Gastrectomy (Total/Subtotal)
ST = Subtotal
| Actions | Day 0 | Day 1 | Day 2 | Day 3 | Day 4 | Day 5 | Day 6 |
|---|---|---|---|---|---|---|---|
| Monitoring | Hourly obs (min) Cardiac monitoring Humidified oxygen via mask | 2-4 hourly obs (min) STOP cardiac monitoring Humidified oxygen via mask | 4 hourly obs (min) Humidified oxygen via mask | 4 hourly obs (min) Humidified oxygen via mask | 4 hourly obs (min) Humidified oxygen via mask | 4 hourly obs (min) STOP oxygen | 6 hourly obs |
| DVT Prophylaxis | TED stockings Clexane 6hrs post-op | TEDs - removed, legs checked, replaced daily Clexane | TEDs Clexane | TEDs Clexane | TEDs Clexane | TEDs Clexane | TEDs Clexane |
| Pain Control | Epidural, PCA or paravertebral IV paracetamol PR diclofenac if required | As per day 0 | REMOVE Epidural or paravertebral ORAL analgesia | ||||
| Exercise | Supported to lie upright in bed Sit out in chair (depend on time get to ward) Leg movements in bed Breathing exercises using incentive spirometer | Sit out in chair Support patient to mobilise QDS Other exercises as per Day 0 | |||||
| NG Tube | In place | ST: Spigot (4-6hrly aspirates) | Spigot (4-6hrly aspirates) ST: Consider removal | Consider removal | |||
| Abdominal (Doudenal stump) Drain | In place | Consider removal | |||||
| Urinary Catheter | In place | Consider removal | |||||
| Central line | In place | Consider removal | |||||
| IV Fluids | In place | Consider stopping | |||||
| Eating and Drinking | IV fluids Liquid food via feeding tube ST: NO jejunostomy tube Sips of water up to 100ml/hr | ST: Free fluids | Free fluids Cont. liquid food via feeding tube | ST: Start soft foods as per dietician advice | Start soft foods as per dietician advice Cont. liquid food via NGT |
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| Wound Care | None | Change drain dressings Surgical wounds checked Change dressings if necessary | Leave surgical wound undressed, if dry and healing well | ||||
| Investigations | CXR in recovery | CXR (NOT ST) FBC, U&E | FBC, U&E | CXR (NOT ST) FBC, U&Es, CRP | FBC, U&E | FBC, U&Es, CRP | FBC, U&Es |