• Choose a category
• All
• Classic-Fiction

Unless clinically indicated, food or enteral feeds should be withheld until there is evidence of return of normal GI motility. Postoperatively, nurses should monitor and document when patients pass flatus and when bowels have opened and the surgical team should be informed. All postoperative bowel movements should be documented (as per Bristol stool chart). Refer to Chapter 6.

Malnutrition

Surgery may exert a deleterious effect on appetite and the ability to maintain adequate nutritional intake postoperatively (Newman et al. 1998). Return to adequate nutritional state is necessary for wound healing (see Chapter 15) and it is particularly important that diabetic patients should return to their preoperative insulin/diet to avoid increased risk of metabolic disturbance. Consequently it is essential that nurses continue to undertake ongoing nutritional assessments and highlight to the dietitian/surgeon when there is cause for concern (see Chapter 8).

Unless contraindicated by the surgery performed (e.g. major abdominal or head and neck surgery) or the patient’s current clinical status (e.g. risk of pulmonary aspiration, vomiting and/or ileus), the majority of patients will be able to meet their nutritional requirements orally in the postoperative period. In line with Essence of Care: Food and Nutrition Benchmark (DH 2001), it is essential that the environment is conducive to enabling patients to eat. This encompasses the implementation of protected mealtimes, assistance to eat and drink (including provision of eating aids), provision of regular snacks and maintenance of oral hygiene. For suggestions on modification of diet for patients experiencing anorexia, sore mouth, dysphagia, nausea and vomiting and/or early satiety in the postoperative period, please refer to Chapter 8.

Any patients unable to meet their nutritional requirements orally may require enteral tube feeding either in the short term or on a more permanent basis. Types of enteral feed tubes include nasogastric, nasoduodenal, nasojejunal, gastrostomy or jejunostomy (see Chapter 8 for information relating to feeding tubes, including potential complications, optimal care and factors to consider prior to terminating feeding).

Whilst enteral feeding is the preferred route of nutritional support (NCCAC 2006), parenteral nutrition may be indicated for some postoperative patients who have undergone major abdominal surgery or those with prolonged ileus, uncontrolled vomiting or diarrhoea, short bowel syndrome or gastrointestinal obstruction (see Professional edition).

Wounds

Wound closure devices

Wounds are usually closed using one of three devices depending on the type of surgery and determined by surgeon preference: clips, sutures, paper sutures.

All should remain in situ and only be removed on surgical advice. For paper sutures, this would usually be 7–10 days and for clips/sutures usually 10–14 days postoperatively.

Dressings for surgical wounds

Turner (1985) wrote that the main functions of a wound dressing are to promote healing by providing a moist environment and to protect the wound from potentially harmful agents or injury. In a closed surgical wound, the main function of the dressing is to absorb blood or haemoserous fluid in the immediate postoperative phase.

When dressings are applied in theatre, it is recommended that they are not removed unless exudate, commonly termed ‘strike-through’, is evident or clinical signs of local or systemic infection occur (Bale and Jones 2006). However, this is often determined by the type of surgery and surgical advice. Unless contraindicated, dressings changes required within 48 hours of surgery should be undertaken using sterile non-touch technique and sterile normal saline (NICE 2008). NICE (2008) guidelines recommend that patients may shower safely 48 hours postoperatively.

The location of the wound and the method of wound closure usually determine whether the wound is dressed or not. Recent studies