Post Op care in gyne

1. POSTOPERATIVE
CARE IN
OBS/GYNAE
Dr. ABEER REHMAN

2. • To enable a successful and faster
recovery of the patient post-operatively
• To reduce post operative mortality rate
• To reduce length of hospital stay
• To provide quality care service
• To reduce hospital and patient cost
during post operative period
Purpose

3. Immediate Intermediate Convalescent
Recovery phase – immediate
care of the patient after
surgery until they can
maintain all vital functions
independently
Second phase is care on the
ward during which the three
most important general
considerations are pain
control, fluid balance and
nutrition
Third phase of care follows
discharge from hospital and
includes consideration of
appropriate follow up
Phases of Post-Op Recovery

4. Immediate Post-Operative Care
o Patient admitted in PACU
o Receive complete patient record from operating room to plan post-op
care (Name, age, procedure,
existing medical problems, allergies, anaesthesia and analgesics given,
fluid replacement, blood loss, urine output, any surgical/anaesthetic problems
encountered)
o Detect early signs of complication.
o Basic responsibilities of PACU staff:
1. Airway management
2. Vitals monitoring
3. Managing post operative pain
4. Treating post operative nausea and vomiting
5. Monitoring surgical site

5. General Principles
o Vitals monitoring
o Fluids and electrolytes
o Pain management –IV/IM
analgesia
o Antimicrobial prophylaxis
o Care of bladder
o Ambulation
o Prophylaxis for thrombo-
embolism

6. Vitals Monitoring
o Regular vital signs monitoring
o Pulse, BP half hourly for 2
hours and then 4-6 hourly for
24 hours at least, to identify
clinical signs of infection or
hypovolemic collapse.

7. o NPO 6-8 hours
o Fluids and electrolytes – Patients are given IV
fluids after surgery until they can resume eating
and drinking
o 2-3 L NS/ RL
o Additional fluid supplementation if high fluid
loss eg from drains or patients suffering from
pyrexia (15% extra fluid loss with every 1
degree rise in temperature.
Goals:
o maintain blood pressure >100/70 mmHg, pulse
rate <120 bpm, urine output between 30-50
ml/hr
o Blood transfusion if major blood loss or if
patient anemic (Hb < 8 mg/dl)
Intravenous Fluids

8. o Narcotic analgesics e.g tramadol,
oxycodone, fentanyl, methadone and
buprenorphine
o Non narcotic analgesics e.g
Acetaminophen, ketorolac, and
gabapentin
o Oral analgesics should be given as a
regular prescription rather than on an "as
required" basis.
Pain Management

9. o Reduces the incidence of post-operative pyrexia
o Broad spectrum antibiotics (Cephalosporins, Metronidazole)
o Therapeutic antibiotics given when indicated
o Parenteral for at least 2 days then shifted to oral
Antimicrobial prophylaxis
Early pyrexia < 36 h Late pyrexia > 36 h
Unexplained fever
Atelectasis
Peritoneal soiling
Occult bowel injury
Bladder injury
Ureteric obstruction
Wound infection
Any of the early causes
UTI
Pneumonia
Haematoma
Pelvic
Wound
DVT/Septic thrombophlebitis

10. o Patient catheterised prior to any
surgery
o Usually removed after 24 hours
o A fluid intake and output chart
must always be kept accurately in
order to check that the urinary
system is resuming its normal
function.
o Catheter must be checked
frequently because kinking of the
catheter or tubing causes back
pressure and harmful distension, as
well as intense discomfort.
Bladder Care

11. o Rapid recovery of bowel function is
directly proportional to operating
time
o Early ambulation helps to recover
bowel function more rapidly as well
as use of alternate analgesics to
opiates
o Auscultate for bowel sounds
(absence of bowel sounds
associated with abdominal
distention implies a paralytic ileus-
NG tube, longer bowel rest with
correction of electrolyte imbalance)
o Oral feeding is started with clear
liquids and then advanced to light
Assess for GI function

12. o Early mobilization encouraged
o Starts after anaesthesia wanes off
o Deep breathing exercises and
movements of limbs encouraged
Ambulation

13. o Reduces mortality and morbidity
from DVT and pulmonary
embolism
o TEDs/LMWH
o There is growing evidence that the
risk for thromboembolic disease
can last for up to 6 weeks so
many clinicians recommend their
patients to wear anti-
embolic stockings for that length of
Thromboprophylaxis

14. Assess the wound for:
o Bleeding / discharge
o Signs of infection e.g. increasing pain,
redness or discharge
o Observe for signs of wound separation or
dehiscence
o Wound dressings should be removed by 48-
72 hours after surgery and abdominal
wound sutures are usually removed on day 5
for pfannestiel incisions and day 7 for
midline incisions
Wound Care

15. o Sutures in the infected part are
removed for free drainage of pus
o Wound swab taken for culture
and sensitivity
o Placed on broad spectrum
antibiotics pending the result of
culture and sensitivity
o Wound dressing and
debridement of necrotic tissues
Management of wound infection

16. o If drains are used these should be
checked
o Drained incisions are likely to
become infected
o Should be removed when there is
less than 100 ml/day being
collected.
o Drains should be avoided when
ascites is present since it may be
difficult to decide when to remove
Drains

17. o Monitoring of vital signs, level of consciousness, urine output and amount of
vaginal bleeding
o Palpation of the fundus
o NPO
o IV fluids
o IV or IM analgesia
o Antimicrobial prophylaxis
o Care of wound
o Ambulation – early mobilization is encouraged
o Prophylaxis for thromboembolism – TEDs and LMWH
o Encourage early breastfeeding
Post c-section care

18. Depends on nature of surgery, General instructions:
o Not to lift heavy weight – 3 months
o Avoid coughing, constipation
o Gradually resume light work after 2-3 weeks
o Take Iron and Vitamin supplements – 6 weeks
o Avoid sexual contact 4-6 weeks
o Follow up after 2-6 weeks or earlier if any problem
Discharge and follow up