Preoperative Care

Current Diagnosis and Treatment Surgery

13th Edition
Chapter 3
Dr. Andina Destiyani Putri

Preoperative Care
Preoperative Evaluation
General Health Assessment
Specific Factors Affecting Operative Risk
A. The Compromised of Altered Host
- Nutritional Assessment
- Assessment of Immune Competence
- Other factors leading to increased
infection
B. Pulmonary Dysfunction
C. Delayed Wound Healing
D. Drug Effects
E. Perioperative Management of Chronic Medications
F. Risks of Thromboembolism
G. The Elderly Patient
H. The Obese Patient
I. Preoperative Hemostatic Evaluation

Preoperative Care
Preoperative Preparations
Informing the Patient
Operative Permit
Asepsis and Antisepsis in the Prevention of Wound
Infection
A. Sterilization
- Autoclaving
- Dry Heat
- Gas sterilization
B. Skin Antiseptics
- Hand scrub routine
- Preparation of the operative field
- In the operating room
C. Control of Hospital Environment

Preoperative Care
..cont
C. Control of Hospital Environment
- Hospital administration
- Cultures
- Isolation
- Aseptic technique
(operating room, patient unit
procedures, hand
washing)
- Antibiotics
- Epidemiology

Preoperative Care
Diabetes Mellitus
Preoperative workup
Preoperative and intraoperative management of
diabetic patients
A. Type 2 (non-insulin-Dependent) Diabetes
Mellitus
B. Type 1 (insulin-dependent) Diabetes Mellitus
- Conventional procedure for insulin
administration
- Intravenous infusion of insulin in glucose
solution
- Use of insulin piggy-backed into the glucose
infusion

Postoperative care
Hyperosmolar coma

Preoperative Care
Thyroid Disease
Adrenal Insufficiency

Postoperative Care

Current Diagnosis and Treatment Surgery

13th Edition
Chapter 3
Dr. Andina Destiyani Putri

Postoperative Care
Wound
Healing

Pain

Postoperative
Care

Tranfusion
Therapy

Fluid Therapy

Postoperative Care
The Immediate Postoperative Period
Postoperative Orders
A. Monitoring : vital signs, central venous
pressure, fluid balance, other types of
monitoring
B. Respiratory Care
C. Position in Bed and Mobilization
D. Diet
E. Administration of Fluid and Electrolytes
F. Drainage Tubes
G. Medications
H. Laboratory Examination and Imaging

Postoperative Care
The Intermediate Postoperative Period
Care of the Wound
Management of Drains
Postoperative Pulmonary Care

Postoperative Care
Respiratory Failure
Postoperative Fluid and Electrolyte
Management
Postoperative Care of the Gastrointestinal
Tract

Postoperative Care
Tranfusion Therapy
Whole Blood
Red Blood Cells (RBCs)
Washed Red Blood Cells
Leukocyte-Reduced Red Blood Cells
Irradiated Red Blood Cells
Frozen-Deglycerolized Red Blood Cells
Platelets
Fresh Frozen Plasma
Cryoprecipitate
Granulocyte Tranfusions

Postoperative Care
Postoperative Pain
Physician-Patient Communication
Parenteral Opioids
Nonopioid Parenteral Analgesics
Oral Analgesics
Patient-Controlled Analgesia
Continuous Epidural Analgesia
Intercostal Block

Postoperative
Complications

Current Diagnosis and Treatment Surgery

13th Edition
Chapter 3
Dr. Andina Destiyani Putri

Postoperative
Complications
Wound Complications
Hematoma
Seroma
Wound Dehiscence
A. Systemic Risk Factors
B. Local Risk Factors
1. Adequacy of Closure
2. Intra-abdominal pressure
3. Deficient wound healing
C. Diagnosis and Management
Miscellaneous Problems

Postoperative
Complications
Respiratory Complications
Atelectasis
Pulmonary Aspiration
Postoperative Pneumonia
Postoperative Pleural Effusion and
Pneumothorax

Postoperative
Complications
Fat Embolism
Cardiac Complications
A. Dysrhytmias
- Intraoperative Dysrhytmias
- Postoperative Dysrhytmias
B. Postoperative Myocardial Infarction
C. Postoperative Cardiac Failure

Postoperative
Complications
Peritoneal Complications
Hemoperitoneum
Complications of Drains
Postoperative Parotitis
Complications Caused by Postoperative Alterations
of Gastrointestinal Motility
Gastric Dilation
Bowel Obstruction
Postoperative Fecal Impaction

Postoperative
Complications
Postoperative Pancreatitis
Postoperative Hepatic Dysfunction
A. Prehepatic Jaundice
B. Hepatocellular Insufficiency
C. Posthepatic obstruction
Postoperative Cholecystitis
Clostridium difficile collitis
Urinary Complications

A. Postoperative Urinary Retention

B. Urinary Tract Infection

Postoperative
Complications
Central Nervous System Complications
A. Postoperative Cerebrovascular
Accidents
Psychiatric Complications

A. Special Psychiatric Problems

- The ICU Syndrome
- Postcardiotomy Delirium
- Delirium Tremens
- Sexual Dysfunction

Postoperative
Complications

Complications of Intravenous Therapy and

Hemodynamic Monitoring
A. Air Embolism
B. Phlebitis
C. Cardiopulmonary Complications
D. Ischemic Necrosis of the Finger

Postoperative Fever

Terima
Kasih