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2)Subselective surgery
(malignant tumors
resection…)
3)Emergency surgery
(spleen rupture…)
Preoperative preparation
Postoperative complication
First part
Preoperative preparation
Diabetes mellitus
Nutritional system
Hypertension
Cardiac disease
Respiratory system
Kidney and liver function
Immunological system
Diabetes mellitus
Blood glucose concentration
A thorough physical examination
Preparation : protein
blood transfusion
vitamin intake
others
Hypertension
Hypertension
LEF:ejection fraction>50%
DCG:dynamic electrocardiogram
Arrhythmia
PVC:premature ventricualr contraction
Cardiac disease
Mortality
Cardiac patients noncardiac patients
2.8times
Cefotaxime 1 g IV or cefoxitin 2 g IV
1)active infection
2)contamination
3)artificial material
4)long time operations
5)gastrointestinal operation
6)cancer or vascular operations
Prep for surgery
bowel preps
antiseptic shower
hair clipping
1.vital sign
2.CVP(Central Venous pressure)
3.renal and bladder function
4. fluid and electrolytes
5.drain tubes
C.Nursing.
Encourage turning
coughing
deep breathing
incentive spirometry
Dressing changes
Any uncofortablity
fever
hypertension
hypotension
tachycardia
bradycardia
bleeding
pain
D.Medications
1)antibiotics
2)sedatives
3)pain relief drugs.
Pain medications
PCA :patient-controlled analgesia
provides better analgesia, and patients
generally require less narcotic than with IM
treatment;
Cause:
hypotension
stress reactions
Management:
droperidol
Antibiotics
Routine medications
infection
Suture removal time
General guidelines for suture removal:
Face 3 to 5 days
Scalp 7 to 10 days
trunk 7 to 10 days
arms 7 to 10 days
legs 10 to 14 days
joints 14days
dorsal surface 14 days
Third part
Common Postoperative complication
1)postoperative bleeding
2)wound infection
3)wound dehiscence
4)Atelectasis
5)Urinary infection
6)fat embolism
Special postoperative complications
Wound complication
1)hematoma
2)seroma
3)postoperative wound infection
4)wound dehiscence
Respiratory complications
1)atelectasis
2)pulmonary aspirations
3)postoperative pneumonia
4)postoperative pleural effusion and
pneumothorax
Cardiac complications
1)Arrhythmias
2)Postoperative mycardial infarction
3)Postoperative cardiac failure
Urinary complications
1)prehepatic jaundice
2)hepatocellular insufficiency
3)benign postoperative intrahepatic cholestasis
4)extrahepatic obstruction
Postoperative Fevers
Respiratory resean of postoperative fever
48 to 72 hours Streptococci
Enteric aerobes
4days Anaerobes
Staphylococci
vascular reason of postoper fever
Thrombophlebitis
management:
Maintain NPO with NG suction
Check electrolytes including calcium
potassium
anticholinergic
Avoid narcotics
calcium channel
blockers.
B.If prolonged
Consider pancreatitis
peritonitis
Intra-abdominal abscess
pneumonia
Free blood in the peritoneum