This document provides guidelines for the general care of surgical patients, including both inpatients and outpatients. For inpatients, it discusses priorities for admission, pre-operative care including diet and informed consent, post-operative care including monitoring of vital signs and potential complications, diet, hygiene, and follow-up. For outpatients, it outlines pre-operative instructions and post-operative care including follow-up responsibilities. The overall aim is to safely care for surgical patients before, during, and after procedures.

1. General Care
of the Surgical Patient
Presenter: R1 鄭瑋之
Instructor: VS 陳靜容醫師
Date: 2012/3/9

2. Outlines
 Surgical patients
 In-patient
 Out-patient

3. In-patient Care
 Surgical Priorities
 Emergency — requires instant admission
ex: acute infection, traumatic injury
 Urgent — can progress to emergency
ex: subacute infection, neoplasm
 Routine — admitted the day before
preparation: blood investigation, consultation,
chest xray, EKG…

4. In-patient Care
 Pre-OP care
n Visits the patient within a few hours of admission.
n Review and revise the findings at the out-patient
exam.
n Record the pulse, temperature, blood pressure,
haemoglobin estimation and urinalysis.
n Check those teeth beyond conservation to be
extracted.
n Replace insecure dressings in case they are dislodged
into a socket or wound.

5. In-patient Care
 Pre-OP care
n Warn the anaesthetist about the loose teeth.
n Extensive haemorrhage?
n Explain to the patient about the nature of the
operation and likely complications.
n Informed consent obtained in writing for both the
anaesthetic and the operation.
n Not only to carry out the local treatment but also to
supervise the day-to-day care.

6. In-patient Care
 Diet
1. Fluid intake and output
 Daily intake: 2500 ml; Daily output: 1000~1500ml
 Water is excreted as exhaled air (400 ml), sweat
(500~1000 ml), urine (1200 ml), and faeces (200 ml)
 Insufficient fluid intake  urine output↓
(minimum: 600 ml)
 If difficulty in feeding  fluid balance chart
 Fluid given by mouth or intravenously

7. In-patient Care
 Diet
1. Solid food
 Balanced diet: carbohydrates + fats + proteins +
vitamins + mineral salts
 Fats are not easily digested.
 Carbohydrate to prevent ketosis.
 Protein for the repair of tissue.
 Discussed with the dietitian.
 NG tube: brought out and cleaned every 2 or 3
days. Replaced through the other nostril.
 Weighed weekly

8. In-patient Care
 Diet
1. Pre-operative diet
 LA: normal meal
If the patient has missed a meal he should be given
a glucose drink before the injection is given.
 GA: light meal
Chiefly of protein and carbohydrate, is advised the
night before.
No food taken for 4 hours nor clear fluids for 2
hours before operation!

9. In-patient Care
 Diet
1. Post-operative diet
 Feeding should be
started as soon as
possible to avoid
nausea.
 Tenderness/tismus 
specially prepared
food

10. In-patient Care
 Excretion
1. Micturition
 This reflex act occurs when the pressure in the
bladder rises sufflciently to cause the sphincter to
relax and the detrusor muscle to contract.
 It may occur after GA.
 Micturition can be encouraged by getting the
patient up but if this fails catheterisation may be
necessary.

11. In-patient Care
 Excretion
1. Sweat
 Sweat contains 0.5 percent of solids (NaCl).
 In fever or in hot weather sweating  10 g of NaCl
can be lost in an hour

12. In-patient Care
 Excretion
1. Defaecation
 Constipation: organic or functional?
 Organic is due to partial obstruction of the lumen.
 Functional is due to defective movements of the
colonic musculature, or a deficiency in bulk of
faeces due to feeding with fluid diets.
 Feeding fruit, vegetables and wholemeal cereals or
by giving laxatives.

13. In-patient Care
 Sleep
 Pain: analgesics/hypnotics
 External stimuli: keep the wards dark and
quiet at night
 Worry or change of habit: dozing by day lead
to insomnia, hypnotic drugs, but only if really
necessary for they are habit-forming.

14. In-patient Care
 Hygiene
 Oral hygiene instruction
 Mouth rinse with 0.2% CHX after every meal
 Intraoral sutures: debris removed each day
 Arch bars: brush with toothpaste, rinse
 Gutta-percha moulds: after the first 10 days, a
syringe between the graft and the mould to
clean the dead space

15. In-patient Care
 Post-OP care
n Put into bed with a pillow behind
shoulders to enable drainage from
mouth.
n Arms kept folded over chest.
n Nurse sits by to watch the airway,
suck out the mouth and oro-
pharynx
n Watch for vomiting and
haemorrhage, and records the vital
signs and level of consciousness.

16. In-patient Care
 Post-OP complications
2. Fever
 Natural reaction to infection, common for 2~3 days
 Chest complaint  sputum culture
 Symptomatic treatment: confinement to bed,
more fluid intake and a high carbohydrate diet to
prevent the breakdown of body proteins.
 > 39.4°C: sponged down with tepid water at 27°C

17. In-patient Care
 Post-OP complications
1. Vomiting
 due to the anaesthetic or swallowed blood
 > 8 hours  upset of the acid base equilibrium
 TX: give milk or alkaline drinks with glucose. sipped
very slowly but frequently or antiemetic
2. Conjunctivitis
 Gently irrigated with normal saline.
 Chloramphenicol eye-drops

18. In-patient Care
 Post-OP complications
1. Sore throat or pharyngitis
 Trauma from the endotracheal tube, excoriation
from a dry pack
 TX: gargles and inhalations
2. Pulmonary conditions
 Routine post-OP breathing exercises will reduce
the incidence.
 TX: antibiotics, physiotherapy, humidified oxygen,
sedatives and mucolytic drugs, frequent hot drinks

19. In-patient Care
 Routine monitoring
n Vital signs: temperature, pulse, blood pressure
n Fluid balance chart
n Bloods: full blood count, haemoglobin,
electrolytes
n Bowel habit
n Dietary intake
n Drug requirements: analgesics, antibiotics,
normal medications

20. Out-patient Care
 Day cases
 Minor operations under endotracheal
anaesthesia
 Morning
 Suitable transport must be available

21. Out-patient Care
 Pre-OP instructions for out-patients
n The nature of the operation must be explained.
n Permission obtained in writing for both general
anaesthetic and surgery.
n Told to come accompanied
n Light and easily digested diet
n Wear no restrictive clothing
n Fast from food or drink for at least 4 hours before OP
n Before entering the surgery, remove their dentures,
contact lenses and earrings, and to empty bowel and
bladder.

22. Out-patient Care
 Post-OP care
n Adequate instructions: diet, oral hygiene,
analgesics and the rest period required before
return to work.
n The operator must be easily available to the
patient to deal with any surgical
complications.

23. Follow Up
 To assume responsibility for
the patient's after-care until
all possibility of post-OP
complications is past.
 Long-term follow-up will
benefit both the surgeon and
his patients.

24. Referrence
Principles of Oral and Maxillofacial
Surgery, 5th edition, UJ Moore

25. Thank you
for your attention!