Post-Operative Care 🏥
Comprehensive guide for post-operative care. Monitoring, common complications, pain management, and recovery protocols for surgical patients.
📋 Immediate Post-Op Assessment (First 24-48h)
- Vital signs: BP, HR, RR, temp, O2 sat - check frequency per protocol
- Pain assessment: location, severity (0-10), response to analgesia
- Wound inspection: bleeding, swelling, signs of infection, drain output
- Neurovascular status: pulses, sensation, movement, colour, temperature
- Fluid balance: input/output, urine output (aim >0.5ml/kg/hour)
- Nausea/vomiting: frequency, severity, response to antiemetics
- Mobility: ability to move, sit up, ambulate as appropriate
- Mental status: alertness, confusion, delirium screening
🔍 Key Monitoring Parameters
- Vital signs: q15min x4, q30min x4, then q4h (adjust per protocol)
- Pain scores: q4h or PRN, document response to interventions
- Wound checks: daily inspection, document any changes
- Drain output: measure and record q8h, note character and volume
- Fluid balance: strict I&O charting, daily weights if indicated
- Laboratory values: FBC, U&E, LFTs as ordered (often day 1-2 post-op)
- Temperature: q4h, investigate any fever >38°C
- Oxygen saturation: continuous if on O2, spot checks if room air
🚨 Red Flags - Call Senior Immediately
- Haemodynamic instability: hypotension, tachycardia, poor perfusion
- Excessive bleeding: wound bleeding, drain output >100ml/hour, falling Hb
- Signs of infection: fever, wound erythema, purulent drainage, spreading cellulitis
- Compartment syndrome: severe pain, tense compartments, neurovascular compromise
- Anastomotic leak: abdominal pain, distension, peritonitis, fever
- Pulmonary complications: respiratory distress, desaturation, chest pain
- Cardiac events: chest pain, arrhythmias, ECG changes
- Neurological changes: altered mental status, focal deficits, severe headache
💊 Common Post-Op Medications
- Analgesia: paracetamol, NSAIDs, opioids (PCA/morphine) - titrate to pain scores
- Antiemetics: ondansetron, cyclizine, metoclopramide - for nausea/vomiting
- Antibiotics: if indicated, usually 24-48h post-op unless infection
- Anticoagulation: LMWH, compression stockings - DVT prophylaxis
- PPI: for stress ulcer prophylaxis in high-risk patients
- Laxatives: to prevent constipation from opioids and immobility
- Insulin: tight glucose control in diabetics (aim 6-10mmol/L)
🩹 Wound Care Essentials
- Daily inspection: look for signs of infection, dehiscence, haematoma
- Dressing changes: as per surgical team instructions
- Drain management: measure output, note character, remove when <30ml/day
- Sutures/staples: removal timing varies (5-14 days depending on location)
- Signs of infection: erythema, warmth, swelling, purulent drainage, fever
- Document: wound appearance, drain output, any concerns
- Photograph: if significant changes or concerns arise
🔄 Early Mobilization & Recovery
- Mobilisation: start as soon as safe (often day 1 post-op)
- Physiotherapy: breathing exercises, early ambulation, range of motion
- Nutrition: start with clear fluids, advance as tolerated
- Bowel function: monitor for return of bowel sounds, flatus, bowel movements
- Bladder function: monitor for urinary retention, especially after pelvic surgery
- Sleep: ensure adequate rest, manage pain to allow sleep
- Psychological support: address anxiety, provide clear information
📊 Common Post-Op Complications
- Atelectasis: encourage deep breathing, early mobilisation, incentive spirometry
- DVT/PE: early mobilisation, compression stockings, anticoagulation
- Wound infection: monitor for signs, may need antibiotics or debridement
- Ileus: NBM, NG tube if severe, monitor for resolution
- Urinary retention: catheterization if needed, monitor for resolution
- Delirium: screen for, manage underlying causes, consider medication review
- Pain management issues: reassess, consider different modalities
- Fluid/electrolyte imbalance: monitor labs, adjust IV fluids
📞 When to Call the Surgical Team
- Any red flag symptoms (see above)
- Worsening pain despite adequate analgesia
- Signs of wound complications or infection
- Concerns about drain output or function
- New symptoms or deterioration in patient condition
- Questions about post-op orders or management plan
- Patient/family concerns that need addressing
- Discharge planning or follow-up arrangements
📝 Documentation Essentials
- Vital signs with trends and any interventions
- Pain scores and response to analgesia
- Wound assessment with detailed descriptions
- Drain output measurements and character
- Fluid balance and urine output
- Mobility status and physiotherapy progress
- Medication administration and effectiveness
- Any concerns, interventions, or communications with surgical team
🏠 Discharge Planning
- Wound care instructions for patient/family
- Pain management plan and medication supply
- Activity restrictions and lifting limitations
- Follow-up appointments with surgical team
- Warning signs to watch for at home
- Contact information for concerns
- Return to work/school timeline
- Driving restrictions (if applicable)