Want to collect culture before beginningAntibiotic could cause bacteria not to growIf >103: Antipyretics and cooling measuresNormal feversImmunocompetent person = 101.5 or aboveImmunosuppressed person = 100.5Elevation in temperature = expected in first few days due to inflammationGastrointestinalNausea/VomitingAntiemeticsAspiration precautionsWhen to resume dietCan’t until they have bowel signs and pass flatusAbdominal distention (begin with least invasive intervention)AmbulationNG tube decompressionRight-side positioningBisacodyl (Dulcolax) suppositoriesHiccupsMeds (these are typically very sedative)GenitourinaryOliguriaUrine output should be at least 0.5mL/kg/hr (adult) VERY IMPORTANTBased on a 60kg personStrict I/OMonitor BUN and creatinineIV fluidsUrinary retentionNormal positioning for urinationAmbulate to BR or BSCPrivacy, running water, etc. Bladder assessment for distentionBladder scanIf empty, may need more fluid intakePalpate bladderCatheterize only if needed, per orders(last resort)Minimize use of indwelling urinary catheters
IntegumentaryPoor would healingPromote nutritionAlso concern for obese and elderlyWould infection due toExogenous flora present in the environment and on the skinOral floraIntestinal floraAssess wounds for signs and symptoms of infectionWould dehiscenceSeparation and disruption of previously joined would edgesEdges of would separateWound eviscerationBowel contents protruding through the abdominal wallTreatment:If OOB, return patient to bedLower head of bed to 20 degrees or lessHave patient bend knees and avoid coughingSterile gauze or towels soaked in normal saline placed over woundAssess wound for colorFrequent vital signsPrepare patient to return to OR for emergency surgery24. DischargePACU DischargePatient is awake or at baselineVS stable or at baselineNo excessive bleeding or drainingNo respiratory depressionO2 Sat > 90%Report givenAmbulatory surgeryAll PACU criteriaNo IV opioids in past 30 minutes (pain needs to be controlled)Minimal Nausea and vomitingVoidedAble to ambulate if not contraindicatedResponsible adult present to accompany patientWritten discharge instructions given and understoodPatient must be stable and near the level of preoperative functioningInformation and teaching requiredCare of incision and dressingsBathroom recommendationsAction and side effects of medications; when and how to take themActivities allowed and prohibited; when normal activities can be resumedDietary restrictions and modificationsWhen and where to return for follow-up careAnswers to questions and concerns**Typically going to be talking to caregiver**25.Blood product transfusions (indications, compatibility, what to do in the event of a reaction)Packed RBCs250-310mLPrepared from whole blood with 85-90% of the plasma removedIndications
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- Fall '08
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