What days are considered dangerous after surgery? Features of rehabilitation of patients after various types of operations. Restoration of surgical blood loss

Postoperative period- the period of time from the end of the operation until recovery or complete stabilization of the patient’s condition. It is divided into immediate - from the end of the operation to discharge, and remote, which occurs outside the hospital (from discharge to the complete elimination of general and local disorders caused by the disease and operation).

All P. p. in the hospital are divided into early (1-6 days after surgery) and late (from the 6th day until discharge from the hospital). During P., four phases are distinguished: catabolic, reverse development, anabolic, and the phase of increasing body weight. The first phase is characterized by increased secretion nitrogenous wastes in urine, dysproteinemia, moderate hypovolemia, weight loss. It covers the early and partially late postoperative period. In the phase of reverse development and the anabolic phase, under the influence of hypersecretion of anabolic hormones (insulin, growth hormone, etc.), synthesis predominates: electrolyte, protein, carbohydrate, and fat metabolism are restored. Then the phase of weight gain begins, which, as a rule, occurs during the period when the patient is on outpatient treatment.

The main points of postoperative intensive care are: adequate pain relief, maintenance or correction of gas exchange, ensuring adequate blood circulation, correction of metabolic disorders, as well as prevention and treatment of postoperative complications. Postoperative pain relief is achieved by administering narcotic and non-narcotic analgesics, using various options conduction anesthesia. The patient should not feel pain, but the treatment program should be designed so that pain relief does not depress consciousness and breathing.

When a patient is admitted to the intensive care unit after surgery, it is necessary to determine the patency of the airways, the frequency, depth and rhythm of breathing, and the color of the skin. Impaired airway patency in weakened patients due to retraction of the tongue, accumulation in respiratory tract blood, sputum, gastric contents, require therapeutic measures, the nature of which depends on the cause of the obstruction. Such activities include maximum extension of the head and abduction lower jaw, insertion of an air duct, aspiration of liquid contents from the airways, bronchoscopic sanitation of the tracheobronchial tree. When signs of severe respiratory failure the patient should be intubated and transferred to artificial ventilation .

Disorders of the central mechanisms of breathing regulation, which usually arise as a result of depression of the respiratory center under the influence of anesthetic and narcotic drugs used during surgery. At the heart of intensive care acute disorders breathing central genesis involves performing artificial pulmonary ventilation (ALV), the methods and options of which depend on the nature and severity of respiratory disorders.

Disturbances in the peripheral mechanisms of respiratory regulation, more often associated with residual muscle relaxation or recurarization, can lead to rare gas exchange disorders and cardiac arrest. In addition, these disorders are possible in patients with myasthenia gravis, etc. Intensive therapy for respiratory disorders peripheral type consists of maintaining gas exchange by mask ventilation or repeated tracheal intubation and transfer to mechanical ventilation until muscle tone is completely restored and adequate spontaneous breathing.

Severe breathing disorders can be caused by pulmonary atelectasis, pneumonia, and pulmonary embolism. When clinical signs of atelectasis appear and the diagnosis is confirmed by X-ray, it is necessary to eliminate first of all the cause of atelectasis. With compression atelectasis, this is achieved by draining the pleural cavity to create a vacuum. For obstructive atelectasis, therapeutic bronchoscopy is performed with sanitation of the tracheobronchial tree. If necessary, the patient is transferred to mechanical ventilation. The complex of therapeutic measures includes the use of aerosol forms of bronchodilators, percussion and vibration massage chest, postural drainage.

The appearance of shortness of breath is always an alarming symptom, especially on the 3-6th day of P. p. The causes of shortness of breath in P. p. can be septic, pleural, pulmonary edema, etc. The doctor should be alerted to sudden unmotivated shortness of breath, characteristic of pulmonary embolism .

Cyanosis, pallor, marbling of the skin, purple, blue spots are signs of postoperative complications. The appearance of yellowness of the skin and sclera often indicates severe purulent complications and developing liver failure. Oligoanuria and anuria indicate the most difficult postoperative situation - renal failure.

A decrease in hemoglobin and hematocrit is a consequence of unreplenished surgical blood loss or postoperative bleeding. A slow decrease in hemoglobin and the number of red blood cells indicates inhibition of erythropoiesis of toxic origin. Hyperleukocytosis, lymphopenia, or reappearance after normalization of the blood count is typical for complications of an inflammatory nature. A number of biochemical blood parameters may indicate surgical complications. Thus, an increase in the level of amylase in the blood and urine is observed during postoperative emission (but is also possible with mumps, as well as high intestinal obstruction); transaminases - with exacerbation of a, myocardial infarction, liver; bilirubin in the blood - with e, obstructive jaundice, pylephlebitis; urea and creatinine in the blood - with the development of acute renal failure.

