Perawatan Lanjutan Pasca Bedah PDF

Post Operative Care of
Surgical Patients and Common

Surgical Diseases in Family
Practice
Fransiscus Arifin
Post Operative Surgical Care
What are the main concern (of

the patient and doctors) after
surgery ?
●How is the operation ? Success/Not
Success/Any complications ?
●How is the wound ?
●What should I eat/not eat ?
●What should I do/not do ?
●How can I manage my pain ?
Wound
Definition:
• Tissue discontinuity (due to any causes)
• An injury to living tissue caused by a
cut, blow, or other impact, typically one
in which the skin is cut or broken
• trauma; an injury, usually restricted to a
physical one with disruption of normal
continuity of structures.
Acute vs Chronic Wound
Acute Chronic
Duration from Injury Hours to Days Weeks to Months
Phases of recovery On Schedule Delayed or no progress
Causes Trauma Trauma (at first),
infection, vascular
problems
Physiology Normal Abnormal
Management Simple Complex
Example Cut by a knife Diabetic foot
Chronic Wound
Definition : wound that does not heal in
normal healing time frame, due to one or
more causes such as infection, poor
blood supply, immune problem, or tissue
defect
Wound Healing Time Frame
Physiology of Wound Healing
Special Wounds
●Stoma
●Diabetic Wounds
Stoma Type
●Tracheostomy
●Gastrostomy
●Yeyunostomy
●Ileostomy
●Colostomy
●Uretrostomy
Diabetic Wound
3 major disruption
●Infection (due to lower immune
resistance)
●Vascular defect
●Nerve damage
Surgical Nutrition
(Related to Wound Healing)
• Macronutrients : Carbohydrates, Fat,
Protein
• Micronutrients
• Trace elements
Energy Sources
●Carbohydrates
- Limited storage capacity, needed for CNS function
- Yields 3.4 kcal/gram
- Pitfall: too much=lipogenesis and increased CO2
production
●Fats
- Major endogenous fuel source in healthy adults
- Yields 9 kcal/gm
- Pitfall: too little=essential fatty acid (linoleic acid
deficiency-dermatitis, increased risk of infections)
●Protein
- Needed to maintain anabolic state (match
catabolism)
- Yields: 4 kcal/gm
- Pitfall: must adjust in patient with renal and hepatic
failure
Nutrition Requirements
●Healthy Adults
●Calories: 25-35 kcals/kg
●Protein: 0.8-1 gm/kg
●Fluids: 30 cc/kg
●Requirement Change for the Surgical Patient
●Special Considerations
- Stress : Injury or disease,Surgery
●Pre-hospital/pre-surgical nutrition status

Nutrition
●The surgical patient : Extraordinary
stressors (hypovolemia, hypervolemia,
bacteremia, medications)
- Wound Healing
●Anabolic state, appropriate vitamins (A, C,
Zinc), and adequate kcals/protein.
●Poor Nutrition=Poor Outcomes
- For every gram deficit of untreated
hypoalbuminemia there is ~30% increase
in mortality
Post-Operative Nutrition Requirements
●Calories:
- 30-40 kcals/kg/day
- Patient on ventilator usually require less
calories ~20-25 kcal/kg
●Protein:
- 1-1.8 grams/kg
●Fluids:
- Individualized
Diet Advancement
●Traditional Method:
- Start clear liquids when signs of bowel
function returns.
- Rationale : Nausea and vomiting due to
post operative ileus
Micronutrients in Wound Healing
●Still disputed
●Not necessary unless depleted
●Vit A ,C and Zinc
Post Surgical Care of Common
Surgical Procedures
Common Assesments
●Diagnosis (complete)
●Indication for operation
●Type of procedure
●Days post op
●Chief complaints
●Physical examination
Hernia Surgery
●What type of hernia ?
●What type of procedure ?
●When it was done ?
●Any complaints regarding :
- Location of the operation
- Involved system :
● GI Tract : nausea,defecation
● Hematologic : bleeding, infection
●Evaluate : Wound, GI Tract, emergencies
Appendectomy
●What type of appendicitis?
- Involved system :
● GI Tract : nausea,defecation
●Evaluate : Wound, GI Tract, emergencies
ORIF
●What type of fracture ?
- Involved system :
● Musculosceletal : Artery, venous, nervous,movement
●Evaluate : Wound, movement, vascular,
nerve, emergencies
Burns
●What type of burns (grade, area) ?
- Involved system :
● Skin : pain, scars,movement
●Evaluate : Wound, movement,
emergencies
Mastectomy
●What type of disease ?
●What type of procedure (simple, radical,
modified radical) ?
- Involved system :
● Metastases / recurrence
●Evaluate : Wound, seroma formation, local
recurrence
Thyroidectomy
●What type of procedure ? (total,subtotal etc) ?
- Involved system :
● Nerve lesion : hoarseness, difficulty in swallowing liquids
● Endocrine : hypothyroidism, hypoparathyroidism
● Respiratory : signs of airway obstruction
●Evaluate : Wound, seroma formation
Bowel Resection
- Involved system :
● GI : defecation, flatus
● Nutrition status
●Evaluate : Wound, GI tract function, DRE
Common Surgical Diseases
in Family Practice
Phymosis and Paraphymosis
Paronychia
Lower Urinary Tract Symptoms (IPSS)

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Post Operative Care of

Surgical Patients and Common

What are the main concern (of

●Pre-hospital/pre-surgical nutrition status

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