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Posloperal|ve Care ard Varagererl ol

Crapler Z
Crapler Z: Posloperal|ve Care 1
Learn|ng 0bject|ves
Crapler Z: Posloperal|ve Care 2
escr|oe pal|erl ror|lor|rg ard recovery care aller ra|e
Rev|eW posloperal|ve d|scrarge |rslrucl|ors
escr|oe esserl|a| las|s dur|rg roul|re ard erergercy
lo||oW-up v|s|ls
Recogr|ze, lreal or reler posloperal|ve corp||cal|ors aller
l |s very |rporlarl lo ror|lor lre pal|erl lor al |easl 30
r|rules aller surgery, oecause |l |s dur|rg lr|s per|od lral
lre ellecls ol surg|ca| lraura ard olrer corp||cal|ors
oecore apparerl.
A|lrougr rurses or olrer slall reroers W||| carry oul lre
las|s re|aled lo posloperal|ve recovery ard d|scrarge, the
surgeon |s u|t|mate|y respons|b|e for the qua||ty of
post-c|rcumc|s|on care.
Crapler Z: Posloperal|ve Care 3
!ostoperat|ve Hon|tor|ng
1. Rece|ve the pat|ent lror lre lrealre; rev|eW
lre pal|erl record.
2. Hon|tor the pat|ent's v|ta| s|gns: crec|
o|ood pressure, resp|ral|or ard pu|se lW|ce al
15-r|rule |rlerva|s.
3. 6heck the surg|ca| dress|ng lor ooz|rg or
4. Ask the pat|ent |f he has any pa|n.
5. 0bserve the genera| cond|t|on ol lre
Crapler Z: Posloperal|ve Care 1
!ostoperat|ve Hon|tor|ng (cont.}
. Adm|n|ster drugs or lrealrerl prescr|oed.
7. !rov|de b|and carbohydrates (such as b|scu|ts} and ||qu|ds lo
ra|se o|ood sugar |eve|s.
8. hand|e the pat|ent gent|y Wrer rov|rg r|r.
9. Hake the pat|ent comfortab|e accord|rg lo lre c||rale.
10. 6omp|ete the pat|ent record form.
Crapler Z: Posloperal|ve Care 5
!at|ent nstruct|ons
%re dress|ng shou|d be removed 24 to 48 hours after
surgery, |l lrere |s ro o|eed|rg or ooz|rg.
%re pal|erl srou|d oe |rslrucled lo ear fresh|y |aundered,
|oose-f|tt|ng underear, Wr|cr srou|d oe crarged eacr day. `
o||oW|rg dress|rg rerova|, lre pal|erl ray sroWer lW|ce a
day, la||rg care lo gerl|y Wasr lre ger|la| area W|lr r||d soap
(oaoy soap) ard Waler.
Crapler Z: Posloperal|ve Care
Crapler Z: Posloperal|ve Care Z
'l |s very |rporlarl lo |rlorr lre pal|erl lral
re srou|d avo|d sexua| |ntercourse and
masturbat|on for
4 to eeks after the procedure lo preverl
orea|doWr ol lre Wourd. A condom shou|d
then be used to protect the ound dur|ng
act of sexua| |ntercourse for at |east
8exua| Act|v|ty fo||o|ng 6|rcumc|s|on
!ostoperat|ve !en||e Erect|ons
A|| rer rave per|od|c per||e erecl|ors dur|rg s|eep ard
yourger rer lrequerl|y gel dayl|re erecl|ors.
Aller lre c|rcurc|s|or, erecl|ors W||| occur oul lrese W||| rol
d|srupl lre process ol Wourd rea||rg.
ur|rg lre |rred|ale recovery per|od, pro|onged or pa|nfu|
erect|on can be stopped by |nha|at|on of one ampou|e of
amy| n|trate.
Crapler Z: Posloperal|ve Care 8
!otent|a| 0anger 8|gns
efore d|scharge:
rsure lral lre pal|erl/parerl urderslards lre s|grs ol polerl|a|
proo|ers re srou|d Walcr oul lor, rare|y:
rcreas|rg o|eed|rg
3evere pa|r |r lre per|s or ger|la| area
rao|||ly lo pass ur|re or severe pa|r Wrer pass|rg ur|re
Pus d|scrarg|rg lror lre surg|ca| Wourd, |rcreas|rg sWe|||rg
Crapler Z: Posloperal|ve Care 9
!otent|a| 0anger 8|gns (cont.}
efore d|scharge:
rsure lral lre pal|erl/parerl:
urderslards lral re srou|d relurr lo lre c||r|c |rred|ale|y or
see| erergercy care |l a proo|er deve|ops.
nos here to go |l ard Wrer corp||cal|ors ar|se.
as oeer g|ven r|tten postoperat|ve |nstruct|ons ard ras
oeer as|ed lo repeal lrer.