Main complications of the postoperative period. Suppuration of a surgical wound is most often caused by aerobic flora, but often the causative agent is anaerobic non-clostridial microflora. The complication usually appears on the 5-8th day of P. p., it can occur after discharge from the hospital, but rapid development of suppuration is also possible already on the 2-3rd day. When the surgical wound suppurates, the body temperature, as a rule, rises again and is usually febrile. Moderate is noted, with anaerobic non-clostridial flora - pronounced lymphopenia, toxic granularity of neutrophils. Diuresis, as a rule, is not impaired.

Local signs of wound suppuration are swelling in the suture area, skin hyperemia, and severe pain on palpation. However, if suppuration is localized under the aponeurosis and has not spread to the subcutaneous tissue, these signs, with the exception of pain on palpation, may not exist. In elderly and old age general and local signs suppuration is often erased, and the prevalence of the process at the same time can be large.

Treatment consists of spreading the edges of the wound, sanitation and drainage, and dressings with antiseptics. When granulations appear, ointment dressings are prescribed, secondary seams. After careful excision of purulent-necrotic tissue, suturing over the drainage and further flow-drip washing of the wound with various antiseptics with constant active aspiration is possible.

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 and includes several stages of recovery. At each period, attentiveness and care for the patient on the part of the nurse, and medical supervision are 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 full recovery sick. It is divided into three stages:

• early period – before discharge from hospital;
• late – after two months after surgery;
• long-term period is the final outcome of the disease.

How long does it last

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

• catabolic – an upward change 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, somatotropic);
• anabolic – restoration of electrolyte, protein, carbohydrate, fat metabolism;
• period of increasing healthy body weight.

Goals and objectives

Observation after surgery is aimed at restoring normal activity of the patient. The objectives of the period are:

• prevention of complications;
• recognition of pathologies;
• patient care - administration of analgesics, blockades, provision of vital functions, dressings;
• preventive actions to combat intoxication and infection.

Early postoperative period

The early postoperative period lasts from the second to the seventh day after surgery. 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 violations renal work due to the redistribution of fluid in sectors of the body.

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

Complications

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

• dangerous bleeding– after operations on large vessels;
• cavity bleeding - during intervention in the abdominal or thoracic cavities;
• pallor, shortness of breath, thirst, frequent weak pulse;
• wound dehiscence, lesion internal organs;
• dynamic paralytic ileus;
• persistent vomiting;
• the possibility of peritonitis;
• purulent-septic processes, fistula formation;
• pneumonia, heart failure;
• thromboembolism, thrombophlebitis.

Late postoperative period

After 10 days from the moment of surgery, the late postoperative period begins. It is divided into hospital and home leave. The first period is characterized by an improvement in the patient’s condition and 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, vitamin intake and activity restrictions are prescribed.

Complications

The following are distinguished: late complications after surgery, which occur while the patient is at home or in the hospital:

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

Doctors cite the following factors as the causes of complications in the later stages after surgery:

• a long period staying in bed;
• initial risk factors – age, illness;
• impaired respiratory function due to prolonged anesthesia;
• violation of the rules of asepsis for the operated patient.

Nursing care in the postoperative period

Plays an important role in patient care after surgery. nursing care which continues until the patient is discharged from the department. If it is insufficient or poorly performed, it leads to adverse outcomes and prolongation recovery period. The nurse should prevent any complications, and if they occur, make efforts to eliminate them.

The duties of a nurse in postoperative patient care include the following responsibilities:

• timely administration of medications;
• patient care;
• participation in feeding;
• hygiene care behind the skin and oral cavity;
• monitoring for deterioration and providing first aid.

From the moment the patient enters the intensive care ward, the nurse begins to perform her duties:

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

How is the postoperative period going?

Depending on the patient’s condition after surgery, the following stages of postoperative processes are distinguished:

• strict bed rest period - it is forbidden to get up or even turn around in bed, any manipulation is prohibited;
• bed rest - under the supervision of a nurse or exercise therapy specialist, it is allowed to turn over in bed, sit down, lower your legs;
• ward period - it is allowed to sit on a chair and walk for a short time, but examination, feeding and urination are still carried out in the ward;
• General regime – patient self-care, walking along the corridor, offices, and walks in the hospital area are allowed.

Bed rest

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

• limitation of physical activity, mobility;
• adaptation of the body to hypoxia syndrome;
• 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, half-lying, half-sitting. The nurse cares for the patient during this period - changes underwear, helps to cope physiological needs(urination, defecation) if they are difficult, feeds and guides hygiene procedures.

