~Teachingcenter的醫學筆記~

肝臟手術、開腹手術、腹壁疝氣

Liver surgery (to general ward)
 Hemodynamic status: Stable
 Moderate abdominal wound pain
 HEENT:
  Pink conjunctiva, anicteric sclera
 Chest:
  Mild coarse breathing sound with basal rales
 Abdomen:
  Soft
  Hypoactive bowel sound
  Abdominal wound at right subcostal area
  little discharge, no hematoma
  V-B drains: light reddish fluid without bile stain
Plan:
    1. NPO with NG decompression
    2. Empiric antibiotics use
    3. Pain control: Analgesics use
    4. Wound care
    5. Chest care with IPPB
    6. Monitor vital signs, abdominal condition and I/O
    7. Monitor hepatorenal function
    8. Monitor and correct coagulopathy or electrolyte abnormalities
    9. Close observation for signs of acute hepatic decompensation, such as
      worsening jaundice, encephalopathy, and ascites.

Liver surgery (to ICU)
 Hemodynamic status: Unstable
 Moderate abdominal wound pain
 HEENT:
  Pink conjunctiva, anicteric sclera
 Chest:
  Mild coarse breathing sound with basal rales
 Abdomen:
  Soft
  Hypoactive bowel sound
  Abdominal wound at right subcostal area
  little discharge, no hematoma
  V-B drains: light reddish fluid without bile stain
Plan:
    1. NPO with NG decompression
    2. Empiric antibiotics use
    3. Pain control: Analgesics use
    4. Wound care
    5. Weaning mechanical ventilator if good weaning profile and clinical condition
    6. Closely monitor vital signs, abdominal condition and I/O
    7. Monitor hepatorenal function
    8. Monitor and correct coagulopathy or electrolyte abnormalities
    9. Close observation for signs of acute hepatic decompensation, such as
      worsening jaundice, encephalopathy, and ascites.

Laparotomy (to general ward)
 Hemodynamic status: Stable
 Moderate abdominal wound pain
 HEENT:
  Pink conjunctiva, anicteric sclera
 Chest:
  Mild coarse breathing sound with basal rales

 Abdomen:
  Soft
  Hypoactive bowel sound
  Sbdominal wound at midline abdomen
  little discharge, no hematoma
  Drains: V-B: light reddish fluid without bile stain
Plan:
    1. NPO with NG decompression
    2. Empiric antibiotics use
    3. Pain control: Analgesics use
    4. Wound care
    5. Chest care with IPPB
    6. Monitor vital signs, abdominal condition and I/O

Laparotomy (to ICU)
 Hemodynamic status: Unstable
 Moderate abdominal wound pain
 HEENT:
  Pink conjunctiva, anicteric sclera
 Chest:
  Mild coarse breathing sound with basal rales
 Abdomen:
  Soft
  Hypoactive bowel sound
  Abdominal wound at midline abdomen
  little discharge, no hematoma
  Drains: V-B: light reddish fluid without bile stain
Plan:
    1. NPO with NG decompression
    2. Empiric antibiotics use
    3. Pain control: Analgesics use
    4. Wound care
    5. Full mechanical ventilator support until the patient is ready for weaning
    6. Closely monitor vital signs, abdominal condition and I/O
    7. Monitor hepatorenal function
    8. Monitor and correct coagulopathy or electrolyte abnormalities

Ventral hernia
 Hemodynamic status: Stable
 Moderate abdominal wound pain
 HEENT:
  Pink conjunctiva, anicteric sclera
 Chest:
  Mild coarse breathing sound without basal rales
 Abdomen:
  Soft
  Normoactive bowel sound
  Abdominal wound at midline abdomen
  little discharge, no hematoma
  Drains: V-B: light reddish fluid without bile stain
Plan:
    1. Sip water --> regular diet, if tolerable
    2. Pain control: Analgesics use
    3. Wound care
    4. Monitor vital signs, abdominal condition