|SURGERY: RECOVERY ROOM|
REASON FOR ORDER
1. Admit to recovery room.
2. Vital signs q 5 minutes x 4, then q 15 minutes in recovery room and/or routine recovery room care.
3. Transfer to floor when stable.
4. Vitals q 4 with neuro checks.
5. Head Of Bed at 30 degrees.
6. If Headache, put Head Of Bed Flat.
7. IV D5 .9 NS + 10 meq KCL/L at 75 ml/hour.
8. Ancef 1 gram IV q 8 x 2 doses, then D/C.
9 Tylenol 650 mg po or supp q 4 prn mild HA or pain.
10. Morphine 2 mg IV q 2 prn moderate to severe pain.
11. Zofran 4 mg IV q 4 prn nausea. May repeat x 1 for total of 8 mg IV q4 prn nausea.
12. If nausea persists more than 6 hours, notify M.D.
13. Continue home meds except blood thinners.
14. Ice chips po until good bowel sounds, then begin clear liquid diet. Advance as tolerated.
15. Lab work, x-ray orders.
16. Teds to mid thigh, SCD's (leg compression device).
17. For BP systolic > 160 or diastolic >100, give Hydralazine 5 mg IV q4 prn. May repeat x 1 for total of 10 mg IV q 4 prn.
1. Need to let the staff know where the patient is going, ie, sometimes the patient will go directly to the ICU for post-op recovery.
2. As a patient awakens from anesthesia, blood pressure may be quite labile. Respirations may not be adequate and can change quickly and need to be observed. Most units have their own protocol set up by anesthesia regarding these issues.
3. After the patient is stabilized, he or she will be transferred to the appropriate floor for continued care.
4. The post-operative orders will be in effect when the patient is transferred and the floor unit needs to know how frequently to observe the patient.
5. Elevating the head of the bed to 30 degrees decreases increased intracranial pressure (ICP) as well as promotes drainage of the shunt.
6. When a shunt is draining too much, it can give a "spinal headache" similar to the headache after a lumbar puncture (spinal tap) or myelogram. Putting the head flat helps to decrease the overdrainage of cerebral spinal fluid which helps relieve the headache.
7. If the brain is swollen from the increased intracranial pressure from hydrocephalus, most neurosurgeons prefer to keep the patient a little on the dry side, usually about 2/3'rd fluid maintenance. Otherwise, maintenance fluid keeping the patient euvolemic is preferred.
8. Prophylactic antibiotics are given just before surgery and for one or two doses after surgery. With shunts, the most common infection is staph.
9. Shunt surgery is usually not extremely painful. It is preferred to first try a pain medication that is not sedating so it will not interfere with neurologic assessment.
10. If a narcotic is needed for pain control, the lowest dose possible is preferred. If the patient is sedated, it is difficult to assess mental status which is critical in a neurological surgery patient. The medication can always be reversed if needed.
11, 12. Many patients will get an ileus after a Ventricular-Peritoneal Shunt. They may have some nausea from overdrainage of their shunt. However, they may also get nausea from shunt malfunction, intracranial hemorrhage and cerebral edema. Neurological assessment is critical. If the patient is not improving, notify the physician.
13. The brain is very sensitive to blood thinners. Bleeding into the brain can be lethal. Blood thinners after intracranial surgery usually carries a higher risk than the benefit gained from the blood thinner in the immediate post-operative period.
14. As noted above, many patients will get an ileus after a Ventricular-Peritoneal Shunt and will not tolerate oral intake.
15. This will vary with the patient's medical condition.
16. This is for DVT prophylaxis.
17. Elevated blood pressure after intracranial surgery may result in bleeding into the operative bed. It is extremely important to keep this under control.