Care of children after urological operations. Prevention of complications after surgery and rehabilitation - intensive care, nursing care and supervision. Vomiting in the postanesthetic period

What you need to know about stitches after appendicitis

After surgery to remove the appendix, the child will receive stitches. The size of the sutures depends on the size of the inlet that the surgeons had to make to remove the inflamed appendix (and the consequences of its inflammation). A protective dressing or special sticker will be applied over the stitches, which is changed every 3-4 days until the stitches are removed. The first stitch care for the child will be provided in the hospital. But the further healing process of the postoperative suture becomes your responsibility.

The seam that you see on the child's body is only one of several that tighten the tissues cut during the appendectomy. And only the surface seam is subject to removal, because. internal ones are made using catgut - a suture material that dissolves within 1-2 months. However, despite the fact that at home you only have to take care of the superficial suture, you need to be prepared for the fact that sometimes internal sutures can also cause postoperative complications.

First of all, you should be attentive to the baby's complaints about pain in the area of the postoperative wound. Pain in a cut wound is natural. However, one must take into account how long the suture bothers the child and how the operation site looks like.

Be sure to show the child to the surgeon in the following cases:

the postoperative suture looks reddened, inflamed
swelling, swelling appeared in the seam area
the seam constantly gets wet, but does not dry out
purulent discharge from the suture area
the formation of one or more tubercles at the site of suturing
the child has a fever
the child continues to complain of pain in the suture area, after 10-12 days
the child suddenly began to hurt the stomach in the area of the seam

Pain in the suture area can have various causes, from benign to requiring surgical intervention. In the first couple of weeks, the child may experience pain during the formation of the scar. Both the forming scar itself and the tissues around it can hurt, because. they experience tension (women who have had a caesarean section know how this happens). The child will have to endure such pain. For most, it resolves in 10-12 days, but in rare cases it can take several months. Sensitive children may experience phantom pain some time later.

However, you should not attribute all complaints of the child after surgery for appendicitis to sensitivity to pain. The cause of pain in the abdomen around the seam can be, for example, a ligature abscess (suppuration in the area of internal seams), a ligature fistula, a divergence of internal seams.

Stitches after appendicitis surgery may come apart for several reasons:

an infected wound (the infection could have been introduced both during the operation and after it)
improper seam care
overstrain of the abdominal wall (weight lifting, untimely physical activity)
reduced immunity (both the healing process and the presence of inflammatory processes around the sutures strongly depend on this)
individual characteristics of a small patient (including diseases such as diabetes, for example).

The main advice to the parents of a child after appendicitis: if you see that “something is not right” with the stitches, do not engage in self-diagnosis, and even more so, self-medicate. Contact a surgeon who can determine the cause and prescribe adequate care for your child.

If the postoperative period passed without complications, in the first months the protracted sutures will be red, and then turn white. After a while, a small light scar remains at the site of the operation.

How to bathe a child after appendicitis

The first weeks after the operation, you will have to forget about the bath. Before the stitches are removed, the operation site cannot be wetted, so the child will have to be washed in parts - wash, rinse the legs, wipe the back, neck, chest. As soon as the protective bandage disappears, the restrictions are lifted. But many doctors still recommend that the first 2-3 weeks after the operation, limit yourself to bathing the child in the shower. If you still prefer a bath, make sure that the bathing water is not too warm, and the baby does not spend a lot of time in it, otherwise the seams will steam out, and the still weak unhealed tissue will pass the infection through them. In the bath, you can add a few grains of potassium permanganate, a decoction of chamomile or string. You should not get carried away with antiseptics and herbs, they dry out the skin, which will provoke the appearance of cracks at the incision site. After bathing, the place of the seam is recommended to be treated with antiseptic agents.

How to handle the seam after appendicitis

Proper suture care after appendicitis surgery significantly reduces the risk of complications associated with wound healing. At the same time, the care itself does not require serious efforts or experience from you. The main rule: follow the instructions that you will definitely be given when you discharge your child from the hospital.

As a rule, unless your instructions say otherwise, it is recommended to treat the superficial suture after appendicitis in a child 2 times a day using the most common antiseptics, such as potassium permanganate solution, hydrogen peroxide, iodine, Castellani liquid, Fukortsin, Zelenka. True, now many doctors do not like “colored” antiseptics that stain the skin for a long time, because because of this, parents can miss the onset of inflammation of the tissues in the suture area (the reddened tissue is simply not visible under the brilliant green). After the seam is processed, leave it open for a while.

Diet after appendicitis in children

Since the operation affects the intestines, sparing nutrition after appendicitis in children is one of the most important conditions for recovery. In the most successful state of affairs, the usual diet is restored by 7-8 days after the operation. As a rule, the child spends this time in the hospital, where he eats in accordance with the diet prescribed after the operation. During this period, the main thing for parents is not to try to feed the baby with something superfluous.

On the first day, it is only allowed to drink water without gas. And even during this period it is better not to give milk, because. it relaxes the intestines. And now the main thing is to avoid too plentiful and frequent bowel movements. The child is in pain, and the process of peristalsis will only increase the discomfort.

The next day, you can offer vegetable puree, liquid oatmeal, less fruit, and grapes and other “gas-forming” products should be excluded. Food should be given in small portions 5-6 times a day.

