CASE 02: PRE-OP & POST-OP CARE

Read: Chapter 24 & 25 p157 Pre-op & Post-op Counseling & Mgmt, PGH
Significance: OB GYN is a surgical specialty.

CASE 2
45, G3P3 consulted because of a pelvic mass which she felt 5 years ago. It gradually grew to its present size, reaching the level
of umbilicus.
Case 2: 45 G3P3The management of the mass will require surgery.
(3-0-0-3)

FIRST: Example Schedule for PRE-OP

What is the nature?  Pre-op (6/12)
 Ask for symptoms that may point to GI tract, GI or  Scheduled for TAH at 7 AM (6/13)
Urinary system  NPO from 12 AM (
 IF from reproductive: Is it UTERINE or ADNEXAL? o To prevent ASPIRATION
o Normal Gastric Emptying Time: 4 – 6 hours
Most Important:  Clean bowels
 Benign or Malignant o Enema/ Laxatives in Rectosigmoid & Colon
 Systemic manifestations of malignancy: weight loss  Early morning of operation: Start of IV fluid
 Prior to Op: Prophylactic antibiotics: Single dose 30 mins
Other details needed: o Us. Cephalosporin 2 gr IV. (Cefuroxime)
 PMH: Meds taken o By operation time: antibiotics in circulation
 Comorbidities: HTH, DM,
 Previous surgery/Anesthesics TX: TAH (Total Abdominal Hysterectomy)
 Allergy (for drugs intending to use in the operation:
antibiotics, analgesic & anesthetic) Note: Age 45 (Not yet menopause)
 IF HTN and - NOT TAHBSO (+Bilateral Saphingo-Oophorectomy)
- Taking anticoagulant (80 mg ASA or Clopidogrel) - Leave the Ovaries behind
- Patient cannot be subjected to surgery at once, - To prevent premature menopause
- Discontinue for 1 - 2 weeks depending on the
dose Hysterectomy:
 ROS (Do I need to get any additional ancillary  Take out the uterus, attachments to the pelvis (Round,
procedures?) Uterine, Ovarian, Cardinal, Utero-sacral, Cervico-vaginal
junction…)
Note: IF px < 45 years old in conjunction with anticoagulant &
OCP, both drugs should be discontinued before the scheduled Radical Hysterectomy
operation.  Part of vagina + uterus
 For Cervical cancer patients w/ chances of going to the
PE: Uterine Mass upper vagina
 Nodularly enlarged uterus to 5 mos size
 PREG @ 20 weeks/ 5 mo = @ level of umbilicus IF 30 yr old: Nulligravid + Mass  DO UTZ
DX: Myoma Uteri (Benign Tumor Muscle of the Uterus)  Need to know the type of myoma to conserve the uterus

Ancillary procedures: IF 50 yr old: Include the ovaries  Expected to have

1. UTZ natural physiologic menopause
 To differentiate: Uterine vs Adnexal
POST-OP:
 What kind? Trans-abdominal (mass risen from the pelvis
 abdomen)
PACU
 IF: 110% SURE that it is Myoma: Still need to do UTZ?
 Post Anesthesia Care Unit (Effects of Anesthetics)
YES: IF you can feel what the patient doesn't feel, you make  Used to be called Recovery Room
her appreciate the mass  Critical period: Life threatening complication may occur in
this time.
2. Blood: CBC, Bld Type, Coagulation, Electrolytes  2 hours close monitoring for the normalization of vital
3. Cardiopulmonary Clearance: ECG & CXR (until 60 yrs old) signs (VS q 15 mins)
4. DM: FBS, Serial monitoring of capillary blood glucose
5. Renal Function Test (monitor receiving of medication) DIFFERENT COMPLICATION: Cardiorespiratory, GI, GU Tract
6. Urinalysis What are the immediate post-op problems manifested by
change in VS?
Preparation: Informed Consent o Bleeding  Tachycardia, Hypotension, Oliguria
o Early onset of FEVER  Atelectasis, NOT an infection (us.
Day 4 - 5)

Do: Deep breathing exercise,

 Good post- op analgesia: NO pain with deep breathing