Following a special diet

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

1. After operations on the gastrointestinal tract, enteral nutrition is provided for the first days (through a tube), then broth, jelly, and crackers are given.
2. When operating on the esophagus and stomach, the first food should not be taken through the mouth for two days. Parenteral nutrition is provided - subcutaneous and intravenous administration of glucose and blood substitutes through a catheter, and nutritional enemas are performed. From the second day broths and jelly can be given, on the 4th day crackers are added, on the 6th day mushy food, from the 10th day a common table.
3. In the absence of violations of the integrity of the digestive organs, broths, pureed soups, jelly, baked apples.
4. After operations on the colon, conditions are created so that the patient does not have stool for 4-5 days. Low fiber diet.
5. When operating on the oral cavity, a probe is inserted through the nose to provide liquid food.

You can start feeding patients 6-8 hours after surgery. Recommendations: follow the water-salt and protein metabolism, provide sufficient amounts 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. Enteral formulas, dietary canned meat and vegetables are used for feeding.

Intensive monitoring 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 and special medications to maintain the operated organ. The tasks of this stage include:

• assessment of physiological parameters;
• eating as prescribed by the doctor;
• compliance with the motor regime;
• administration of drugs, infusion therapy;
• prevention of pulmonary complications;
• wound care, drainage collection;
• laboratory tests and blood tests.

Features of the postoperative period

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

1. Organs abdominal cavity– monitoring the development of bronchopulmonary complications, parenteral nutrition, prevention of gastrointestinal paresis.
2. Stomach, duodenum, small intestine - parenteral nutrition for the first two days, including 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.
3. Gallbladder– special diet, removal of drainages, allowed to sit for 15-20 days.
4. Colon– the most gentle diet from the second day after surgery, there are no restrictions on fluid intake, prescription Vaseline oil inside. Discharge – 12-20 days.
5. Pancreas – preventing the development of acute pancreatitis, monitoring the level of amylase in the blood and urine.
6. Organs chest cavity– the most severe traumatic operations that threaten blood flow disruption, hypoxia, and massive transfusions. For postoperative recovery, it is necessary to use blood products, active aspiration, and chest massage.
7. Heart – hourly diuresis, anticoagulant therapy, drainage of cavities.
8. Lungs, bronchi, trachea – postoperative prevention of fistulas, antibacterial therapy, local drainage.
9. Genitourinary system– postoperative drainage urinary organs and tissues, correction of blood volume, acid-base balance, sparing calorie nutrition.
10. Neurosurgical operations – restoration of brain functions and respiratory ability.
11. Orthopedic and traumatological interventions - compensation of blood loss, immobilization of the damaged part of the body, physical therapy is given.
12. Vision – 10-12 hours of bed time, walks with next day, regular intake antibiotics after corneal transplant.
13. In children - postoperative pain relief, elimination of blood loss, support of thermoregulation.

In elderly and senile patients

For a group of elderly patients post-operative care different in surgery the following features:

• exalted position upper body in bed;
• early turning;
• postoperative breathing exercises;
• humidified oxygen for breathing;
• slow intravenous drip 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;
• prescription of a vitamin complex;
• skin care to avoid the formation of bedsores on the skin of the body and extremities.

Video

The concept of the postoperative period. Postoperative period is considered to be the period from the end of the operation to discharge from the surgical department and restoration of ability to work. Depending on the nature and extent of the surgical intervention, general condition For the patient, it can last from several days to several months. The outcome largely depends on how the postoperative period is carried out. surgery. A major role in caring for patients in the postoperative period belongs to nursing staff. Correct and timely implementation of medical prescriptions and sensitive attitude towards the patient create conditions for a quick recovery.

Transporting the patient from the operating room. The delivery of the patient from the operating room to the recovery room is carried out under the guidance of an anesthesiologist or nurse in the recovery room. Care must be taken not to cause additional injury, not to displace the applied bandage, or to break the plaster cast. From the operating table the patient is transferred to a gurney and transported to the recovery room. The gurney with the stretcher is placed with the head end at a right angle to the foot end of the bed. The patient is picked up and transferred to the bed. You can lay the patient down from another position: the foot end of the stretcher is placed at the head end of the bed and the patient is transferred to the bed (Fig. 29).

Preparing the room and bed. Currently, after particularly complex operations under general anesthesia patients are placed in the intensive care unit for 2-4 days. Subsequently, depending on their condition, they are transferred to the postoperative or general ward. The ward for postoperative patients should not be large (maximum for 2-3 people). The ward must have a centralized oxygen supply and a full range of instruments, devices and medications for resuscitation measures.
Functional beds are usually used to give the patient comfortable position. The bed is covered with clean linen, and oilcloth is placed under the sheet. Before putting the patient to bed, the bed is warmed with heating pads.
In the postoperative period, patients often sweat, which is why they have to change their underwear. Linen is changed in a certain sequence. First pull it out carefully back shirt and transfer it over the head to the chest, then remove the sleeves, first from the healthy arm, then from the sick one. Put the shirt on in the reverse order: first on the sore arm, then on the healthy arm, then through the i tin and pull it over the back, trying to straighten the folds. When soiled, the sheet must be changed. The sheets are changed as follows. The patient is turned on his side and moved to the edge of the bed. The free half of the sheet is moved towards the patient's back. A clean sheet is placed on the vacant part of the mattress, the patient is turned over on his back and placed on a clean sheet. The dirty sheet is removed, and the clean sheet is straightened without wrinkles (Fig. 30).

