information for PO

1. 1.Trần Lê Phú Quốc
2.Lê Thị Trần Hồng Phấn
3.Lại Bảo Chung
4.Nguyễn Khánh Phương

2. WHAT IS PO???
• Postoperative care is the care you receive after a surgical procedure.
• The type of postoperative care you need depends on the type of surgery you
have, as well as your health history

3. POSTOPERATIVE NOTES
• The patient should be discharged to the ward with comprehensive orders for the following:
 Vital signs
 Pain control
 Rate and type of intravenous fluid
 Urine and gastrointestinal fluid output
 Other medications
 Laboratory investigations

4. ORDERS TO MONITOR
PATIENTS
• The patient’s progress should be monitored and should include at least:
 A comment on medical and nursing observations
 A specific comment on the wound or operation site
 Any complications
 Any changes made in treatment

5. COMPLICATIONS
• Postoperative complications may either be general or specific to the type of surgery undertaken
and should be managed with the patient's history in mind.
• Common general postoperative complications include postoperative fever, atelectasis, wound
infection, embolism and deep vein thrombosis (DVT).

7. NAUSEAAND VOMITING
• Most people think of nausea and vomiting as
something pretty insignificant, however it is a
side effect that can delay someone’s discharge
home if uncontrolled.
• And postoperatively, expect about half of
your patients to experience nausea and 30%
to experience the vomiting with it
(Koutoukidis et al. 2017; Gan et al. 2014).

8. ABDOMINAL DISTENSION AND
PARALYTIC ILEUS
• These two complications are very similar.
The patient will complain of abdominal
pain and be unable to pass flatus, they may
also have nausea and vomiting as well as a
distended abdomen.

9. • There are many factors which can
contribute to decreased urinary
function following surgery, resulting
in urinary retention. These include
pain, anxiety and a depressed
micturition reflex with certain
anaesthetic agents or when a spinal
anaesthetic or epidural is used.

13. HAEMORRHAGE
• Postoperative haemorrhage can classed into 2 categories:
 Reactionary haemorrhage occurs within the first 24 hours following the surgery from
dislodgement of clots from vessels
 Secondary haemorrhage results from infection that weaken these blood clots or the vessel
walls causing the haemorrhage

14. • Hypoxia is the term for when your blood isn’t
carrying enough oxygen for your body’s
needs, and we all know that our tissues and
organs need the oxygen from our blood to
survive so it is a very significant complication
following surgery.

15. Deep Vein Thrombosis (DVT)
• DVTs can occur following surgery due to
blood becoming stagnant in the veins, or
venous stasis.
• This happens because the blood needs some
help to flow back up your legs to your heart.
• Our calf muscles usually act as a pump to do
this but after surgery when your patient is
resting in bed for a prolonged period of time,
this will not occur and can result in a DVT
formation

16. • A pulmonary embolism (PE) occurs when
one of the pulmonary arteries is blocked by a
blood clot, air or fat.
• The patient will often complain of a sudden
onset of dyspnea, chest pain, cyanosis and a PE
can result in sudden circulatory collapse and
death

17. WOUND INFECTION
• Wound infections can also occur in the surgical wound;
therefore it is important that any dressing changes are
completed using aseptic technique.

18. • Wound dehiscence can
be quite traumatic for
the patient and also has
been found to be
associated with
mortality rates as high
as 45%!

20. Encourage early mobilization
• Deep breathing and coughing
• Active daily exercise
• Joint range of motion
• Muscular strengthening
• Make walking aids such as canes, crutches and walkers
available and provide instructions for their use

21. Ensure adequate nutrition

22. • Prevent skin breakdown and pressure sores:
 Turn the patient frequently
 Keep urine and faeces off skin

23. Provide adequate pain control

24. SIGNS OF RECOVERING
PATIENTS
• The recovering patient is fit for the ward when:

25. AWAKE, OPENS EYES

26. EXTUBATED

27. BLOOD PRESSURE AND PULSE ARE
SATISFACTORY

28. CAN LIFT HEAD ON COMMAND

29. NOT HYPOXIC

30. BREATHING QUIETLYAND
COMFORTABLY

31. APPROPRIATE ANALGESIA HAS BEEN
PRESCRIBED AND IS SAFELY ESTABLISHED

32. POST OPERATIVE PAIN RELIEF
PAIN
Provide useful clinical information help the patient and alleviate suffering.
Manage pain wherever you see patients and anticipate their needs for pain
management after surgery and discharge.
Do not unnecessarily delay the treatment of pain.

