Post Operative Care (Post ITU/HDU to Discharge)

Post Operative Care (post ITU/HDU to Discharge)

PROBLEM

GOAL

ACTION

BREATHING

Potential difficulty with breathing
due to surgery (pain) and obesity.

Steady unlaboured quiet breathing. Respirations to remain between16-20/min. Mucous membranes pink. No peripheral cyanosis.
Endeavour to keep patient pain free and comfortable.

Assist patient to maintain upright position when in bed, encourage mobilisation, encourage deep breathing and coughing
Administer prescribed medication to promote deep breathing.

Potential chest infection due to anaesthesia, reduced mobility and reduced tidal volume.

Prevent chest infection. Sputum to remain clear, temperature to remain within normal limits.
For patient to breath deeply and efficiently.
Ensure patient comfortable/pain free.

Encourage deep breathing, coughing and expectoration.
Encourage and assist with taught deep breathing exercises.
Ensure early visit by Physiotherapist.
Administer and monitor effect of prescribed analgesia.

PROBLEM

GOAL

ACTION

MAINTAINING SAFE ENVIRONMENT
Potential development of shock and haemorrhage due to surgical intervention.	Ensure early recognition of bleeding and shock. Ensure blood pressure remains within acceptable limits as dictated by preoperative assessment	Observe dressings and drains 2 hourly for bleeding. Record blood pressure and pulse 2 hourly for bleeding. Observe patients colour and peripheral perfusion, Observe for increased restlessness and and/or change in response level
Pain due to surgical procedure.	For patient to state they are comfortable, pain free or pain within acceptable limits.	Listen and talk to patient and ascertain the nature of the pain. Encourage use of pain assessment tool. Position patient for maximum comfort. Give prescribed analgesia and assess effect. Offer analgesia as prescribed.
Potential development of a deep vein thrombosis due to venous stasis and reduced mobility.	For patients calves to remain soft, pain free and not red or swollen. To promote venous return and encourage mobility. To maintain venous integrity after discharge and prevent venous thrombosis.	Remind patient of preoperative leg exercises, encourage performance two hourly. Observe calves for swelling pain and redness. Ensure anti embolic devices are appropriately applied and working correctly sequential compression devices or anti embolic devices. Encourage early mobilisation. Remove when mobile. Teach patient self administration of subcutaneous low molecular weight heparin.
Potential deterioration in pressure areas due to surgery, reduced mobility and body weight.	For the patients skin to remain intact, not sore or red	Use Waterlow score to assess pressure areas on return from theatres Encourage movement while in bed sliding and transfer equipment as appropriate Keep sheets wrinkle free and dry Encourage early mobilisation

PROBLEM

GOAL

ACTION

EATING & DRINKING	For BOMSS diet sheets please mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Potentially unstable blood sugar due to pre-operative fasting.	To maintain blood sugar within normal limits as specified by medical team.	To review oral hypoglycaemic and insulin regime in light of pre-operative dietary restrictions, administer medications as prescribed.
Potential obstructive reflux due to band insertion.	Detect problem early and take appropriate action. Inform Surgeon.	Observe and communicate with patient.
Restricted fluid intake post surgery (B).	Encourage patient to take sufficient oral fluids.	Increase to free clear fluids, as tolerated, progressing to liquid diet as directed by local policy. Remove IV when free fluids tolerated.
Potential development of dry sore mouth due to oral restrictions.	Clean comfortable mouth.	Perform hourly mouth care, until patient able to be self- caring. Encourage use of mouthwash.
Potential nausea and vomiting due to surgery and anaesthesia	Monitor, detect and prevent.	Talk with patient ascertain if nausea present. Administer anti-emetics as required
Need for patient to adopt post band insertion diet, and new dietary regime post discharge.	For patient to tolerate new dietary regime, achieve appropriate weight loss while maintaining a healthy balanced diet	Explanation, education, support and feedback, Link back to pre-operative dietary education, and explain discharge dietary advice.
Potential misuse/abuse/misunderstanding of new diet. Inability to adhere to new dietary regime	For patient to understand and comply with dietary regime, and to be comfortable with new diet	Explain, educate, risks of self adjustment (damage, infection) Remind patients that band is currently deflated and will be adjusted on first clinic visit
Potential development of maladaptive eating patterns post discharge.	To ensure patient understands the importance of eating regular small well balanced meals and not resorting to liquidising foods or exchanging a balanced diet for high calorie snacks (biscuits, ice cream, sweets).	Reinforce pre-operative education regarding dietary intake post discharge.
Potential misuse of band i.e. self deflation/inflation.	For patient to understand the importance of professional adjustment and monitoring of band.	Explain educate risks of self adjustment, i.e. damage, infection.
Potential dehydration due to reduced oral intake.	Ensure patient understands the potential of dehydration and how to avoid it. For patient not to suffer from constipation	Educate need to monitor fluid intake. Patient should take 2Litres /day. Reiterate the importance of limiting fluid intake at meal times.
Need for long term / lifelong follow up	Ensure patient understands that follow up is essential to maintain health and well being and that appropriate adjustment of the band is essential to maintain adequate weight loss	Appointment for primary adjustment and surgeon specific subsequent follow up. Ensure patient understands fill procedure, to ensure adequate time allowed for clinc visit and remains in unit after adjustment.

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