In order to prevent bedsores, especially in the sacral area, the patient can be placed on an inflatable rubber circle wrapped in a sheet. The patient is covered with a blanket on top. You should not wrap him too warmly. A nursing station is installed near postoperative patients.
The nurse should record basic functional indicators: pulse, respiration, arterial pressure, temperature, amount of fluid drunk and excreted (with urine, from the pleural or abdominal cavity).
Observation and care of the patient. A large role is given to the nurse in monitoring the patient in the postoperative period. The patient's complaints should be taken into account. It is necessary to pay attention to the patient’s facial expression (suffering, calm, cheerful, etc.), the color of the skin (pallor, redness, cyanosis) and their temperature when palpated. It is necessary to measure body temperature (low, normal, high), and a general examination of the patient should be carried out regularly. It is necessary to carefully monitor the condition of the most important organs and systems.
A good prevention of various complications is a properly organized general care for the sick.
The cardiovascular system. The activity of the cardiovascular system is judged by pulse, blood pressure, and skin color. A slowdown and increase in heart rate (40-50 beats per minute) may indicate a disturbance in the activity of the central nervous system. nervous system due to swelling and hemorrhage in the brain, meningitis. An increased and weakened pulse against the background of a drop in blood pressure and pallor of the skin (more than 100 beats per minute) is possible with the development of secondary shock or bleeding. If the corresponding picture appears suddenly and is accompanied by chest pain and hemoptysis, one can think about the patient having a pulmonary embolism. With this pathology, the patient can die within a few seconds.
Prevention and treatment of secondary shock is the use of anti-shock measures (blood transfusions and blood-substituting fluids, cardiac and vascular tonics). Early active movements of the patient, therapeutic exercises and anticoagulants (heparin, neodicoumarin, etc.) are good prevention of thrombosis and embolism.
Respiratory system. In the postoperative period, patients, to a greater or lesser extent, regardless of the location of the operation, experience a decrease in ventilation of the lungs (frequent and shallow breathing) due to a decrease in respiratory excursions (pain, forced situation patient), accumulation of bronchial contents (insufficient sputum discharge). This condition can lead to pulmonary insufficiency and pneumonia. Prevention of pulmonary failure and postoperative pneumonia is early active movement of patients, physical therapy, massage, periodic oxygen inhalation, antibiotic therapy, systematic expectoration, carried out with the help of a nurse.
Digestive organs. Any surgical intervention affects the function of the digestive organs, even if the operation was not performed on them. The inhibitory effect of the central nervous system, restriction of the activity of the postoperative patient causes a certain dysfunction of the digestive organs. The “mirror” of the work of the digestive organs is the tongue.
Dry tongue indicates loss of fluid by the body and impaired water metabolism. A thick, brown coating against the background of a dry tongue and cracks can be observed with pathology in the abdominal cavity - peritonitis of various etiologies, paresis gastrointestinal tract.
For dry mouth, rinsing or rubbing is recommended. oral cavity acidified water, and if cracks appear - with a solution of soda (1 teaspoon per glass of water), 2% solution boric acid, hydrogen peroxide (2 teaspoons per glass of water), 0.05-0.1% potassium permanganate solution, lubricated with glycerin. Against the background of dry mouth, stomatitis (inflammation of the mucous membrane) or mumps (inflammation of the parotid gland) may develop. To enhance salivation (salivation), add lemon juice or cranberry juice to the water.
Nausea and vomiting can be a consequence of anesthesia, intoxication of the body, intestinal obstruction, peritonitis. If you have nausea and vomiting, you need to find out the cause. First aid for vomiting: tilt your head to the side, pass a thin probe through your nose and rinse your stomach. You can use medications (atropine, novocaine, aminazine). It is necessary to ensure that aspiration of vomit does not occur.
Hiccups occur when the diaphragm contracts convulsively due to irritation of the diaphragmatic or vagus nerve. If the irritation is reflexive in nature, they may good effect atropine, diphenhydramine, aminazine, vagosympathetic blockade, gastric lavage.
Flatulence (bloating). The causes of flatulence are intestinal paresis and the accumulation of gas in it. In order to relieve flatulence, it is recommended to consistently carry out the following measures: periodically lift the patient, insert a gas outlet tube into the rectum, give cleansing or hypertonic enemas (150-200 ml of 5% sodium chloride solution), administer 30-50 ml of 10% potassium chloride solution intravenously, 1-2 ml of 0.05% proserin solution subcutaneously. In severe cases of paresis, a siphon enema is indicated. A rubber tube is placed on a funnel with a capacity of 1-2 liters, the second end of which is inserted into the rectum. Water at room temperature is poured into the funnel, the funnel is raised up, the water goes into the large intestine; when lowering the funnel, water along with feces and gases escape into the funnel. An enema requires 10-12 liters of water. In some cases, they resort to perinephric novocaine blockade (100 ml of a 0.25% novocaine solution is injected into the perinephric tissue). The blockade can be carried out from both sides.
Constipation. A good way to prevent constipation is early active movement. Food should contain a large amount of fiber and have a laxative effect (yogurt, kefir, fruit). You can use enemas.
Diarrhea. The reasons are very diverse: neuroreflex, achilic (decreased acidity gastric juice), enteritis, colitis, peritonitis. Treatment of diarrhea is the fight against the underlying disease. For acute diarrhea, a good result is achieved by administering hydrochloric acid with pepsin.
Urinary system. Normally, a person excretes about 1500 ml of urine per day. But in a number of cases, kidney function is sharply impaired (neuro-reflex, due to intoxication, etc.) up to the complete cessation of urine output (anuria). Sometimes in the background normal operation kidneys, there is urinary retention - ischuria, often of a neuro-reflex nature.
For anuria, perinephric novocaine blockade, diathermy of the kidney area, pilocarpine, and diuretics help. With persistent anuria and the development of uremia, the patient is transferred to hemodialysis using an artificial kidney apparatus.
In case of ischuria, if the condition allows, the patient can be seated or even stood up, a heating pad placed on the lower abdomen, the patient seated or placed on a heated vessel, and water dripped into the basin (reflex effect). If these measures are unsuccessful, catheterization is performed as prescribed by the doctor. Bladder.
Neuropsychic system. The state of mind has great importance in the postoperative period. A capricious, unbalanced patient does not follow the regimen and instructions well. In this regard, healing often occurs with complications. In the postoperative period, it is necessary to relieve neuropsychic tension, which is achieved not only by prescribing drug therapy, but also by good care.
Observation of the bandage. When recovering from anesthesia, if the patient develops motor agitation, he may accidentally tear off or move the bandage, which can lead to bleeding or infection of the wound, followed by suppuration.
The bandage can become saturated with blood even when the patient is at rest. In all these cases, the nurse should notify the doctor immediately. As a rule, such dressings must be replaced.
Skin care. With improper skin care, bedsores often occur in areas of bony protrusions. Clinically, this is expressed in redness of the skin (hyperemia). Subsequently, this area becomes dead, the skin is torn away, and purulent melting of the tissue appears. Prevention of bedsores: active behavior of the patient after surgery, rubbing the skin with camphor alcohol, massage, use of pads. Treatment: treatment antiseptic solutions, bandages with Vishnevsky ointment, lubrication with a 5% solution of potassium permanganate. After disinfection, the patient must wash the perineum. For women... Skin washing must be done daily, even if there is no stool.

