post operative care during AH and VH.pptx

Post operative care

1. POSTOPERATIVE CARE DURING ABDOMINAL AND VAGINAL HYSTERECTOMY

2. AIMS OF POST OPERATIVE CARE Support to restore patient’s physiological functions. Promote tissue healing. Prevention/management of complications.

3. RETURN FROM OPERATION THEATRE PREREQUISITES PRIOR TO SHIFTING 1.Vitals such as pulse,respiration and blood pressure become steady. 2.Patient recovers from anaesthesia and is fully conscious. 3.Anaesthetist’s consent should be available. 4.Fluid balance and bleeding from surgical site are checked.

4. FIRST 24 HOURS OBSERVATION Observation of vital signs such as pulse,respiration and blood pressure half hourly in the initial period.Interval is increaded if found steady. Attention paid for bleeding from operated site.

5. FLUID REPLACEMENT Intravenous fluid replacement. Amount of fluid to be replaced decided upon 1.Intraoperative blood loss 2.Operating time 3.Urine output 4.Volume of fluid already replaced.

6. Urine output of atleast 30 ml/hr indicates adequate fluid replacement. On an average,after replacement of fluid loss at operation,additional 2-2.5 litres f fluid is infused. Blood transfusion if needed is given during operation and soon after and should not be given unnecessarily.

7. PAIN MANAGEMENT Adequate pain control ensures; 1.deep breathing 2.Adequate oxygenation 3.Early mobilization 4.Prompt wound healing 5.Reduced pulmonary complication 6.Less hospital stay

8. ANTIBIOTICS Perioperative prophylactic antibiotics as mentioned i preoperative care are to be considered. It should be administered parenterally for 48 hours followed by oral route for another 3 days.

9. BLADDER CARE Foleys catheter is inserted and it keeps the bladder empty throughout and reduces risk of bladder injury. Helps to monitor urine output,reduces risk of urinar retention and pain. Prolonged catheterisation associated with urinary tract infection. Catheter is kept for 7-10 days in patients having bladder injury. Following removal of catheter,postoperative urinary retention is a common problem due to pain,spasm of pelvic floor muscle,tissue edema or following regional anaesthesia. Catheter have to be kept for 24 to 48 hours.

10. MOBILIZATION Patient should be encouraged to move freely in bed and to lie in any posture comfortable to her. Deep breathing and movements of legsand arms are encouraged to minimize leg vein thrombosis and pulmonary embolism It ia advantageous to allow the patient to sit or stand by the side of bed by evening. Patient can have sips of water to relieve thirst.

11. FIRST POSTOPERATIVE DAY GENERAL CARE Vital signs are noted atleast twice daily. Abdominal ausculataion dobe for appearnce of peristaltic sounds. Enquiry made about passage of flatus. Vaginal plug if any is removed early in the morning. Ambulate the patient.

12. DIET Oral feeding in the form of plain or electrolyte water is given in small but frequent intervals. With the appearnce of bowel sound or passage of flatus,full liquid diet is precribed

13. ANALGESICS Parenteral analgesics are gradually replaced with oral drugs in combination.

14. SECOND POSTOPERATIVE DAY Patient feels comfortable,moves around and goes to washroom. Light solid diet.

15. THIRD, FOURTH AND FIFTH POSTOPERATIVE DAY Daily observation of vital signs twice daily as a routine. Diet gradually bought to her normal. Bowels usually move normally,otherwise low enema or suppository may be given. Stitches are removed early in the morning when the patient is in empty stomach.

16. DISCHARGE Recovery of all organ functions needed before discharge. Written information given to patient as regard to operative procedures.

17. Examination prior to discharge ABDOMINAL HYSTERECTOMY Abominal wound is to be thoroughly checked for evidences of sepsis,hematoma or dehiscence. Vaginal discharge if any,is to be noted.

18. VAGINAL HYSTERECTOMY Perineal wound is checked to assess the state of healing. Vaginal exploration with finger is used to detect accidentally retained and forgotten gauze piece.

19. ADVICE ON DISCHARGE Light household work can be resumed after 3 weeks and outside or office work to be resumed after 4 to 6 weeks. Coitus should not be resumed prior to the postoperative check up/6weeks to promote vaginal cuff healing. Follow up earlier if any complications occur or after 2 weeks and 6 weeks.

20. ABDOMINAL HYSTERECTOMY Scope of wide exploration of abdominal and pelvic oragans. Tubo ovarian pathologies can be tackled effectively and simultaneously. Postoperative complications are slightly high. Increased incidence of peritonitis,fever,pulmonary and vascular complications. More post operative pain and more need of analgesia. More hospital stay. Delayed resumption of day to day activities. Morbidity and mortality are more compared to vaginal hysterectomy. Presence of abdominal scar. Difficult in obese patients.

21. VAGINAL HYSTERECTOMY Postoperative complications are less. Less morbidity and mortality. Less post operative pain and less need of analgesia. Less hospital stay. Early resumption of day to day activities. No abdominal incision and scar. Can be effectively done in obese patients. Exploration of abdominal and pelvic organs can be done. Difficult in cases with restricted uterine mobility,limited vaginal space and associated adnexal pathology. Limitation in cases with uterus>12 weeks size,presence of pelvic adhesions or previous history of laparotomy with adhesions.