The aims of postoperative care are to:
- Monitor the patient’s postoperative period to detect and correct any anomalies.
- Keep the patient comfortable and give adequate analagesia. Rectal diclofenac 100 mg(adults), paracetamol for children or pethidine 1 mg/kg TDS.
- Offer supportive feeding.
- Restore normal health and independence.
IMPORTANT: To achieve the above, the surgeon must give legible, concise, and clear postoperative instructions and involve other team members like physiotherapists in the management of the patient.
IMMEDIATE POST OPERATIVE RECOVERY PHASE
This period normally lasts about 1-2 hours from theatre to that period in the recovery ward, where facilities allow. During that period, the following are carried out:
- Keep the patient in a semi prone position with extended neck and flexed limbs.
- Maintain clear airway using oropharyngeal airway and provide supplemental oxygen till fully awake.
- Monitor vital signs every 15 minutes( ½ hourly ).
- Keep in recovery ward till fully awake (arousal)
TRANSIT FROM THE THEATRE TO WARD
During this process, keep the airway clear to avoid upper airway obstruction and aspiration pneumonitis. Use a recommended Stretcher/trolley with side rails.
POST OPERATIVE CARE IN THE FIRST 24 HOURS
This involves the following procedures:
- Continue observing vital signs 4 hourly or as often as individual case demands.
- Relieve pain with analagesia, e.g. pethidine 50-100mg every 6 hours in adults and in children 1 mg/kg in divided doses or use infiltration method at the operative table as for example intercostal infiltration in thoracotomies.
- Transfuse if necessary.
- In not feeding, give intravenous fluids, Hartmann’s normal saline, or 5% or 10% dextrose about 4 litres in 24 hours for a 70 kg adult. Titrate against state of hydration.
- Maintain an input and output chart(urine output1-2ml/kg/hour).
- Watch for airway obstruction, reactionary bleeding, etc.
- Attend to drains if in situ and make sure they are draining.
- Offer general nursing care, e.g keep the patient warm,turn in bed, and change wet linen to avoid bed sores.
- Carry out appropriate wound care.
POST OPERATIVE PERIOD 72 HOURS-7 DAYS
During this period, the following procedures are carried out:
- Mobilize out of bed after about 18-72 hours to avoid static pneumonia and thrombosis.
- Encourage Independence, e.g self feeding, attention to calls of nature.
- Give oral medication as appropriate.
- Take observations every 6 to 12 hours.
- Carry out wound care as appropriate.