Patients postoperative

Many postoperative patients require less narcotics when they are able to self-administer a narcotic for pain. Because the self-administration system is under the control of the nurse, who adds the drug to die infusion pump and sets the time interval (or lockout interval) between doses, the patient cannot receive an overdose of the drug. 

The nurse immediately reports to the primary health care provider any significant change in the patient s vital signs. Narcotic analgesics can cause hypotension. Particularly vulnerable are postoperative patients and individuals whose ability to maintain blood pressure has been compromised. 

The nurse describes, explains, and demonstrates postoperative patient activities, such as deep breathing, coughing, and leg exercises. 

After surgery, the nurse has die following responsibilities, which vary according to where the nurse first sees die postoperative patient ... 

Elderly or postoperative patients Exercise care in administering sodium-containing solutions in renal or cardiovascular insufficiency, with or without CHF. 

Cardiovascular effects Several instances of hypotension, hypertension, pulmonary edema, and ventricular tachycardia and fibrillation have been reported in postoperative patients. 

Promethazine Promethazine also is indicated for preoperative, postoperative, or obstetric sedation prevention and control of nausea and vomiting associated with certain types of anesthesia and surgery an adjunct to analgesics for control of postoperative pain sedation and relief of apprehension, and to produce light sleep antiemetic effect in postoperative patients active and prophylactic treatment of motion sickness (oral and rectal only). 

Because of the anticholinergic action of these agents, use with caution and with appropriate monitoring in patients with glaucoma, obstructive disease of the Gl or GU tract, and in elderly males with possible prostatic hypertrophy. These drugs may have a hypotensive action, which may be confusing or dangerous in postoperative patients. 

The initial combination modality clinical studies with cisplatin and fractionated radiation therapy was carried out in head and neck cancer with weekly cisplatin (120-160 mg/m2) and conventional single daily fraction radiation (95). In a follow-up intergroup study, patients were randomized to radiation therapy alone or to radiation therapy plus 20 mg/ m2/wk cisplatin (96). Both studies showed no major increase in normal tissue toxicity in the radiation field and showed an increase in response rate. There was no increase in complete response rate or in survival. Bachaud et al.(97) carried out a randomized study comparing radiation therapy alone with concurrent cisplatin (50 mg/m2) and radiation therapy in postoperative patients. This trial produced a significant reduction in local recurrence and improved disease-free survival with 59% of the patients receiving the full planned dose of cisplatin. 

D. K. Menon, G.G. Lockwood, C.J. Peden, i.J. Cox, J. Sargentoni, J.D. Beii, G.A. Courts, J.G. Whitwam, In-vivo F-19 magnetic-resonance spectroscopy of cerebrai haiothane in postoperative-patients—preiiminary-resuits, Magn. Reson. Med. 30 (1993) 680-684. 

The postoperative patient should report nausea as soon as it occurs because prompt administration of the drug increases its effectiveness... 

Excessive dosage in postoperative patients may produce significant excitement, tremors, and reversal of analgesia. 

Pruitt, J.H., et al. (1996) Increased soluble interleukin-1 type 11 receptor concentrations in postoperative patients and in patients with sepsis syndrome. Blood. 87, 3282-8. 

When oral intake of food and water is limited as in pre and postoperative patients or in the patients with severe hepatic or cardiac or GIT disease. 

In developing protein and peptide trans-dermal delivery systems, one must be mindful of the high interindividual variation in drug absorption across the skin. Large variations in bioavailability have been demonstrated with fentanyl patches, initially intended for postoperative pain relief but later abandoned due to unacceptable variability among individuals receiving the same dose [9]. Response in postoperative patients to the application of a fentanyl patch ranged from ineffective pain relief to severe respiratory depression, and effects were correlated with variations in plasma fentanyl levels [9]. 

Renal function is depressed by opioids. It is believed that in humans this is chiefly due to decreased renal plasma flow. In addition, opioids have been found to have an antidiuretic effect in humans. Mechanisms may involve both the CNS and peripheral sites. Opioids also enhance renal tubular sodium reabsorption. The role of opioid-induced changes in antidiuretic hormone (ADH) release is controversial. Ureteral and bladder tone are increased by therapeutic doses of the opioid analgesics. Increased sphincter tone may precipitate urinary retention, especially in postoperative patients. Occasionally, ureteral colic caused by a renal calculus is made worse by opioid-induced increase in ureteral tone. 

Postoperative patients and patients with chronic diseases... 

The gamma camera, with computer-assisted data analysis, is used together with l3lI-hippuran to measure renal function. The renogram is of most clinical value in the assessment of ureter impairment m pre-and postoperative patients with carcinoma of the cervix and other pelvic and gynecological tumors. 

Aygun S, Kocoglu H, Goksu S, et al. Postoperative patient-controlled analgesia with intravenous tramadol, intravenous fentanyl, epidural tramadol and epidural ropivacaine + fentanyl combination. EurJ Gynaecol Oncol. 2004 25 498-501. 

Ballantyne JC, Carr DB, Chalmers TC, et al. Postoperative patient-controlled analgesia meta-analyses of initial randomized control trials. J Clin Anesth. 1993 5 182-193. 

Sveticic G, Eichenberger U, Curatolo M. Safety of mixture of morphine with ketamine for postoperative patient-controlled analgesia an audit with 1026 patients. Acta Anaesthesiol Scand. 2005 49 870-875. 

A. R. Dal Nogoie, G. B. Toews, and A. K. Pieces. Increased saHvary elastese precedes gram-negative bacillary colonization in postoperative patients. Am Rev. Resp. Dig. 

The most efficient topical medications to reduce lOP in postoperative patients are those whose mechanism involves aqueous suppression. These agents would include topical carbonic anhydrase inhibitors, apracloni-dine, brimonidine, beta-blockers, and oral carbonic anhydrase inhibitors. Prostaglandin analogues and miotics are effective in lowering the lOP postoperatively however, they may cause increased inflammation and should not be considered a first-line treatment. 

Postoperative patients who are found to have symptomatic tears or frank retinal detachment should be referred immediately to a vitreoretinal surgeon for treatment. Repair of a rhegmatogenous retinal detachment involves locating retinal breaks, draining subretinal fluid, and sealing the breaks with cryotherapy, endolaser, or diathermy in conjunction with application of a scleral buckle or sponge or pneumatic retinopexy. 

Bioassay methods led to the identification of an antidiuretic hormone (ADH) in the urine of postoperative patients (C8) which was found to persist for at least 24 hours (E5). 

Gairola RL, Gupta PK, Pandley K. Antagonists of morphine-induced respiratory depression. A study in postoperative patients. Anaesthesia 1980 35(1) 17-21. 

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