Bile Duct Resection and Roux-on-Y
| Actions | Day 0 | Day 1 | Day 2 | Day 3 | Day 4 | Day 5 | Day 6 | Day 7 | Discharge |
|---|---|---|---|---|---|---|---|---|---|
| Monitoring | Hourly obs (minimum) Cardiac monitoring Oxygen via mask | 2-4 hourly obs (min) STOP oxygen and cardiac monitoring | 4 hourly obs (min) | 4 hourly obs (min) | 6 hourly obs (min) | 6 hourly obs (min) | 6 hourly obs (min) | 6 hourly obs (min) | Obs stable |
| DVT Prophylaxis | TED Stockings Clexane 6hrs post-op | TEDs Clexane | TEDs Clexane | TEDs Clexane | TEDs Clexane | TEDs Clexane | TEDs Clexane | TEDs Clexane | Home with Clexane for 28 days |
| Pain Control | PCA IV paracetamol | As per day 0 plus Oral analgesia | STOP PCA Oral analgesia | Oral analgesia | Oral analgesia | Oral analgesia | Oral analgesia | Oral analgesia | Pain controlled |
| NG Tube | In place | Spigot if <500ml in 24hrs | REMOVE if <500ml in 24hrs | ||||||
| Abdominal Drain | In place | In place | REMOVE if no bile/enteric contents in drain | ||||||
| Urinary Catheter | In place | REMOVE unless contra-indicated | |||||||
| Central line | In place | REMOVE unless contra-indicated | |||||||
| IV Fluids | In place | STOP | |||||||
| Investigations | CXR in recovery/HDU FBC, LFTs, U&Es, Monitor lactate & Clotting screen - APTT & PT | FBC, LFTs, U&Es, Monitor lactate & Clotting screen - APTT & PT | FBC, LFTs, U&Es, Clotting screen - APTT & PT | FBC, LFTs, U&Es | All results acceptable level Bilirubin <3x normal and/or LFTs improving |
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| Eating and Drinking | Sips of water | Sips of water | Free fluids | Normal diet and free fluids | Normal diet and free fluids | Normal diet and free fluids | Normal diet and free fluids | Normal diet and free fluids | Eating and Drinking |
| Wound Care | None | Check wound, only change dressing if leaking | If wound is dry, REMOVE dressing | Wound satisfactory Wound care advice given |
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| Exercise | Keep head of bed raised to at least 30° Show & encourage deep breathing & leg exercises | Keep head of bed raised to >30° Assist pt to sit out and mobilise 2-4 times Encourage breathing & leg exercises | Keep head of bed raised to >30° Assist pt to sit out and mobilise 4 times Encourage breathing & leg exercises | Keep head of bed raised to >30° Assist pt to sit out and mobilise 4 times Encourage breathing & leg exercises | Mobilise fully | Mobilise fully | Mobilise fully | Mobilise fully | Independently mobilising to pt's norm |
| Personal Care | Assist pt with personal care | Assist pt with personal care | Encourage pt to self-care and dress in day clothes | Encourage pt to self-care and dress in day clothes | Pt dressed in day clothes | Pt self-caring as normal | Pt self-caring as normal | Pt self-caring as normal | Independent as patients normal |