The third day is decisive. If after the operation the baby has not defecated yet, he will be prescribed an enema with 100 ml of water.

When the stool improves, you can expand the menu: on the 4th day, the child can be fed low-fat broth with chicken meatballs, and on the 5th day, offer a piece of boiled and twisted meat in a meat grinder. From these days, a gradual return to food of a solid consistency begins.

Most of the questions about nutrition after appendicitis in children are related to the period after discharge from the hospital. It takes at least 3 weeks to fully restore the digestive system after an appendectomy. Therefore, doctors advise sticking to a strict diet for at least 2 more weeks after discharge.

Here's what a child can do after appendicitis in the second week:

steamed or boiled vegetables
steamed dried fruits (but not exotic)
low fat chicken broth
vegetable broths
simple soups without spices and frying
low-fat varieties of fish and meat, boiled or steamed
low fat dairy products
buckwheat, rice oatmeal cooked in water, without adding milk (you can add a little butter)
tea, jelly, compote - try not to add sugar to them
white bread (in limited quantities)

Here is what a child cannot do after appendicitis for the first three weeks:

sweets (including marshmallows and marshmallows), ice cream, pastries, including pancakes and pancakes - all this can provoke bloating, so they are prohibited for at least a month!
sugary drinks, especially carbonated ones, as well as water with gas (sources of excess gas in the stomach)
jam as a sweetener for cottage cheese or yogurt (also leads to increased gas formation)
black bread (at least, banned for a week)
any fried foods (minimum 3 weeks)
french fries, chips and other deep-fried products
any legumes, incl. and their soups
raw cabbage (in salads, for example)
grape
pork, any fatty meat, incl. cutlets from them
sausages, including "baby" sausages
any semi-finished products
spices
any products containing dyes, artificial flavors, sweeteners - read the labels carefully!

According to parents who have had the experience of recovering a child after appendicitis, the most difficult thing in the postoperative period is to keep a month without sweets. Therefore, the most effective way is if a diet without sweets and pastries is followed not only by a small patient, but by the whole family. Not keeping forbidden foods at home is easier than denying them to a child.

How to avoid adhesions

Adhesions - the fusion of tissues, for example, intestinal rings, which were affected to some extent during the operation - begin to form almost immediately. Fortunately, in children they occur quite rarely, but not excluded. The main method of dealing with such a complication is movement. That is why, within a few hours after a simple surgical intervention, the crumbs can move. Those who have not yet learned to walk are allowed to turn over on their tummy, and those who have mastered the skill are allowed to walk around the ward. In another day, the doctor will show mom several massage and gymnastics techniques that will reduce the risk of adhesions. The complex must be performed daily until it is canceled by the doctor. If the operation went with complications and the baby was given drainage, the rules change.

Avoid colds

Postoperative complications often occur against the background of weakened immunity, so it is better for the operated baby not to get sick. Will it be possible to avoid infection if the doctor gave permission to attend kindergarten. There are no universal tips on how to protect yourself. Some parents find a way to leave the baby at home longer, others give him immunostimulants and vitamin-mineral complexes from a pharmacy. All these techniques help, but do not give a full guarantee that the baby will not get sick. It is important to leave the crumbs at home at any hint of the onset of a cold, then the disease, if it starts, will end faster and will not drag on.

What can a child after appendicitis: games, activities

Restrictions are minimal, but it all depends on the condition of the crumbs and the number of days that have passed since the operation. The more time has passed, the fewer restrictions. During the first time, feeling pain, the child himself is unlikely to want to show any physical activity. And later, when his mood improves, many taboos will no longer be relevant. Even if the temperature is kept at 37C, the child is allowed to do the usual things - play, draw, and so on. Physical activity, as well as sports activities that affect the press, of course, are still banned. About when the child can return to them, you should consult your doctor.

Reminder for parents

After the removal of the appendix and discharge from the hospital, it is recommended:

within 7-10 days to observe the home regimen (do not attend kindergarten or school);
it is obligatory to be observed by the surgeon in the clinic at the place of residence;
measure body temperature for 4-5 days (to track the possible onset of inflammation);
monitor nutrition: do not overfeed, give the child light food (vegetable soups, sparse cereals) that do not burden digestion;
if the surgery was performed with a traditional incision, it will be necessary to ensure that the child does not lift weights in the first month after the operation;
exemption from physical education after abdominal surgery can be extended by 2-3 months;
if laparoscopic surgery has been performed, then physical restrictions may be minimal (no more than 1 month), since small wounds heal much faster.

The role of the nurse in the postoperative period exceptionally large. A poorly conducted postoperative period can nullify a complex and lengthy operation. After the operation, the child is taken to the intensive care unit, provided with oxygen, equipment, medicines necessary for anesthesia and resuscitation. By the time the child arrives from the operating room, his bed should be warmed with heating pads. Due to the fact that gypsum splints are very often used to immobilize the operated limbs, a wooden shield is placed under the mattress in the bed of the operated person to prevent sagging of the bed and possible deformation of the gypsum bandage. The place on which the operated limb is placed should be covered with oilcloth and a diaper to prevent the mattress from getting wet. In order for the moisture from the plaster bandage to evaporate, on the 1st-2nd day after the operation, the plaster bandage should not be covered with a blanket. To reduce edema, prevent soft tissue compression and circulatory disorders in the operated limb, it is necessary to give it an elevated position. If the swelling of the limb in the bandage increases, it is necessary to call the doctor on duty. With his participation, the bandage is cut longitudinally and re-fixed with a bandage.