Crapler Z: Posloperal|ve Care 10
!at|ent nstruct|ons (cont.}
efore d|scharge:
rsure lral lre pal|erl/parerl:
as oeer g|ven med|cat|ons as ordered.
as rade a fo||o-up appo|ntment.
as a respons|b|e adu|t to accompany h|m home (lr|s |s ol
parl|cu|ar |rporlarce lor procedures dore or urderage
Crapler Z: Posloperal|ve Care 11
|na| 8teps for !at|ent 0|scharge
rsure lral lre pal|erl:
as oeer conf|rmed to be d|scharged oy lre operal|rg
surgeor or r|s/rer des|gree.
Record has been comp|eted.
A|| pal|erl records srou|d oe ra|rla|red al lre serv|ce s|le
Wrere lre procedure loo| p|ace, ard lre s|le srou|d serd
a copy |r case lre pal|erl |s lrarslerred.
Crapler Z: Posloperal|ve Care 12
Rout|ne o||o-&p
3rou|d occur |th|n 7 days ol procedure
3rou|d |rc|ude:
6heck ol med|ca| record or relerra| lorr
Ask|ng aooul ary prob|ems or comp|a|nts:
ourd d|scrarge or o|eed|rg
ur|rary d|ll|cu|l|es
Pa|r or olrer d|slress
Per||e or scrola| sWe|||rg
Crapler Z: Posloperal|ve Care 13
Rout|ne o||o-&p (cont.}
Exam|ne lre s|le ol operal|or lo assess rea||rg ard lre
aoserce ol |rlecl|or.
%real ary corp||cal|ors or reler lre pal|erl lo a r|grer
As| lre pal|erl lor correrls lral W||| re|p |rprove lre
0ocument lre lo||oW-up v|s|l |r lre pal|erl's red|ca|
record (oomp|a|nrs, o|anos|s ano rrearmenrj.
Crapler Z: Posloperal|ve Care 11
Emergency o||o-&p V|s|ts
Exam|ne lre pal|erl |rred|ale|y. Crec| a|| areas re|aled
lo r|s corp|a|rl.
Read the med|ca| record, |l ava||ao|e.
As| lre pal|erl aooul lre sequerce ol everls s|rce lre
operal|or, ard aooul ary proo|ers dur|rg lre surgery or
aller ard lrealrerls oola|red.
0ec|de on the treatment lor proo|ers lral car oe
rard|ed or ar oulpal|erl oas|s.
Crapler Z: Posloperal|ve Care 15
Emergency o||o-&p V|s|ts (cont.}
Arrarge lor a r|grer |eve| ol lrealrerl lor polerl|a||y
ser|ous corp||cal|ors.
Nole or lre pal|erl record a|| proo|ers ard acl|ors la|er.
rlorr lre lac|||ly Wrere lre ra|e c|rcurc|s|or Was
perlorred aooul lre erergercy lo||oW-up v|s|l (|l
Crapler Z: Posloperal|ve Care 1
Recogn|t|on and Hanagement of
Crapler Z: Posloperal|ve Care 1Z
Th|s sect|on descr|bes:
Corp||cal|ors lral car oe raraged
|r lre c||r|c sell|rg
rd|cal|ors lor relerra| lo a r|grer
|eve| ol care
0rgan|z|ng Referra|s
%re pal|erl srou|d oe lrarslerred oy arou|arce, |y|rg l|al.
%re pal|erl ard r|s lar||y srou|d oe g|ver a lu|| exp|aral|or ol
Wral |s rapper|rg ard Wry.
A c|ear role srou|d oe serl lo lre relerra| cerlre W|lr lre
%re pal|erl srou|d oe lo|d rol lo eal ard, deperd|rg or lre
|erglr ol lre jourrey, rol lo dr|r|, as a gerera| araeslrel|c ray
reed lo oe g|ver al lre relerra| cerlre. Ary accorpary|rg
lar||y reroer srou|d a|so oe g|ver lr|s |rlorral|or.
