Perawatan pra dan pasca bedah BADRIATUNNOR

PRIMUM, NON NOCERE FIRST, DO NO HARM HIPPOCRATES’S TENET ( BC)

TOTAL CARE Tidak Kecolongan / Terkaget-kaget ada Masalah pada Intra-Pasca Bedah !

10 Butir Total Care / THE 10 COMMANDMENTS : 1. Triage ? 2. Diagnosa ? 3. Kasus bedah / bukan ? 4. Masalah yang dapat timbul ? 5. Jenis op. / teknik op. (School Of Surgery / School Of Anesthesiology) ? 6. Timing operasi ? 7. Masalah pra bedah ? 8. Masalah intra bedah ? 9. Masalah pasca bedah ? 10. Follow Up ?

Preoperative visiting - Confirming their identify, history of illnesses, assessing their current health, and identifying any issues the patient may have - Educating patients is important to prepare them for surgery and provides knowledge on what is going to happen to them and why. - This may also help to reduce their anxiety before anaesthesia on the day of surgery.

Preoperative assessment  Assessment of needs; diagnosis of issues; requirements for anaesthesia (e.g. denture removal, latex allergy, pain relief, suitable time of fasting to avoid the risk of inhaling gastric fluids into the lungs);  Physiological assessment (e.g. blood pressure, heart rate and rhythm, respiration, body temperature);  Fluid and electrolyte needs; psychosocial needs (e.g. anxiety, fear, lack of understanding, maintaining dignity;

Preoperative investigations Knowledge of these results also improves patient safety and helps to identify anaesthetic and surgical needs during the procedure Investigations may include areas such as;  Radio opaque dyes (to identify areas of the body and the flow of fluids in the body);  Arteriograms and venograms (to identify problems with the cardiovascular system)  Barium swallow or enema (to identify problems with the GI tract);  Diagnostic imaging (e.g. X ray, ultrasound, magnetic resonance imaging (MRI)  Computerised tomography (CT),

Post operative

Post operative management  Respiratory monitoring  Cardiovascular monitoring  Neuromuscular monitoring  Psychological monitoring  Temperature monitoring  Pain monitoring  Monitoring nausea and vomiting  Fluid monitoring  Urine output and voiding  Drainage and bleeding  Monitoring of the airway

Pain  The first stage in managing pain is to find out its cause.  The second stage is to assess the pain. The primary way to assess pain is to ask patients – if they say they are in terrible pain, then they will need urgent help to reduce the level of pain  The final stage is to help reduce pain by using drugs, and to reduce their side effects to a minimum.  Systemic opioids  Nonsteroidal anti ‐ inflammatory drugs (NSAIDS)  Regional techniques; spinal or epidural  Non ‐ pharmacologic techniques; These can include electrical stimulation of peripheral nerves, which may affect pain ‐ inhibitory pathways, acupuncture or massage.

Post Operative Nausea and Vomiting (PONV) Anti ‐ emetic therapy; Metoclopromide is a D2 receptor antagonist in the stomach, gut and chemoreceptor trigger zone. Droperidol is a D2 receptor antagonist and an α ‐ adrenergic agonist. Dosages up to 2.5 mg can be given. Hyoscine (Scopolamine) is anticholinergic and is effective for PONV associated with vestibular inputs (sense of movement in the inner ear). Cyclizine is an H1 receptor antagonist that also produces anticholinergic responses. Ondansetron is a 5 ‐ HT3 receptor antagonist. The 5 ‐ HT3 receptor is a serotonin receptor found in terminals of the vagus nerve and in certain areas of the brain Dexamethasone is an effective anti ‐ emetic at a dose of 8 mg. It is a member of the glucocorticoid class of steroid drugs that has anti ‐ inflammatory and immunosuppressant properties

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