Postoperative period begins from the end of the operation and continues until the restoration of working capacity.

There are three phases of the postoperative period:

1) early - 3-5 days after surgery;

2) late - up to 2-3 weeks after surgery;

3) long-term - until full restoration of working capacity.

The main objectives of the postoperative period are the prevention and treatment of postoperative complications; acceleration of recovery processes (regeneration) in tissues and organs; restoration of the patient's ability to work.

Preparing the room and bed for the patient after surgery.

After operations under general anesthesia patients are placed in a ward in the intensive care unit or surgical department, which are specially organized for monitoring patients, carrying out resuscitation measures and intensive care. The department (ward) has an express laboratory, control and diagnostic (monitoring) equipment and medicinal products: kit medicines and transfusion agents, centralized oxygen supply, mechanical ventilation equipment, sterile sets for venesection and tracheostomy, cardiac defibrillation apparatus, sterile catheters, probes, equipped with instrumental and material table.

After minor operations performed under local anesthesia, the patient is placed in the general ward of the surgical department.

The nurse should ensure in advance that the recovery room is cleaned and ventilated, deprived of bright light and sound stimuli. It is advisable to use a functional bed that allows you to give the sick patient the necessary position. The bed must be placed in such a way that the patient can be approached from all sides. It should be dressed in clean, wrinkle-free linen and warmed with several heating pads. To protect the mattress, an oilcloth is placed on the sheet under the patient, which is covered with another sheet. Cover the patient with a clean sheet and blanket. Care products should be provided on the bedside table and at the patient’s bed (inflatable rubber circle, sippy cup, urinal, tray, towel, sterile gastric tube, etc.).

