Post Operative Patient Care Activate RAAS -> hang on to water and sodium -> conservations. Fluid redistribution -> 3 rd spacing. Fever Increase in cortisol and stress hormones The postop ward round Airway Breathing Circulation DVT, drains, drugs and diet. Exposure - wounds and lines. Fever, fluids and lines Gut and glucose Information Review the chart Talk to the nurses Talk to the patient’s family Pain is important part of the discussion. Early identification of complications Physiologically how much fluid does a 70kg average person need Maintenance fluid if no pathology needed -> 20-30ml per kg per day -> fine with 85-100 ml per hour. When charting for a patient we just do not think about maintenance we also need to be thinking about loses, e.g. vomit, diarrhoea, sepsis etc. Patients in severe pain Delayed recovery -> more immobility -> greater risk of DVT If in the abdomen near diaphragm i.e. laparoscopy -> painful breathing -> minimise breathing, cannot deep breath -> no proper ventilation -> atelectasis, pulmonary collapse, pulmonary edema and possibly hospital acquired pneumonia. MUST PICKED UP ON THIS EARLY ON. Most feared complication after gallbladder surgery Perforation -> Bowel leak -> irritate peritoneal cavity -> peritonitis UO One of the ways of assessing patient circulation What is an adequate urine output (IMPORTANT FOR EXAM) 0.5 ml/kg/hr Careful not to charge excess fluid just because the patient has low urine output. Need to know more information about the patient. E.g. the patient has cardiac failure, renal failure etc. Overloaded state -> pulmonary edema, desaturation, patient going into respiratory failure. Also careful not give the patient fluid too fast as could cause the same issue especially If they have heart failure and renal failure. Dealy but avoidable post-operative surgery Pulmonary embolism due to immobility. Classical change in PE other than O2 stat as does not happen that many: Sinus tachycardia (post patients) or AF