Crapler Z: Posloperal|ve Care 18
T|m|ng of 6omp||cat|ons
Corp||cal|ors ray occur:
Crapler Z: Posloperal|ve Care 19
1-2 0ays
aller 3urgery
1-2 weeks
aller 3urgery
6omp||cat|ons 0ccurr|ng
Crapler Z: Posloperal|ve Care 20
1-2 ays
aller 3urgery
1-2 ee|s
aller 3urgery
xcess|ve adres|ors
Acc|derla| |rjury
xcess|ve o|eed|rg
Excess|ve Adhes|ons
l lrere are excess|ve adhes|ons, |l ray oe very d|ll|cu|l lo
separale lre lores||r lror lre g|ars (e.g., pr|ros|s).
eperd|rg or lre exper|erce ol lre c|rcurc|s|or lear, |l may be
better to stop the procedure ard |r lr|s s|lual|or:
Repa|r lre dorsa| s||l us|rg sl|lcres lo slop o|eed|rg.
Keep lre area as c|ear as poss|o|e.
Reler lre rar lo lre relerra| rosp|la| as soor as corver|erl.
%re rar srou|d oe seer W|lr|r 21-18 rours.
Crapler Z: Posloperal|ve Care 21
Excess|ve |eed|ng
l lrere |s excess|ve o|eed|rg dur|rg surgery, lre l|rsl ru|e lor lre
surgeor |s 00'T !A6".
P|ace a sab under the pen|s ard lrer a second sab over the
b|eed|ng po|nt.
6ontro| the b|eed|ng |th f|rm pressure and wAT Crec| ellecls
al 5-r|rule |rlerva|s (l|red oy lre c|oc|).
Aller 5 r|rules, s|o|y ||ft off the sab ard, rore oller lrar rol,
lre o|eed|rg W||| rave slopped.
Crapler Z: Posloperal|ve Care 22
Excess|ve |eed|ng (cont.}
l o|eed|rg ras rol slopped, app|y a haemostat|c artery forceps.
l lr|s does rol corlro| lre o|eed|rg, lrer app|y pressure over a
gauze sWao lor a lurlrer 5 r|rules (l|red oy lre c|oc|).
Al lre erd ol lr|s l|re, lre sWao |s gerl|y ||lled aga|r ard lre
o|eed|rg area |s under-run |th a f|gure of e|ght suture.
l o|eed|rg corl|rues, transfer to a referra| centre as ar
erergercy or ca|| a rore exper|erced surgeor lo re|p.
Crapler Z: Posloperal|ve Care 23
Acc|denta| njury
Acc|derla| |rjury car |rc|ude |rjury lo lre g|ars, ra||rg |l
d|ll|cu|l lo corlro| o|eed|rg.
The chance of these acc|dents |s reduced |f a||
c|rcumc|s|on surgeons rece|ve proper tra|n|ng and
cert|f|cat|on ard |l lrere |s a sysler ol orgo|rg appra|sa| ard
recerl|l|cal|or |r p|ace.
A dargerous s|lual|or |s Wrer lre surgeor oecores
overcorl|derl or Wrer l|relao|e corslra|rls resu|l |r rurr|ed
Crapler Z: Posloperal|ve Care 21
Acc|denta| njury (cont.}
l lrere |s ar acc|derla| |rjury dur|rg surgery:
6ontro| b|eed|ng by pressure over a p|ece ol gauze.
Transfer lre rar lo a relerra| cerlre (or ca|| a rore exper|erced
surgeor or uro|og|ca| spec|a||sl).
Pass a ur|rary calreler ard Wrap lre per|s |r sler||e gauze W|lr lre
gauze laped |r p|ace, |l lrarsler l|re W||| oe |org.
ur|rg lre lrarsler, lre pat|ent shou|d be |y|ng f|at.
%re pal|erl ard r|s re|al|ves srou|d oe lo|d Wral ras rappered ard
Wral |s go|rg lo oe dore.
Crapler Z: Posloperal|ve Care 25
6omp||cat|ons 0ccurr|ng
Crapler Z: Posloperal|ve Care 2
ur|rg 3urgery
1-2 0AY8
after 8urgery
1-2 ee|s
aller 3urgery
aeralora lorral|or
ourd d|srupl|or
%re rosl |||e|y corp||cal|or dur|rg lre l|rsl 21-18 rours |s b|eed|ng
or haematoma.
l lre pal|erl cores oac| W|lr b|ood-soaked dress|ngs, remove
lrer ard |nspect the c|rcumc|s|on ound lor ar oov|ous o|eed|rg
l lrere |s fresh b|ood from the sk|n edge, p|ace further sutures
(urder lu|| sler||e cord|l|ors) |rc|ud|rg |oca| araeslres|a ard sler||e
Crapler Z: Posloperal|ve Care 2Z
haematoma lorral|or ray a|so oecore rar|lesl.
l ray oe assoc|aled W|lr cors|derao|e oru|s|rg ard s||r
haematomas are best |eft a|one un|ess they are very |arge or
lrere |s corl|rued o|eed|rg.