Transporting the patient from the operating room.

After the end of the operation, stabilization of the main functional indicators, application of a sterile dressing to the surgical wound, the patient is transferred from the operating table to a stretcher, covered with a sheet, blanket and transported to the recovery room under the guidance of an anesthesiologist or nurse anesthetist. After minor operations performed under local anesthesia, the patient is transported by the medical staff of the surgical department under the guidance of a guard nurse.

During transportation, it is necessary to exclude trauma, cooling and sudden changes in the patient’s body position, monitor the condition of the patient himself, the surgical wound, drainages and intravenous catheter with an infusion system.

The patient must not be left unattended during this period.!

Position of the patient on the bed.

The nurse serving the recovery room must know in what position the patient should be placed.

Depending on the nature of the operation, it may vary:

The supine position is the most common. In this position, the patient is placed horizontally without a pillow (for 2 hours) to prevent anemia of the brain, mucus and vomit from entering the respiratory tract;

The lateral position is allowed after the patient’s condition has stabilized. This position facilitates the work of the heart, promotes the functioning of the gastrointestinal tract, and vomiting is less likely to occur with it;

A semi-sitting position is recommended after operations on the gastrointestinal tract. It prevents congestion in the lungs, facilitates breathing and cardiac activity, promotes better rapid recovery gastrointestinal tract functions;

The prone position is used after spinal surgeries, as well as after some brain surgeries, with a soft cushion. After operations on cervical spine the spine must be positioned on the back (a shield is placed under the mattress);

A position with the head end lowered (Trendelenburg position) or the leg end raised (Clark position) is used in cases where the patient has had large blood loss, a state of traumatic or postoperative shock;

The elevated head position (Fawler position) is necessary when draining the peritoneal cavity or pouch of Douglas. To prevent the patient from sliding down, a box is placed under his feet for support;

The elevated limb position is used after limb surgery. The lower limb is placed on a Beler or Brown type splint.
Unless your doctor gives special instructions, the most comfortable position is with the head of the bed elevated and your legs slightly bent.

Patients' problems and postoperative complications in the postoperative period can be divided into local (from the wound) and general:

The nurse must constantly monitor the patient’s appearance: facial expression (suffering, calm, cheerful); the color of the skin (pallor, hyperemia, cyanosis) and their temperature when palpated, in cases where in the postoperative period there are no dysfunctions of organs and systems and there are no complications associated with surgical intervention, talk about normal course postoperative period.

If dysfunctions of organs and systems occur in the patient’s body after surgery, complications appear, and they speak of a complicated course of the postoperative period. The operation itself and the factors associated with it (mental trauma, anesthesia, pain, cooling the body, forced position on the operating table and in the postoperative period, blood loss, tissue trauma with instruments, the use of tampons and drainages, dysfunction of the patient’s organs and systems) always cause reactive changes in the patient’s body, which are characterized as a postoperative condition.

The described reactions of the body to surgical trauma during the active functioning of organs and tissues of the body disappear by the 3rd - 5th day of the postoperative period and have little effect on the patient’s condition. In those cases where in the preoperative period the prerequisites for these reactions of the body were discovered, and even more so their correction was carried out, the presence of such reactions of the body requires active therapeutic measures to eliminate them.

When using heating pads to warm a patient, the nurse must remember that after anesthesia the sensitivity of the patient's tissues is reduced and hot heating pads can cause burns.

Patient care.

After returning to the ward, pulse, blood pressure and respiratory rate are monitored regularly, almost hourly or every 2 hours. For patients who have undergone complex operations on the stomach or intestines, hourly monitoring of nasogastric tube discharge, diuresis and wound discharge is indicated. Surveillance is carried out nurse under the supervision of the attending physician or surgeon on duty (if necessary, other consultants). Permanent medical supervision removed when the patient's condition stabilizes.

In the majority medical institutions examination of patients by medical personnel in order to ascertain their condition, well-being and dynamics of key indicators vital functions carried out in the morning and evening. Sudden onset of anxiety, confusion, inappropriate behavior, or appearance- often the most early manifestations complications. In these cases, pay attention to the state of general hemodynamics and respiration, pulse, temperature and blood pressure. All data is monitored and recorded in the medical history. The question of the need to preserve probes and catheters is decided only by a doctor.

The lower extremities are examined for swelling, soreness of the calf muscles, and changes in skin color. In patients receiving intravenous fluids, monitor daily diuresis. Plasma electrolytes are measured daily. Intravenous infusions are stopped as soon as the patient begins to drink fluids on his own.

For some patients, insomnia can be a distressing and depressing problem after surgery, and it is therefore important to recognize and promptly treat such patients (including silence, care, and communication with staff and relatives).