After skin plastic surgery to prevent local postoperative complications, it is recommended to apply an ice pack near the skin graft site. Cooling of the skin graft site may continue for the first 5 days after surgery, as directed by the physician. Cooled tissues experience less need for oxygen and are easier to tolerate temporary circulatory disturbance caused by surgery. If the operation was performed under general anesthesia, the child should be laid on his back without a pillow and covered with a blanket; heating pads should be placed at his feet. When using the heating pad, the nurse should check to see if it is leaking and wrap the heating pad in a towel so as not to cause burns. Usually the child is taken to the ward with a drip infusion system applied during the operation. With incompletely recovered consciousness, the child can pull the needle (catheter) out of the vein with a sharp movement, damage the bandage, so the awakening period requires special attention from the sister. Until the moment of full awakening of the child, his limbs should be fixed with cotton-gauze cuffs.

During the awakening period, oxygen therapy should be carried out and vigilantly ensure that vomit does not get into the windpipe if the child vomits. Fluid intake in the first hours after anesthesia, despite the usual thirst, must be sharply limited, since the intake of water inside can cause repeated vomiting. In the future, following the instructions of the doctor, it is necessary to gradually expand the drinking regimen and start feeding the child. The nature and frequency of feeding will be determined by the doctor.

The nurse should monitor the frequency of the child's natural excretions and, above all, the amount and nature of urine, monitor the state of the bandage applied during the operation, monitor the general condition and well-being of the child, behavior, complaints, check the pulse and respiration rate, body temperature. A sudden rise in temperature, the appearance of the first signs of respiratory or heart failure, urinary retention, soaking the bandage with blood, anxiety of the child - all these deviations in his condition should be a reason for an immediate call to the doctor. To prevent pulmonary complications, the child is prescribed inhalations and mustard plasters on the chest on the 1st day after the operation. On the second day after the operation of free skin grafting, child care becomes even more complicated. Under general anesthesia, a dressing is performed, during which the surgeon removes the upper layers of the dressings from the places where the skin was borrowed from; then the child is placed in a forced position in such a way that the donor sites remain open and can be dried under the frame with an electric lamp solux. The lamp is installed at a distance of 75 cm - 1 m from the patient. In order not to cause overheating of the child, the lamp must be turned off for 1.5 minutes every 30-45 minutes of warming up.

Depending on the location of the donor sites, the child has to be kept on the stomach, back or side, that is, in the same position, forced and uncomfortable, for 6-8 days, until a dry crust forms on the donor wounds - a scab. Only with the help of the systematic use of painkillers and psychological impact, it is possible to overcome this difficult period for the patient. On the 6-8th day after the operation, single-layer wipes on donor wounds, together with the lymph that has soaked them, dry up, forming a crust, and acute pain disappears. By this time, the child gets used to the forced position. Drying donor wounds helps prevent infection. In the future, their healing occurs under a scab from one layer of gauze and ends by the 10-15th day after the operation.

Burns in children. Kazantseva N.D. 1986

Surgery under general anesthesia in a person of any age is a concern. Adult people come out of anesthesia in different ways - someone moves away from the procedure easily, and someone badly, recovering for a very long time. Children, in addition to a general disturbance of well-being, are not aware of what is happening and cannot adequately assess the situation, so an operation under general anesthesia can become a lot of stress. Parents worry about the consequences of anesthesia, how it will affect the child's well-being and behavior, and what kind of care children will need after waking up.

Recovery period after surgery under general anesthesia

A little about drugs

Modern drugs for anesthesia practically do not have a negative effect on the child and are quickly excreted from the body, which provides an easy recovery period after general anesthesia. For anesthesia in children, in most cases, inhalation methods of administering an anesthetic are used - they are absorbed into the blood in a minimum concentration and excreted by the respiratory organs unchanged.

Helping a child recover from anesthesia

The exit from anesthesia occurs under the strict supervision of an anesthesiologist and begins immediately after the cessation of the administration of the anesthetic. The specialist closely monitors the child's vital signs, evaluating the effectiveness of respiratory movements, blood pressure levels and the number of heartbeats. After making sure that the patient's condition is stable, he is transferred to the general ward. It is advisable that parents wait in the ward for the child - an unpleasant condition after anesthesia, as a rule, scares children, and the presence of a loved one will help to calm down. In the first hours after waking up, the baby is lethargic, inhibited, his speech may be slurred.

Girl in the room after surgery

With the use of modern drugs, the period of their excretion lasts no more than 2 hours. At this stage, such unpleasant symptoms as nausea, vomiting, dizziness, pain in the surgical area, and fever may disturb. Each of these symptoms can be alleviated by taking certain measures.

