Post Operative Management for Gynaecological Surgeries

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

7

Pages:

5
Author:

Mariam A. A.

Post Operative Management for Gynaecological Surgeries Orders First 24 hours Vitals -> HR, BP, RR, O2 stats Every 15 minutes for the first hour Then hourly for the next four hours Then every four hours Strict input/output charting Hourly urine output Pain score Every 4 hours or as needed PCA monitoring Abdominal exam Every sift Check for distension Tenderness Bowel sounds Neurovascular status If epidural or regional blocks were used IV fluids Continue maintenance fluids at: 1 L normal saline at 8/24ly rate (125 mL/hour), followed by 1 L normal saline at 8/24ly rate, followed by 5% dextrose at 8/24ly rate Consider if symptomatic hypovolemia or low serum albumin due to ascitic loss Check electrolytes Nill by mouth Ice chips for comfort Analgesia PCA morphine -> continue as required monitor sedation score and RR Paracetamol 1 g IV/PO q6h PRN; consider NSAIDs if renal function normal and no contraindications Assessment following a large amount of vomit first impression given it is a green bilious vomit I would prioritise assessment for bowel obstruction until proven otherwise I want to rule out – post-operative ileus, adhesive small bowel obstruction or gastric stasis History Onset Volume Colour Projective vs passive Triggers/context Pain -> SCORATES Diet tolerance Medications Examination General inspection Hydration status Abdominal exam – distension, tenderness, guarding, bowel sounds Cardiovascular/respiratory exam JVP, features of heart or resp failure Wound – signs of infection Catheter Urine volume PCA monitoring – sedation score, opioid dose Investigations Bloods FBC, UEC, LFTs Electrolyte imbalance End organ failure/dysfunction CRP, ESR and other inflammatory markers AXR -> dilated loops, air fluid levels CT abdo /pelvis with contrast With AXR is inconclusive CXR Pneumonia aspiration -> may be suggested by the green vomit Pneumoperitoneum Atelectasis, effusion or infection Result Interpretation, Diagnosis and Management Result Interpretation Most likely post-operative small bowel obstruction AXR -> classic features of SBO CXR -> no aspiration or perforation WCC -> suggests a severe inflammatory response Either stress response or compromise Hb -> expected post-op K+ -> secondary to vomit Urine output Borderline low Reflect dehydration or early renal hypoperfusion Management NPO NGT -> relief vomit and decompress bowel IV fluid resus Electrolyte correction Anti-emetics Analgesia review Reduce opioids to minimise gut motility Prophylactic antibiotics Surgery review If no features of strangulation or infraction -> conservative management Surgical interventions