The nurse monitors the patient’s compliance with diet and physical activity and, as prescribed by the doctor, carries out drug therapy, monitors the condition of the postoperative wound, ensures daily dressings, changing drains, drainage systems, controls wet cleaning and quartzing of wards.

Wound drainage is performed to prevent the accumulation of fluid or blood and allows you to control any discharge - in case of anastomotic failure, accumulation of lymph or blood. In recent years, many surgeons have preferred to use closed vacuum drainage systems with low aspiration force (for example, corrugated vacuum drainages produced by the domestic industry) after vascular operations. Typically, the drain is removed when the amount of fluid received daily is reduced to a few milliliters.

Skin sutures are traditionally left in place until the wound has healed completely. Adhesive strips (such as adhesive tape) may then be placed over the sutures to prevent dehiscence and better healing. On open areas skin (face, neck, upper and lower extremities), intradermal (cosmetic) sutures applied with absorbent or non-absorbent synthetic threads are more preferable. If the wound becomes infected, it may be necessary to remove one or more sutures ahead of schedule, the edges of the wound are separated, and drainage is performed.

Elderly people demand special attention and care. Reaction to pathological process in them it is slower and less pronounced, and drug resistance is usually reduced. In older people, the sensation of pain is significantly reduced and therefore complications that arise can be asymptomatic. Therefore, it is necessary to listen carefully to how the elderly patient himself assesses the development of his illness, and in connection with this, change the treatment and regimen.

The postoperative period begins immediately after the end of the operation and ends with the patient’s recovery. It is divided into 3 parts:

early - 3-5 days

late - 2-3 weeks

long-term (rehabilitation) - usually from 3 weeks to 2-3 months

Main taskspostoperative period are:

Prevention and treatment of postoperative complications.

Acceleration of regeneration processes.

Rehabilitation of patients.

The early postoperative period is the time when the patient’s body is primarily affected by surgical trauma, the effects of anesthesia and the forced position.

The early postoperative period may be uncomplicated And complicated.

In an uncomplicated course of the postoperative period, the reactive changes that occur in the body are usually moderate and last for 2-3 days. In this case, there is a fever of up to 37.0-37.5 ° C, inhibition of the central nervous system is observed, and there may be moderate leukocytosis and anemia. Therefore, the main task is to correct changes in the body, control the functional state of the main organs and systems.

Therapy for an uncomplicated postoperative period is as follows:

pain management;

correct position in bed (Fowler's position - the head end is raised);

wearing a bandage;

prevention and treatment of respiratory failure;

correction of water-electrolyte metabolism;

balanced diet;

control of the function of the excretory system.

The main complications of the early postoperative period.

I. Complications from the wound:

bleeding,

development of wound infection,

suture dehiscence (eventeration).

Bleeding- the most serious complication, sometimes threatening the patient’s life and requiring repeated surgery. In the postoperative period, to prevent bleeding, place an ice pack or a load of sand on the wound. For timely diagnosis monitor pulse rate, blood pressure, and red blood counts.

Development of wound infection can occur in the form of the formation of infiltrates, wound suppuration, or the development of a more serious complication - sepsis. Therefore, it is imperative to bandage patients the next day after surgery. To remove the dressing material, always soak the wound with sanguineous discharge, treat the edges of the wound with an antiseptic and apply a protective aseptic bandage. After this, the bandage is changed every 3 days when it is wet. According to indications, UHF therapy is prescribed to the surgical site (infiltrates) or antibiotic therapy. It is necessary to monitor the portal functioning of drainages.

Suture dehiscence (eventeration) most dangerous after abdominal surgery. It may be associated with technical errors when suturing the wound (the edges of the peritoneum or aponeurosis are closely captured in the suture), as well as with a significant increase in intra-abdominal pressure (with peritonitis, pneumonia with severe cough syndrome) or with the development of infection in the wound. To prevent suture dehiscence during repeated operations and with a high risk of developing this complication, suturing the anterior wound is used. abdominal wall on buttons or tubes.

II. The main complications of the nervous system: in the early postoperative period there are pain, shock, sleep and mental disorders.

Elimination of pain in the postoperative period is given exceptional importance. Painful sensations can reflexively lead to disruption of the cardiovascular system, respiratory system, gastrointestinal tract, and urinary organs.

Pain is controlled by prescribing analgesics (promedol, omnopon, morphine). It must be emphasized that unreasonable long-term use of drugs in this group can lead to the development of a painful addiction to them - drug addiction. This is especially true in our time. In addition to analgesics, the clinic uses long-term epidural anesthesia. It is especially effective after abdominal surgery; within 5-6 days makes it possible to sharply reduce pain in the area of ​​surgery and in as soon as possible eliminate a couple of intestines (1% trimecaine solution, 2% lidocaine solution).