Nausea and vomiting are common side effects of general anesthesia. It has been noted that the likelihood of vomiting is associated with blood loss - with extensive bleeding, the patient vomits in very rare cases. With nausea, the child is not recommended to eat for the first 6-10 hours after the operation, the liquid can be taken in small quantities so as not to provoke a new attack of vomiting. As a rule, relief occurs within a few hours after recovery from anesthesia. In the event that the child's condition has deteriorated significantly and vomiting does not bring relief, you can ask the nurse to give an injection of an antiemetic drug.
Dizziness and weakness are the body's natural reaction to anesthesia in the first hours after waking up. Recovery takes some time, and it is best if the child gets a few hours of sleep. In the event that for one reason or another sleep is impossible, you can distract the baby with cartoons, a favorite toy, an interesting book or a fairy tale.
Trembling is a consequence of a violation of thermoregulation. It is recommended to take care of a warm blanket in advance, which will help the child to warm up.
An increase in temperature is usually observed on the first day after surgery. Such a reaction of the body is considered normal in the case when the values \u200b\u200bdo not exceed subfebrile numbers. An elevated temperature a few days after the operation suggests the development of complications and requires an additional examination.

Nurse measures girl's temperature after surgery

General anesthesia has the greatest impact on babies up to a year. In infants, a clear diet and sleep pattern has been developed, which goes astray after anesthesia - children can confuse day and night, being awake at night. In this case, only patience will help - after a few days or weeks, the baby will return to his usual regime on his own.

In rare cases, parents observe that their child "fell into childhood", that is, he began to do things that are not typical for his age. You don't have to worry about it, it's most likely temporary and will go away on its own.

Some children after surgery with general anesthesia do not sleep well, are naughty, refuse to eat. To help your child fall asleep, there are some rituals that should be performed every day before bedtime. It can be a glass of warm milk, interesting fairy tales or a relaxing massage. Watching TV should be limited - frequent change of pictures provokes excitation of the nervous system, even the most familiar harmless cartoons can increase sleep disturbances.

Feeding a child after anesthesia

If the baby feels well, sleeps well, he is not bothered by fever, nausea or vomiting, then doctors advise returning to normal life as soon as possible. Early activation of the patient contributes to rapid recovery and prevention of postoperative complications. After 5-6 hours, doctors may allow your child to eat. Food should be light - it can be vegetable soup, jelly with crackers or toast, cereals on the water. Babies receive mother's breast or formula milk.

In the absence of vomiting, drinking plenty of fluids will help you recover quickly. Pure non-carbonated water, compotes, fruit drinks, teas are most suitable. Juices and sugary carbonated drinks are not recommended for frequent drinking, as they contain a large amount of sugar.

Proper psychological preparation, the presence of loved ones and compliance with all the doctor's recommendations will help the child to more easily survive the postoperative period. The child's body has the ability to recover quickly, and in a few days the baby will feel much better than on the first day after the operation.

After intervention in the body of a sick patient, a postoperative period is required, which is aimed at eliminating complications and providing competent care. This process is carried out in clinics and hospitals, it includes several stages of recovery. At each of the periods, attentiveness and care for the patient by a nurse, doctor's supervision is required to exclude complications.

What is the postoperative period

In medical terminology, the postoperative period is the time from the end of the operation to the complete recovery of the patient. It is divided into three stages:

early period - before discharge from the hospital;
late - after two months after the operation;
the remote period is the final outcome of the disease.

How long does it take

The end date of the postoperative period depends on the severity of the disease and the individual characteristics of the patient's body, aimed at the recovery process. Recovery time is divided into four phases:

catabolic - an increase in the excretion of nitrogenous wastes in the urine, dysproteinemia, hyperglycemia, leukocytosis, weight loss;
period of reverse development - the influence of hypersecretion of anabolic hormones (insulin, growth hormone);
anabolic - restoration of electrolyte, protein, carbohydrate, fat metabolism;
a period of healthy weight gain.

Targets and goals

Follow-up after surgery is aimed at restoring normal activities of the patient. The objectives of the period are:

prevention of complications;
recognition of pathologies;
patient care - the introduction of analgesics, blockades, ensuring vital functions, dressings;
preventive measures to combat intoxication, infection.

Early postoperative period

From the second to the seventh day after the operation, the early postoperative period lasts. During these days, doctors eliminate complications (pneumonia, respiratory and renal failure, jaundice, fever, thromboembolic disorders). This period affects the outcome of the operation, which depends on the state of kidney function. Early postoperative complications are almost always characterized by impaired renal function due to the redistribution of fluid in the sectors of the body.

Renal blood flow decreases, which ends on 2-3 days, but sometimes the pathologies are too serious - loss of fluid, vomiting, diarrhea, impaired homeostasis, acute renal failure. Protective therapy, replenishment of blood loss, electrolytes, stimulation of diuresis help to avoid complications. Shock, collapse, hemolysis, muscle damage, burns are considered common causes of pathologies in the early period after surgery.

Complications

Complications of the early postoperative period in patients are characterized by the following possible manifestations:

dangerous bleeding - after operations on large vessels;
abdominal bleeding - with intervention in the abdominal or chest cavity;
pallor, shortness of breath, thirst, frequent weak pulse;
divergence of wounds, damage to internal organs;
dynamic paralytic obstruction of the intestines;
persistent vomiting;
the possibility of peritonitis;
purulent-septic processes, the formation of fistulas;
pneumonia, heart failure;
thromboembolism, thrombophlebitis.

Late postoperative period

After 10 days from the moment of operation, the late postoperative period begins. It is divided into hospital and home. The first period is characterized by an improvement in the patient's condition, the beginning of movement around the ward. It lasts 10-14 days, after which the patient is discharged from the hospital and sent for home postoperative recovery, a diet, vitamins and activity restrictions are prescribed.

