergies; NPO = nil per os; NS = normal saline; N/V = nausea and vomiting; P = pulse; PCA = patient-controlled analgesia; PO = per os; RR = respiratory rate; SCD = sequential compression device; s/p = status post; UOP = urine output; VS = vital signs.

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Fluid and Electrolytes

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Nearly half of the average female body’s weight is water. Two thirds of this water is contained in the intracellular compartment, and the remainder is stored extracellularly. This ...

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