Eliminating pain, combating intoxication and excessive stimulation of the neuropsychic sphere are the prevention of such complications from the nervous system as postoperative sleep and mental disorders. Postoperative psychoses often develop in weakened, exhausted patients (homeless people, drug addicts). It must be emphasized that patients with postoperative psychosis require constant supervision. Treatment is carried out jointly with a psychiatrist.

Let's look at an example: A patient with destructive pancreatitis developed psychosis in the early postoperative period. He jumped out of the intensive care unit window.

III. Complications from the cardiovascular system can occur primarily as a result of weakness of cardiac activity, and secondarily as a result of the development of shock, anemia, severe intoxication.

The development of these complications is usually associated with concomitant diseases Therefore, their prevention is largely determined by the treatment of concomitant pathology. The rational use of cardiac glycosides, glucocorticoids, sometimes vasopressants (dopamine), compensation of blood loss, complete oxygenation of the blood, combating intoxication and other measures taken taking into account the individual characteristics of each patient make it possible in most cases to cope with this severe complication of the postoperative period.

An important issue is the prevention of thromboembolic complications, the most common of which is thromboembolism pulmonary artery - a serious complication, which is one of the common causes of death in the early postoperative period. The development of thrombosis after surgery is due to slow blood flow (especially in the veins of the lower extremities and pelvis), increased blood viscosity, water and electrolyte imbalance, unstable hemodynamics and activation of the coagulation system due to intraoperative tissue damage. The risk of pulmonary embolism is especially high in elderly obese patients with concomitant pathology of cardio-vascular system, the presence of varicose veins lower limbs and a history of thrombophlebitis.

Principles for the prevention of thromboembolic complications:

early activation of patients, active management in the postoperative period;

impact on a possible source (for example, treatment of thrombophlebitis);

ensuring stable dynamics (control of blood pressure, pulse);

correction of water and electrolyte balance with a tendency to hemodilution;

the use of disaggregants and other agents that improve the rheological properties of blood (reopolyglucin, trental, neoton);

the use of direct anticoagulants (heparin, fraxiparin, streptokinase) and indirect action(sincumar, pelentan, aescusin, phenylin, dicoumarin, neodicoumarin);

bandaging the lower extremities in patients with varicose veins veins

IV. Among the postoperative complications from the respiratory system the most common are tracheobronchitis, pneumonia, atelectasis, and pleurisy. But the most dangerous complication is development of acute respiratory failure, associated primarily with the consequences of anesthesia.

That's why the main measures for the prevention and treatment of respiratory complications are:

early activation of patients,

adequate position in bed with the head end elevated

(Fowler's position),

breathing exercises,

combating hypoventilation of the lungs and improving the drainage function of the tracheobronchial tree (inhalation of humidified oxygen,

cupping, mustard plasters, massage, physiotherapy),

thinning sputum and using expectorants,

prescribing antibiotics and sulfa drugs taking into account sensitivity,

sanitation of the tracheobronchial tree in seriously ill patients (through an endotracheal tube during prolonged mechanical ventilation or through a microtracheostomy during spontaneous breathing)

Analysis of inhalers and oxygen system.

V. Complications from the abdominal cavity in the postoperative period are quite severe and varied. Among them, peritonitis, adhesive intestinal obstruction, and gastrointestinal paresis occupy a special place. Attention is drawn to the collection of information when examining the abdominal cavity: examination of the tongue, examination, palpation, percussion, auscultation of the abdomen; digital examination of the rectum. The special importance in the diagnosis of peritonitis is emphasized in such symptoms as hiccups, vomiting, dry tongue, muscle tension in the anterior abdominal wall, bloating, weakened or absent peristalsis, the presence of free fluid in the abdominal cavity, and the appearance of the Shchetkin-Blumberg symptom.

The most common complication is the development paralytic obstruction (intestinal paresis). Intestinal paresis significantly disrupts the digestive processes, and not only them. An increase in intra-abdominal pressure leads to a high position of the diaphragm, impaired ventilation of the lungs and heart activity; In addition, there is a redistribution of fluid in the body, absorption of toxic substances from the intestinal lumen with the development of severe intoxication of the body.

Basics of preventing intestinal paresislaid down for operations:

careful handling of fabrics;

minimal infection of the abdominal cavity (use of tampons);

careful hemostasis;

novocaine blockade of the mesenteric root at the end of the operation.

Principles of prevention and control of paresis after surgery:

early activation of patients wearing a bandage;

rational diet (small convenient portions);

adequate gastric drainage;

insertion of a gas outlet tube;

stimulation of motility of the gastrointestinal tract (proserin 0.05% - 1.0 ml subcutaneously; 40-60 ml of hypertonic solution IV slowly drip; cerucal 2.0 ml IM; cleansing or hypertonic enema);

2-sided novocaine perinephric blockade or epidural blockade;