App|y a lurlrer c|ear dress|rg ard:
Rev|e the pat|ent |n 24 hours, or
8end the pat|ent to the referra| centre.
Crapler Z: Posloperal|ve Care 28
wound 0|srupt|on
&nusua| |n the f|rst fe days ard ray oe assoc|aled
W|lr suoculareous o|eed|rg ard raeralora lorral|or
Wrer lre sl|lcres cul oul.
Vay serd lre rar lo a relerra| cerlre Wrere:
%re Wourd car e|ther be sutured or
Left to hea| by secondary |ntent|on.
l lre d|srupl|or occurs W|lr|r lre l|rsl 18 rours ol lre
operal|or, exp|ore ard re-sulure lre Wourd.
Crapler Z: Posloperal|ve Care 29
6omp||cat|ons 0ccurr|ng
Crapler Z: Posloperal|ve Care 30
ur|rg 3urgery
1-2 ays
aller 3urgery
1-2 wEE8
after 8urgery
ourd |rlecl|or
ourd d|srupl|or ard cull|rg oul ol sl|lcres
ourr|er's gargrere
wound nfect|on
Aller 2-3 days, lre rosl |||e|y proo|er |s ound |nfect|on.
%realrerl |s oy frequent shoer|ng and ant|b|ot|cs, W|lr c|ean
dress|ngs beteen shoers.
Ly|ng don W|lr lre per|s as lre r|gresl po|rl ol lre oody
promotes dra|nage of |ymphat|c f|u|d.
%re Wourd car oe rursed oper, oul |l srou|d oe prolecled lror
Crapler Z: Posloperal|ve Care 31
wound 0|srupt|on and
6utt|ng 0ut of 8t|tches
when st|tches cut out, lr|s usua||y |nd|cates an |nfect|on ard lre
reed lor arl|o|ol|cs.
l rore lrar 18 rours, lre ound shou|d be |eft to hea| by
secondary |ntent|on.
Va|e arrargererls lor regu|ar c||n|c rev|es unt|| the ound
has hea|ed.
%re rea||rg process aller |rlecl|or |eaves ar url|dy resu|l lor lre
l|rsl leW rorlrs. oWever, aller a year or so lre appeararce
oecores rerar|ao|y rorra|.
Crapler Z: Posloperal|ve Care 32
ourn|er's angrene
A rare r|s| ol ger|la| surgery |s |rlecl|or
W|lr ru|l|p|e oacler|a caus|rg progress|ve
s||r |oss, |roWr as ourn|er's gangrene.
Vore common |n d|abet|c men.
l lrere are s|grs ol spread|rg |rlecl|or or
o|ac| gargrerous s||r:
urgerl|y transfer the man to a referra|
centre lor lre rerova| ol a|| lre dead s||r
urder gerera| araeslres|a.
Crapler Z: Posloperal|ve Care 33
6omp||cat|ons 0ccurr|ng
Crapler Z: Posloperal|ve Care 31
ur|rg 3urgery
1-2 ays
aller 3urgery
1-2 ee|s
aller 3urgery
ecreased g|ars sers|l|v|ly
0versers|l|v|ly ol lre g|ars
urs|grl|y c|rcurc|s|or Wourds, ragged scars ard cosrel|c corcerrs
Pers|slerl adres|ors al lre corora ard |rc|us|or cysls
recl||e d|scorlorl
%ors|or (r|sa||grrerl) ol lre s||r ol lre per||e srall
0peral|ve corp||cal|ors ol ra|e c|rcurc|s|or car |rc|ude:
xcess|ve o|eed|rg
aeralora lorral|or
ursal|slaclory cosrel|c ellecl
Laceral|ors ol lre per||e or scrola| s||r
rjury lo lre g|ars
Crapler Z: Posloperal|ve Care 35
8ummary (cont.}
C|rcurc|s|or corp||cal|ors car oe avo|ded oy:
Allerl|or lo aseps|s
Perlorr|rg adequale oul rol excess|ve exc|s|or ol lre |rrer ard
ouler prepul|a| |ayers
Prov|d|rg adequale raeroslas|s
Pay|rg allerl|or lo cosrel|c ellecls
Crapler Z: Posloperal|ve Care 3
Crapler Z: Posloperal|ve Care 3Z
Photo credit. Dipo Otolorin