33. • Depends on the level of surgery, location of pain , history of patients, have rehabilitation after
surgery , the ability of the unit… about take care of patients.
PAIN MANAGEMENT AND
TECHNIQUES
• Effective analgesia is an essential part of postoperative management.

34. Score scale describe the pain
Score Describe
0 No pain
1-2 Mild, annoying pain. Not affect to normal activities , daily life
3 Uncomfortable .Maybe affect to daily life
4 Moderate
5-6 Distracting , Unmanageable .The pain is on the rise
7 Intense. All the daily life are affected by the pain
8-9 Much pain
10 Unable to move. The patient lay motionless or exhausted because of the pain

35. • Tier 1:Patient with 0 to 3 point => Non-morphine (paracetamol, nonsteroidal anti-inflammatory
drugs, noramidopyrin, floctafenin ...).
• Tier 2: Patient with 4 to 6 point => Morphine (codeine, dextropropoxyphen, buprenorphin,
tramadol).
• Tier 3: Patient with 7 to 10 point => Strong morphine.
ASSESSING THE PAIN IN 3 TIER OF WHO:

36. • Table of doses of some pain relievers of Level 1 -2 according to the World Health Organization
 Pain medication level 1:
 Piroxicam
 Celecoxib
 Etoricoxib
 Paracetamol
 Diclofenac
 Meloxicam

37.  Paracetamol 500mg-1500mg / day
 Diclofenac 50mg, 2 capsules / day, or 75mg / day

38.  Meloxicam 5mg-15mg / day
 Piroxicam 20mg / day

39.  Celecoxib 200 - 400mg / day
 Etoricoxib 60-90mg once a day

40.  Secondary painkillers - Paracetamol in combination with codeine or tramadol:
 Paracetamol 500mg + codeine 30mg (Eferalgan- codeine) 1-3 tablets / day
 Paracetamol 325mg + Tramadol 5 mg
(Ultracet) 1-2 tablets x 4 -6 times
daily, no more than 8 tablets / day

41. WHEN TO BE DISCHARGE
• Discharging patients from the hospital is a complex process
• One classification scheme to categorize these interventions is to consider them as:
 pre-discharge interventions
 post-discharge interventions
 bridging interventions

42. ELEMENTS OF THE DISCHARGE PROCESS
Discharge
planning
Medication
reconciliation
Patient
instructions
Discharge
checklist

43. DISCHARGE PLANNING
• The development of an individualized discharge
plan for the patient, prior to leaving the hospital, to
ensure that patients are discharged at an appropriate
time and with provision of adequate post-discharge
services.

44. MEDICATION RECONCILIATION
• Medication reconciliation, or medication
review, is the process of verifying patient
medication lists at a point-of-care transition.

45. MEDICATION RECONCILIATION
• The first step is having an accurate medication list at
hospital discharge, which depends on the following:
 Having an accurate preadmission medication list.
 Having an accurate list of medications being taken by the patient at the time of discharge.
 Having knowledge of what medication changes were made during hospitalization and the
reasons for the changes.

46. DISCHARGE SUMMARY
• The primary mode of communication between the hospital
care team and aftercare providers is often the discharge
summary, raising the importance of successful
transmission of this document in a timely fashion.

47. DISCHARGE SUMMARY
 The outcome of the hospitalization
 The disposition of the patient
 Provisions for follow-up care including appointments, statements of how care needs will be
met, and plans for additional services (eg, hospice, home health assistance, skilled nursing)
• Important elements in the discharge summary, as mandated by the Centers for Medicare and
Medicaid Services,are:

48. PATIENT INSTRUCTIONS
• At the time of discharge, the patient should be provided with a document that includes
language and literacy-appropriate instructions and patient education materials to help in
successful transition from the hospital.
• These documents should be brief, focused on critical information to the patient, and primarily
directed at what the patient needs to understand to manage his or her condition after discharge.

49. • One model for patient materials, developed by the National Patient Safety Foundation, is
called “Ask Me 3” :
(1) What is my main problem? (ie, why was I in the hospital?)
(2) What do I need to do? (ie, how do I manage at home, and what should I do if I run into
problems?)
(3) Why is it important for me to do this?
PATIENT INSTRUCTIONS

50. DISCHARGE CHECKLIST
• Checklists provide an effective mechanism for ensuring
that discharge communications (the discharge summary
and direct communication with both aftercare providers
and patients/families) reliably incorporate all key
elements.

51. On discharging the patient from the
ward, record in the notes:
 Ensure that a copy of this information is given to the patient, together with details of any
follow-up appointment
• Diagnosis on admission and discharge
• Summary of course in hospital
• Instructions about further management, including drugs prescribed.