Complications

There are the following late complications after surgery that occur while the patient is at home or in the hospital:

postoperative hernia;
adhesive intestinal obstruction;
fistulas;
bronchitis, intestinal paresis;
repeated need for surgery.

The causes of complications in the later stages after surgery, doctors call the following factors:

a long period of being in bed;
underlying risk factors – age, disease;
impaired respiratory function due to prolonged anesthesia;
violation of asepsis rules for the operated patient.

Nursing care in the postoperative period

An important role in the care of the patient after the operation is played by nursing care, which continues until the patient is discharged from the department. If it is not enough or it is performed poorly, this leads to unfavorable outcomes and a lengthening of the recovery period. The nurse must prevent any complications, and if they occur, make efforts to eliminate them.

The tasks of the nurse for postoperative care of patients include the following responsibilities:

timely administration of drugs;
patient care;
participation in feeding;
hygienic care of the skin and oral cavity;
monitoring the deterioration of the condition and providing first aid.

From the moment the patient enters the intensive care unit, the nurse begins to fulfill her duties:

ventilate the room;
eliminate bright light;
arrange the bed for a comfortable approach to the patient;
monitor the patient's bed rest;
prevent coughing and vomiting;
monitor the position of the patient's head;
feed.

How is the postoperative period

Depending on the condition after the operation of the patient, the stages of postoperative processes are distinguished:

strict bed resting period - it is forbidden to get up and even turn in bed, it is forbidden to carry out any manipulations;
bed rest - under the supervision of a nurse or an exercise therapy specialist, it is allowed to turn in bed, sit down, lower your legs;
ward period - it is allowed to sit on a chair, walk for a short time, but examination, feeding and urination are still carried out in the ward;
general mode - self-service by the patient himself, walking along the corridor, offices, walks in the hospital area is allowed.

Bed rest

After the risk of complications has passed, the patient is transferred from the intensive care unit to the ward, where he should be in bed. The goals of bed rest are:

limitation of physical activation, mobility;
adaptation of the organism to the syndrome of hypoxia;
pain reduction;
restoration of strength.

Bed rest is characterized by the use of functional beds, which can automatically support the patient's position - on the back, stomach, side, reclining, half-sitting. The nurse takes care of the patient during this period - changes linen, helps to cope with physiological needs (urination, defecation) with their complexity, feeds and performs hygiene procedures.

Following a special diet

The postoperative period is characterized by adherence to a special diet, which depends on the volume and nature of the surgical intervention:

After operations on the gastrointestinal tract, enteral nutrition is carried out for the first days (through a probe), then broth, jelly, crackers are given.
When operating on the esophagus and stomach, the first food should not be taken for two days through the mouth. Produce parenteral nutrition - subcutaneous and intravenous intake through a catheter of glucose, blood substitutes, make nutrient enemas. From the second day, broths and jelly can be given, on the 4th add croutons, on the 6th mushy food, from the 10th common table.
In the absence of violations of the integrity of the digestive organs, broths, pureed soups, jelly, baked apples are prescribed.
After operations on the colon, conditions are created so that the patient does not have a stool for 4-5 days. Food low in fiber.
When operating on the oral cavity, a probe is inserted through the nose to ensure the intake of liquid food.

You can start feeding patients 6-8 hours after the operation. Recommendations: observe water-salt and protein metabolism, provide a sufficient amount of vitamins. A balanced postoperative diet for patients consists of 80-100 g of protein, 80-100 g of fat and 400-500 g of carbohydrates daily. For feeding, enteral mixtures, dietary canned meat and vegetables are used.

Intensive observation and treatment

After the patient is transferred to the recovery room, intensive monitoring begins and, if necessary, treatment of complications is carried out. The latter are eliminated with antibiotics, special medicines to maintain the operated organ. The tasks of this stage include:

assessment of physiological parameters;
eating according to the doctor's prescription;
compliance with the motor regime;
drug administration, infusion therapy;
prevention of pulmonary complications;
wound care, collection of drainage;
laboratory tests and blood tests.

Features of the postoperative period

Depending on which organs have undergone surgical intervention, the features of patient care in the postoperative process depend:

Abdominal organs - monitoring the development of bronchopulmonary complications, parenteral nutrition, prevention of gastrointestinal paresis.
Stomach, duodenum, small intestine - parenteral nutrition for the first two days, inclusion of 0.5 liters of liquid on the third day. Aspiration of gastric contents for the first 2 days, probing according to indications, removal of sutures on days 7-8, discharge on days 8-15.
Gallbladder - a special diet, removal of drainage, it is allowed to sit for 15-20 days.
Large intestine - the most sparing diet from the second day after the operation, there are no restrictions on fluid intake, the appointment of vaseline oil inside. Extract - for 12-20 days.
Pancreas - preventing the development of acute pancreatitis, monitoring the level of amylase in the blood and urine.
The organs of the chest cavity are the most severe traumatic operations, threatening blood flow disturbance, hypoxia, and massive transfusions. Postoperative recovery requires the use of blood products, active aspiration, and chest massage.
Heart - hourly diuresis, anticoagulant therapy, drainage of cavities.
Lungs, bronchi, trachea - postoperative fistula prevention, antibiotic therapy, local drainage.
Genitourinary system - postoperative drainage of urinary organs and tissues, correction of blood volume, acid-base balance, sparing high-calorie nutrition.
Neurosurgical operations - restoration of brain functions, respiratory capacity.
Orthopedic-traumatological interventions - compensation for blood loss, immobilization of the damaged part of the body, physiotherapy exercises are given.
Vision - 10-12 hours bed period, walks from the next day, regular antibiotics after corneal transplantation.
In children - postoperative pain relief, elimination of blood loss, support for thermoregulation.

