术前和术后护理

Pre and Postoperative Care,Dept of Surgery Yong Loo Lin School of MedicineNational University of Singapore,Preoperative Care,“The most important decision a surgeon can make is to operate on a patient”The decision is a Risk-Benefit Analysis,Goals(Why),Recognize and Optimize the risk factors for surgery,How to do it,HistoryExaminationInvestigations,History Taking,Past medical & surgical historyCardiac, respiratory, renal, nutritionDrug hxSocial HxFunctional status,ASA Classification,Investigations,Basics (for all age50)FBC, urea/electrolyteCXR, ECGSpecific (when indicated)LFT; PT/PTTABG; Pulmonary function testothers,Special Preparation,Management of DiabetesDVT ProphylaxisBowel preparationProphylactic antibiotics selectively,Postoperative Care,Recognize postop complicationsPain managementPostop fevers,Postop Complications,General Examples: AMI, CVA, pneumonia/atelectasis, renal failureSpecificExamples: anastomotic leakage, abscess formation, wound infection, ileus, bleeding,Postop Complications,General Important examples: AMIpneumonia/atelectasisrenal failureDVT/Pulmonary embolismCVA,Postop Complications,SpecificExamples:anastomotic leakage abscess formationwound infection ileus bleeding,Scenario,Pain Management,Essential part of postop managementPain can increase risk of complicationsPain relief- Multimodal E.g. PCA, IM pethidine, oral analgesics,Postop Fevers,An important sign of postop complicationsMany possible DDXTime of onset may guide the management,Postop Fevers,First 48hrsAtelectasisTransfusion rxnPre-existing infection3-7 days: infectionsUTI, wound infection, pneumonia, anastomotic leakage,Postop Fevers,About 7 days onwardsInfectionsAbscess formationDVT/PE,Postop Fevers,HistoryExaminationInvestigations (to confirm the diagnosis),Summary,Pre and Postop care are essential parts of surgical treatmentGood History, physical examination a