PREOPERATIVE AND POSTOPERATIVE CARE

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• PREOPERATIVE
• AND
• POSTOPERATIVE CARE
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Preoperative and Postoperative Car

• Emergency Surgery
• Urgency Surgery
• Elective Surgery

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• Preoperative Care
• Anesthesia and operation
• Postoperative Care

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Preoperative Care

• Diagnostic work up
• Preoperative evaluation
• Preoperative preparation

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DIAGNOSTIC WORK UP

• DISEASE OF SURGERY
• - LAB
• - EXTENT OF DISEASE
• - RADIOLOGY
• - HISTOPATHOLOGY

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PREOPERATIVE EVALUATION

• Hx
• PE
• LAB ROUTINE WORK UP
• CBC
• UA
• CXR

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SPECIAL LAB

• EKG gt 45 YRS
• STOOL EXAM
• BS SUBCLINICAL DM
• LFT
• PIATELET COUNT , PT , PTT
• BUN , Cr , electrolyte
• PFT , ABG

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HIGH RISK OF PATIENT

• OBESITY
• MALNUTRITION
• ANEMIA
• PULMONARY DYSFUNCTION
• ELDERLY
• INFANT
• PREGNANCY

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PREOPERATIVE PREPARATION

• INFORMING THE PATIENT
• OPERATIVE PERMIT
• PREOPERAIVE ORDER

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PREOPERATIVE ORDER

• DIET
• SKIN PREPARATION
• ENEMA
• BEDTIME PREANESTHETIC MEDICATION
• SPECIAL ORDERS
• - BLOOD TRANSFUTION
• - VENOUS ACCESS HEMODYNAMIC MONITORING
• - NG TUBE
• - BLADDER CATHETER
• - PREOPERATIVE HYDRATION

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POSTOPERATIVE CARE

• IMMEDIATE POSTOPERATIVE PERIOD
• ( POSTANESTHETIC RECOVERY PHASE )
• IMMEDIATE POSTOPERATIVE PERIOD
• CONVALESCENT PERIOD

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IMMEDIATE POSTOPERATIVE PERIOD

• POSTOPERATIVE ORDERS
• MONITORING
• - VITAL SIGN
• - CVP
• RESPIRATORY CARE
• POSITION
• RENAL AND BLADDER FUNCTION
• FLUID ELECTOLYTE
• DRAINAGE TUBES

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THE INTERMEDIATE POSTOPERATIVE PERIOD

• CARE OF WOUND
• POSTOPERATIVE PULMONARY CARE
• POSTOPERATIVE FLUID AND ELECTROLYTE MANAGEMENT
• POSTOPERATIVE CARE OF GI TRACT
• POSTOPERATIVE PAIN

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COMMON POSTOPERATIVE COMPLICATION

• IMPAIRED CONCIOUSNESS
• POSTOPERATIVE PYREXIA
• INTRAOPERATIVE FEVER
• IMMEDIATE POSTOPERATIVE FEVER ( lt
  24 HRS )
• LATE POSTOPERATIVE FEVER

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COMMON POSTOPERATIVE COMPLICATION

• WOUND COMPLICATION
• HEMATOMA
• SEROMA
• WOUND DEHISCENCE
• WOUND INFECTION

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RESPIRATORY COMPLICATION

• ATELECTASIS
• PULMONARY ASPIRATION
• POSTOPERATIVE PNEUMONIA
• POSTOPERATIVE PLEURAL EFFUSION PNEUMOTHORAX
• FAT EMBOLISM FAT EMBOLI SYNDROME

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CADIOVASCULAR COMPLICATION

• HEMORRHAGE
• MASSIVE BLOOD TRANSFUTION
• BLOOD TRANSFUTION REACTION
• MYOCARDIAL INFARCTION

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CADIOVASCULAR COMPLICATION

• POSTOPERATIVE CARDIAL FAILURE
• THROMBO PHLEBITIS
• SUPPERATIVE PHLEBITIS
• DVT

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GASTROINTESTINAL COMPLICATION

• POSTOPERATIVE ILEUS
• PROLONG ILEUS AND INTESTINAL OBSTRUCTION
• GASTRIC DILATATION
• POSTOPERATIVE FECAL IMPACTION

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GASTROINTESTINAL COMPLICATION

• POSTOPERATIVE DIARRHEA
• HICUCUPS
• POSTOPERATION PAROTITIS
• COMPLICATION OF DRAINS

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URINARY COMPLICATION

• POSTOPERATIVE URINARY RETENSION
• URINARY TRACT INFECTION

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CLASSIFICATION OF WOUND

• CLEAN WOUND , INFECTION 1 2
• CLEAN CONTAMINATION WOUND lt 10
• CONTAMINATION WOUND 15 20
• DIRTY WOUND lt 40

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PRINCIPLES OF ANTIBIOTIC PROPHYLAXIS

• PROPHYLACTIC USE
• THERAPEUTIC USE

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PRINCIPLE OF ANTIBIOTIC PROPHYLAXIS

• Surgical wound infection gt 5
  ( Clean Contamination )
• Surgical wound ESP transplantation
• Prothasis ORIF, AVBE,
• Heart valve
  replacement

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PRINCIPLE OF ANTIBIOTIC PROPHYLAXIS

• Common infection
• Prolong Intervention procedure EXP. Foley
  s cath , ICD , not USE

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PROPHYLACTIC ANTIBIOTIC DRUG

• SPECIFICATION OF ORGANISM
• LOW TOXICITY
• 30 60 MIN BEFORE SURGERY
• DURATION lt 24 HR
• PROLONG SURGERY, 2nd dose ( half life )

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DRAIN

• Passive drain gauze drain
• Penrose drain
• Cigarette drain
• Active drain Sump drain
  Jackson
  Pratt drain
  Radivac drain

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AIMS OF DRAINAGE

• THERAPEUTIC
• PROPHYLAXIS
• DIAGNOSIS