In elderly and senile patients

For a group of elderly patients, postoperative care in surgery is distinguished by the following features:

elevated position of the upper body in bed;
early turning;
postoperative breathing exercises;
humidified oxygen for breathing;
slow drip intravenous injection of saline solutions and blood;
careful subcutaneous infusions due to poor absorption of fluid in the tissues and to prevent pressure and necrosis of skin areas;
postoperative dressings to control wound suppuration;
the appointment of a complex of vitamins;
skin care to avoid the formation of bedsores on the skin of the body and limbs.

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Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.

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Postoperative period

The postoperative period is the period from the end of the operation until the patient recovers (or until the patient is discharged from the hospital).

The problem of postoperative complications and mortality remains very relevant. Of particular importance is the postoperative nursing of elderly patients and children.

It is customary to share postoperative period into three phases:

1. Early phase(early postoperative period) - up to 3-5 days after surgery.

2. Late phase(late postoperative period) - 2 - 3 weeks after surgery.

3.Remote phase- 3 weeks - 3 months after surgery.

The main tasks of the medical staff in the postoperative period are:

Provide care for the patient by the forces of a doctor, nurses, orderlies (pain relief, ensuring vital functions, dressings).

To prevent the occurrence and to treat the complications that have arisen in the postoperative period.

At the end of the operation, the administration of narcotic substances is stopped.

The patient is transported from the operating room on a gurney to the recovery room, or to the intensive care unit. In this case, the patient can be taken out of the operating room only with restored spontaneous breathing. The anesthesiologist must accompany the patient to the intensive care unit, or the post-anesthetic ward, together with two (at least) nurses.

During the transportation of the patient, it is necessary to monitor the position of catheters, drains, dressings. Careless handling of the patient can lead to loss of drainage, removal of the postoperative bandage, accidental removal of the endotracheal tube. The anesthesiologist must be prepared for respiratory problems during transport. For this purpose, the team transporting the patient must have manual breathing apparatus(or ambu bag).

During transport, intravenous infusion therapy can be (continued), but in most cases, during transportation, the system for intravenous drip of solutions is blocked.

The patient in the post-anesthesia period, up to full awakening, should be under the constant supervision of the medical staff, since in the first hours after the surgical operation, complications associated with anesthesia are most likely:

1. Loss of language

3. Violation of thermoregulation.

4. Violation of the heart rhythm.

The fall of the language

In a patient who is still in a narcotic dream, the muscles of the face, tongue and body are relaxed. A relaxed tongue can move down and close the airway. Timely restoration of airway patency is necessary with the introduction air tube, or by tilting the head back and protruding the lower jaw.

It should be remembered that the patient after anesthesia should be constantly under the supervision of the medical staff on duty until full awakening.

Vomiting in the postanesthetic period

The danger of vomiting in the postoperative period is due to the possibility of vomit flowing into the oral cavity, and then into the respiratory tract ( regurgitation and aspiration of vomit). If the patient is in a narcotic sleep, this can lead to his death from asphyxiation. When vomiting in an unconscious patient, it is necessary to turn his head to one side and clean the mouth from vomit. In the postoperative ward, an electric aspirator should be ready for operation, with which vomit is removed from the oral cavity or from the respiratory tract during laryngoscopy.

Vomit can also be removed from the oral cavity with a gauze napkin on a forceps.

If vomiting has developed in a conscious patient, it is necessary to help him, by giving a basin, to support his head above the basin. In case of repeated vomiting, it is recommended to administer to the patient cerucal(metoclopramide)

Violation of the rhythm of cardiac activity and respiration up to their stop occurs more often in the elderly and infants. Respiratory arrest is also possible due to recurarization - repeated late relaxation of the respiratory muscles after muscle relaxation during endotracheal anesthesia. It is necessary in such cases to be prepared for resuscitation and have breathing equipment ready.

Violation of thermoregulation

Violation of thermoregulation after anesthesia can be expressed in a sharp increase or decrease in body temperature, severe chills. If necessary, it is required to cover the patient, or vice versa, create conditions to create conditions for improved cooling of his body.

With high hyperthermia, intramuscular administration of analgin with papaverine and diphenhydramine is used. If after the introduction of the lytic mixture the body temperature does not decrease, physical cooling of the body by rubbing with alcohol is used. With the progression of hyperthermia, ganglionic blockers (pentamine, or benzohexonium) are administered intramuscularly

With a significant decrease in body temperature (below 36.0 - 35.5 degrees), warming the body and limbs of the patient with warm heating pads can be applied.

Pain management in the postoperative period.

Complications associated with pain in the postoperative period.

