Total Pancreatectomy +/- Splenectomy
| Actions | Day 0 | Day 1 | Day 2 | Day 3 | Day 4 | Day 5 | Day 6 | Day 7 | Day 8 | Discharge |
|---|---|---|---|---|---|---|---|---|---|---|
| Monitoring | Hourly obs (min) Cardiac Monitor Oxygen via mask | 2-4 hourly obs (min) STOP oxygen and cardiac monitor | 4-6 hourly obs (min) | 6 hourly obs (min) | 6 hourly obs (min) | 6 hourly obs (min) | 6 hourly obs (min) | 6 hourly obs (min) | 6 hourly obs (min) | Obs stable |
| DVT Prophylaxis | TEDs Clexane 6hrs post-op | TEDs Clexane | TEDs Clexane | TEDs Clexane | TEDs Clexane | TEDs Clexane | TEDs Clexane | TEDs Clexane | TEDs Clexane | Home with Clexane for 28 days |
| Pain Control | Epidural IV paracetamol | As per Day 0 | As per Day 0 | REMOVE epidural Oral analgesia | Oral analgesia | Oral analgesia | Oral analgesia | Oral analgesia | Oral analgesia | Pain controlled |
| Ranitidine | IV - 50mg TDS | IV - 50mg TDS | IV - 50mg TDS | Oral - 150mg BD | Oral - 150mg BD | Oral - 150mg BD | Oral - 150mg BD - FINAL DOSE | |||
| If Splenectomy - Antibiotics | Oral penicillin 250mg BD | Oral penicillin 250mg BD | Oral penicillin 250mg BD | Oral penicillin 250mg BD | Oral penicillin 250mg BD | Oral penicillin 250mg BD | Oral penicillin 250mg BD | Oral penicillin 250mg BD | TTAs include oral penicillin 250mg BD. If no vaccination pre-op, advice pt and GP of need for vaccination within 6 weeks |
|
| If Splenectomy - Aspirin | None | Aspirin 75mg OD, if PLT>1000 | Aspirin 75mg OD, if PLT>1000 | Aspirin 75mg OD, if PLT>1000 | Aspirin 75mg OD, if PLT>1000 | Aspirin 75mg OD, if PLT>1000 | Aspirin 75mg OD, if PLT>1000 | Aspirin 75mg OD, if PLT>1000 | Aspirin 75mg OD, if PLT>1000 | If PLT count is still high, include aspirin on TTA |
| Insulin | Sliding Scale | Sliding Scale Refer to diabetic team | Sliding Scale until insulin regimen agreed by diabetic team/nurse | Sliding Scale until insulin regimen agreed by diabetic team/nurse | Insulin as per diabetic team advice | Insulin as per diabetic team advice | Insulin as per diabetic team advice | Insulin as per diabetic team advice | Insulin as per diabetic team advice | Pt seen by diabetic team Understands how to manage insulin Has follow-up appointment |
| NG Tube | In place | Spigot if <500ml in 24hrs | REMOVE if <500ml in 24hrs | |||||||
| Abdominal Drain | In place | In place | In place | REMOVE if NO bile/enteric leak | ||||||
| Urinary Catheter | In place | In place | REMOVE unless contra-indicated | |||||||
| IV Fluids | In place | In place | If drinking well, STOP | STOP | ||||||
| Investigations | FBC, LFT, U&Es, clotting screen - APTT & PT | FBC, LFT, U&Es, clotting screen - APTT & PT | FBC, LFT, U&Es, clotting screen - APTT & PT | FBC, LFT, U&Es | FBC, LFT, U&Es | All results acceptable levels | ||||
| Eating & Drinking | Sips of water Continue TPN IF commenced pre-op | Sips of water Continue TPN IF commenced pre-op | Free fluids | Normal diet and free fluids CREON 40,000 with meals CREON 25,000 with snacks | Normal diet and free fluids CREON 40,000 with meals CREON 25,000 with snacks | Normal diet and free fluids CREON 40,000 with meals CREON 25,000 with snacks | Normal diet and free fluids CREON 40,000 with meals CREON 25,000 with snacks | Normal diet and free fluids CREON 40,000 with meals CREON 25,000 with snacks | Normal diet and free fluids CREON 40,000 with meals CREON 25,000 with snacks | Eating and drinking Understands how to use CREON TTA includes CREON |
| Wound Care | None | Check wounds, only change dressings 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 >30° Show & encourage deep breathing & leg exercises | Keep head of bed raised to >30° Assist pt to sit out AM & PM, mobilise BD Encourage deep breathing & leg exercises | Keep head of bed raised to >30° Assist pt to sit out AM & PM, mobilise QDS Encourage deep breathing & leg exercises | Keep head of bed raised to >30° Assist pt to sit out AM & PM, mobilise QDS Encourage deep breathing & leg exercises | Keep head of bed raised to >30° Mobilise fully | Keep head of bed raised to >30° Mobilise fully | Keep head of bed raised to >30° Mobilise fully | Keep head of bed raised to >30° Mobilise fully | Keep head of bed raised to >30° Mobilise fully | Independently mobilising - to patient'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 to patient's norm | Pt self caring to patient's norm | Pt self caring to patient's norm | Pt self caring to patient's norm | Pt self caring to patient's norm |