Peculiarities of the management of patients after some typical operations

After appendectomy, Greenacre, ligation hemorrhoids, which is the most common surgical operations departments for the prevention of pulmonary and other complications are applied physiotherapy, early rising, easy diet.
After uncomplicated appendectomy and Greenacre appoint: 1-day - Desk № 0 (by M. I. Pevzner); day 2 - Desk № 2; 3-4th day - Desk № 4 (mechanical high-fiber diet with coarse fiber, butter - 20 g, white bread - 150 g per day). 5-th day the patient is transferred to diet number 2.
After resection of the stomach in the postoperative period encourage the heart activity, eliminate pain, conduct diet therapy, physiotherapy, General health-improving measures. When smooth flow in the first three days injected antibiotics: penicillin by 100-200 thousand UNITS 4-6 times a day and streptomycin 250-500 thousand UNITS 2 times a day. In the first three days prescribed injections under the skin of 20% camphor oil 2 ml 3 times a day, 10% solution of pain-sodium benzoate 1 ml, 2 times a day. In the fall of cardiac activity intravenous glucose (20 ml 40% solution) 0.5-0.75 ml 0.05% solution strofantina or 1 ml of corglycon or ephedrine.
In the first 2 to 3 days after resection of the stomach patient per os food and drink are not given, veins protein products, poliglyukin, 5% glucose, rectum drip - saline. On 2-3rd day with smooth postoperative course give sweet tea, broth, tomato sauce, fruit juices. On 4 - 6 days - Desk № 1A, 7-10 day - Desk № 16, white bread, then to discharge from hospital - table № 1. Congestive stomach contents display in a thin probe or apply continuous suction. After resection of the stomach in a smooth the postoperative period patients are allowed to sit with 2-3 days, to walk with 5-7 agricultural Skin sutures are removed on 8-9 days, and malnourished patients on the 10-12 day. Write a patient on 12-21 days.
After an operation for biliary tract allowed to drink from the 2nd day, appoint strict, mostly protein and carbohydrate, diet. Depending on the nature of the intervention (cholecystectomy, surgery of biliary tract, liver) support protein and carbohydrate balance the introduction of glucose, protein solutions, blood. In the postoperative period during operations on bile ducts in the presence of jaundice, it is necessary to remember about the possibility halamickova bleeding. To combat intoxication during operations on bile ducts in the acute period of the disease, especially in the presence of jaundice, it is recommended to start intravenous drip of blood, 5% glucose solution, solutions dry plasma directly on the operating table. Depending on the severity of intoxication and the state of the heart activity, the number of in-flow solutions regulate, in order to avoid the possible overload of the right heart and the pulmonary circulation. To prevent bleeding in the postoperative period (especially during mechanical jaundice) from the first day after surgery appoint menadione, vitamin K, produce infusion of calcium, blood transfusion.
After surgery of the biliary tract may occur liver failure, resulting sometimes in the so-called hepato-renal syndrome (see Hepatorenal syndrome).
After resection of the small intestine patients give liquid food on the 2-th day after operation, gradually including 3-day cereals, mashed potatoes, crackers. 5-day add cheese, boiled chicken purees, stale bread. With the 12th day give vegetables, fruits, and then in 2-3 days translate the patient on the table.
After resection of the colon strictly liquid food allowed with 2 days. From the 3rd day give cereals, mashed potatoes, 5 - crackers, cheese, boiled chicken purees, from 14th - fruits, vegetables. From the 3rd day after surgery are inside 15% solution of magnesium sulfate or vaseline oil, 1 tbsp 2-3 times a day, to resolve the stagnation of feces. Recommended intake of mineral water (Essentuki № 17, Borjomi, Smirnovskaya). When liquid stools appointed tanalin, bismuth 0.5 g 3 times a day, sulfa drugs.
Also nourish the patient and after resection of the colon imposition of CECO - or colostomy.
After surgery about hemorrhoids give a liquid diet and detain chair for 4-5 days techniques tincture of opium (3 times a day for 5-7 drops). Then appoint a laxative.
After operations on the lungs , blood transfusion, or 5% glucose solution, held during the operation, continue over the next hours after surgery to stabilize blood pressure. Systematically conduct inhalation of oxygen. Medicines under the skin using 2% solution of omnopon 1 ml up to 6 times a day, 20%camphor oil 3 times a day for 3 ml Intramuscularly injected penicillin 200 thousand UNITS every 3-4 hours and streptomycin by 0.25 - 0.5 g 2 times per day.
From the trachea and bronchi periodically suck mucus, blood, sputum. The pleural cavity puncture performed according to the testimony. The degree of lung straightening, the presence of exudate and inflammatory lesions in control of a chest x-ray. In acute respiratory failure due to traumatic injuries of the chest and after extensive interventions impose tracheostomy; in connection with the difficulties of self-breathing resort to artificial respiration with the help of respiratory devices.
After radical surgery for neoplasms of the oesophagus and the cardiac portion of the stomach by transabdominal or transpleural in the first day shall carry out measures on prevention of shock, the fight against respiratory and cardiovascular disorders: promedol, ephedrine, oxygen therapy, elevated position in bed, blood transfusion and blood substitutes. To prevent infection, impose penicillin bicillin and intramuscular injection streptomycin and vnutriplevralno.
Nutrition in the first days of strictly parenteral and through the gastrostoma, if the latter imposed; only with the 6-7th day, you can start feeding through the mouth, giving liquid food in small SIPS. Ingestion of small amounts of pasty food can be resolved with the 10-12-th day, when the danger of a divergence of seams on the esophagus fully passed.
After heart operations maintain postoperative period requires special knowledge and experience. It accurately monitor carried out during the first 2-3 days after the operation: systematically applied pain, heart drugs, oxygen therapy.
Early rational nutrition operated patients given the nature of the operation, the active behavior of the patients after the operation, the early rising (in the first 24 to 48 hours) and physiotherapy accelerate recovery and regeneration of tissues. These measures form a set of active management of the postoperative period. Contraindications to the active method of doing post-operative period are acute inflammatory processes, lack of cardiac activity, pneumonia, severe General condition.