Prolonged exposure to pain and pain of high intensity lead not only to moral and mental experiences, but also to quite real biochemical metabolic disorders in the body. The release into the blood of a large amount of adrenaline ("stress hormone" produced by the adrenal cortex) leads to an increase in blood pressure, increased heart rate, mental and motor (motor) excitement. Then, with the continuation of pain, the permeability of the walls of blood vessels is disturbed, and the blood plasma gradually enters the intercellular space. Biochemical changes in the composition of the blood also develop - hypercapnia (increase in CO 2 concentration), hypoxia (decrease in oxygen concentration), acidosis (increase in blood acidity), changes occur in the blood coagulation system. Linked together by the circulatory system, all human organs and systems are affected. Pain shock develops.

Modern methods of anesthesia make it possible to prevent the dangerous consequences of pain in injuries, surgical diseases and during surgical operations.

The tasks of the medical staff in the relief of pain are:

Reducing the intensity of pain

Reducing the duration of pain

Minimizing the severity of adverse disorders associated with pain.

The pain prevention strategy includes :

Limiting the number of punctures, injections, taking tests.

The use of central catheters to exclude multiple punctures of the veins.

Painful procedures should only be carried out by trained medical personnel.

Careful dressings, removal of adhesive plasters, drains, catheters.

Ensuring adequate pain relief before painful procedures

Non-pharmacological methods of dealing with pain .

1. Creation of comfortable conditions for the patient

2. Painful procedures should only be performed by an experienced specialist

3. Maximum breaks between painful procedures are created.

4. Maintaining an advantageous (least painful) position of the patient's body.

5. Limitation of external stimuli (light, sound, music, loud conversation, rapid movements of personnel).

In addition, it is advisable to use cold to reduce pain in the area of the surgical wound. With local application of cold, the sensitivity of pain receptors decreases. An ice pack or cold water is applied to the surgical wound.

Pharmacological methods of dealing with pain

The use of narcotic anesthetics

Promedol - used as a universal narcotic analgesic after most surgical operations

Fentanyl - in the postoperative period is used at a dose

0.5 - 0.1 mg for intense pain. Also used in combination with droperidol (neuroleptanalgesia)

Tramadol - has less pronounced narcotic properties, i.e. causes euphoria, addiction and withdrawal syndrome is noticeably less than drugs. It is used as a solution subcutaneously, intramuscularly and intravenously, 50 mg per 1 ml (ampoules 1 and 2 ml).

The use of non-narcotic anesthetics.

Barbiturates - phenobarbital and sodium thiopental have a hypnotic and analgesic effect

Ibuprofen

Metamizole sodium (analgin) is most often used in the postoperative period to reduce the intensity of pain intramuscularly and subcutaneously, (and sometimes intravenously) by injection. Tablet forms are also used, which include metamizole sodium - sedalgin, pentalgin, baralgin.

Application of local anesthetics

In addition to the solutions used for local infiltration and conduction anesthesia, for anesthesia of injections, punctures and other painful procedures, contact anesthetics are used, such as: tetracaine cream, instillagel, EMLA cream, lidocaine.

Prevention of postoperative pneumonia

The risk of developing postoperative pneumonia is highest in operated patients who are immobile for a long time, as well as in patients on mechanical ventilation and in patients with tracheostomy. The presence of a nasogastric tube in a patient can also lead to infection of the respiratory tract.

Therefore, with prolonged artificial ventilation of the lungs, it is necessary to regularly sanitize the respiratory tract, washing them with solutions of soda, enzymes, or antiseptics and removing accumulated sputum with an electric aspirator.

If the patient has a tracheostomy, they also periodically sanitize the respiratory tract with sputum removal with an electric aspirator, and regularly replace the contaminated cannula of the tracheostomy tube with a new sterilized one.

For the prevention of congestive pneumonia, a regular change in the position of the patient in bed is necessary. If possible, the patient should be raised in bed as soon as possible, planted, and carried out with him in physiotherapy exercises. If possible, it is also recommended that the patient get up early and walk.

Respiratory gymnastics in postoperative patients includes periodic deep breaths, inflation of plastic or rubber balloons, or toys.

Thromboembolism

A very formidable complication of operations in elderly patients is thromboembolism of the vessels of the heart, lungs, and brain. These complications can lead to death in the shortest possible time. Thromboembolism is promoted by disorders of the blood coagulation system in the elderly, an increase in blood viscosity. It is necessary to constantly monitor the coagulogram in the postoperative period in elderly patients. In the event of thrombosis and embolism, it is necessary to be prepared for the introduction of thrombolytics - fibrinolysin, streptokinase, heparin. In peripheral vascular thromboembolism, vascular probing with the removal of a thrombus, or surgical removal of a thrombus, is used. With the development of thrombophlebitis, heparin ointment, troxnvasin, troxerutin are used topically.

Postoperative bleeding

Bleeding may occur in the early postoperative period due to slipping of the ligature (knot) from the tied vessel, due to the detachment of a blood clot from the vessel in the wound. For minor bleeding, local application of cold, a hemostatic sponge, and a tight bandage may be sufficient. With heavy bleeding, they need to be stopped. So: in case of bleeding from the surgical wound, the imposition of a ligature again, or additional suturing of the wound, is required.

Abundant internal bleeding in the early postoperative period is deadly. They are often associated with insufficient intraoperative hemostasis and slippage of the ligature from the blood vessel.

Bleeding in the late postoperative period often develops due to purulent fusion of tissues in the wound, decay of tumor tissue, and failure of sutures. Stopping late postoperative bleeding often requires repeated emergency surgery.

In the late postoperative period, complications such as suppuration of the postoperative wound, the development of bedsores, the development of adhesive intestinal obstruction, relapses of the disease (hernias, tumors, varicocele, fistulas) develop.

Suppuration of the postoperative wound

The following factors can lead to the development of purulent inflammation of the postoperative wound:

1. Microbial contamination of the surgical wound.

2. Massive tissue destruction in the area of the surgical wound.

3. Violation of tissue trophism in the area of the surgical wound.

4. The presence of concomitant inflammatory diseases in the operated patient (tonsillitis, boils, pneumonia, etc.)

Clinically, suppuration of a postoperative wound is manifested by the development of redness, an increase in soreness, swelling, and a local increase in temperature in the wound area. . Sometimes fluctuation (fluctuation, softening) in the wound area is determined.

It is necessary to remove the sutures, releasing pus, to drain the wound. Dressings, antibiotic therapy, wound washing with antiseptics are carried out.

Adhesive intestinal obstruction

After operations on the abdominal cavity with peritonitis, acute appendicitis, injuries of the abdominal cavity, multiple adhesions between the intestines, intestines and peritoneum may develop. Adhesions can lead to disruption of intestinal motility and the development of complete intestinal obstruction. Adhesive intestinal obstruction is manifested by intense pain in the abdomen, repeated vomiting, lack of feces and gases, and requires emergency surgical treatment.

Relapses of diseases

The re-development of a surgical disease after surgical treatment occurs in diseases such as hernias, tumors, purulent fistulas and is associated either with insufficiently thorough operation or with a special severity of the disease. If possible, repeated surgical treatment of recurrent hernias, tumors, fistulas, etc.

Features of care for patients after various surgical operations.

Care of the patient after surgery on the organs of the chest cavity

Strict bed rest.

Semi-sitting position in bed.

Drain leak control.

Control over the operation of the valve during passive aspiration of the pleural cavity according to Bulau.

Determine the amount and nature of discharge through pleural drains.

Intravenous administration of blood substitutes and blood products.

The introduction of painkillers: analgesics, or drugs.

Control of the intravenous catheter, periodic washing of the catheter with a solution of heparin.

Wound dressings.

Antibiotic therapy.

Feeding the patient.

Hygienic care of the skin, oral cavity.

Ensuring defecation, urination.

Periodic X-ray control.

Carrying out blood tests with control of hemoglobin, erythrocytes, hematocrit.

Control over body temperature, blood pressure, pulse rate, respiratory rate.

Care of the patient after surgery for peritonitis

Strict bed rest.

Removal of stomach contents with an indwelling nasogastric tube.
Fowler's position in a functional bed.
The introduction of painkillers: analgesics, drugs.
Antibiotic therapy.
Intravenous drip introduction of blood substitutes, blood products, parenteral nutrition.
Caring for an intravenous (peripheral or central) catheter.
Care of drains: periodic dressings, if necessary, washing.
Control over the amount and nature of discharge through drainage.
Bandaging of the surgical wound.
Fistula care (in the presence of a colostomy, gastrostomy, intestinal intubation)
In the presence of a catheter in the epidural space, periodic administration of an anesthetic.
Humidified oxygen inhalation.
A catheter in the bladder to determine kidney function.
General blood tests, urine, biochemical blood tests.
Control of body temperature, pulse rate, blood pressure, respiratory rate

Care of the patient after surgery for purulent surgical pathology.

Isolate from "clean" surgical patients.

Antibacterial therapy (antibiotic therapy, nitrofurans, sulfonamides)

Painkillers, sleeping pills.

Immobilization of the affected area of the body, limbs ...

Dressings, change of wet dressings, if necessary, replacement of drains.

Intravenous administration of blood substitutes, blood products, detoxification drugs.

The introduction of painkillers, sleeping pills.

Monitoring of general blood and urine tests.

Control over body temperature, pulse rate, respiration, blood pressure.

Caring for the urological patient

Dressings, change of wet bandages.

Antibiotic therapy.

The introduction of painkillers, antispasmodics or drugs.

Care for suprapubic drainage (epicistostomy), lumbar drainage (nephrostomy, pyelostomy).

If necessary, flush the drains with antiseptics.

Introduction of diuretics (if necessary)

Diuresis control

General analyzes of urine, blood.

Control of body temperature, pulse, blood pressure

Care of the patient after oncological surgery.

Painkillers for pain.

Bandaging of the surgical wound.

In the presence of fistulas, fistula care.

Chemotherapy, radiation therapy prescribed by an oncologist

Exclusion of physiotherapy procedures, massage.

Parenteral nutrition when normal nutrition is not possible.

Optimistic attitude in relations with the patient.

Sparing information about the nature of the tumor.

oxygen therapy

Oxygen inhalation is used to combat hypoxia in postoperative patients. Due to the toxicity of pure oxygen, it is given to patients in the form of a gas mixture with air at a concentration of 40 - 60%.

Oxygen inhalation is carried out using a face mask, nasal catheter, nasal cannula. Can also be used for oxygen therapy tents and endotracheal tubes.