02/08/2026
# đŠē āϏāĻžāϰā§āĻāĻžāϰāĻŋ āϰā§āĻā§āϰ Morning Follow-up āĻā§āĻāĻžāĻŦā§ āĻĻā§āĻŦā§āύ?
# # āĻāύā§āĻāĻžāϰā§āύ āĻāĻŋāĻāĻŋā§āϏāĻāĻĻā§āϰ āĻāύā§āϝ āĻāĻāĻāĻŋ āĻŦāĻžāϏā§āϤāĻŦāĻāĻŋāϤā§āϤāĻŋāĻ āĻāĻžāĻāĻĄ
āϏāĻžāϰā§āĻāĻžāϰāĻŋ āĻā§āĻžāϰā§āĻĄā§ āϏāĻāĻžāϞā§āϰ follow-up āĻļā§āϧ⧠âāϰā§āĻā§ āĻā§āĻŽāύ āĻāĻā§â āĻāĻŋāĻā§āĻā§āϏ āĻāϰ⧠āĻāϞ⧠āĻāϏāĻžāϰ āύāĻžāĻŽ āύā§āĨ¤ āĻāĻāĻŋ āĻāĻŽāύ āĻāĻāĻāĻŋ clinical skill, āϝā§āĻāĻžāύ⧠āĻā§ā§āĻ āĻŽāĻŋāύāĻŋāĻā§āϰ āĻŽāϧā§āϝ⧠āĻāĻĒāύāĻžāĻā§ āĻŦā§āĻāϤ⧠āĻšāĻŦā§âāϰā§āĻā§ āĻāĻžāϞ⧠āĻšāĻā§āĻā§, āĻāĻāĻ āĻ
āĻŦāϏā§āĻĨāĻžā§ āĻāĻā§, āύāĻžāĻāĻŋ āύā§āϰāĻŦā§ āĻā§āύ⧠complication-āĻāϰ āĻĻāĻŋāĻā§ āϝāĻžāĻā§āĻā§āĨ¤
āĻ
āύā§āĻ āĻāύā§āĻāĻžāϰā§āύ āϏāĻāĻžāϞ⧠āϰā§āĻā§āϰ āĻāĻžāĻā§ āĻāĻŋā§ā§ āĻĒā§āϰāĻĨāĻŽā§āĻ āĻŦāϞā§āύâ
âāĻā§āĻŽāύ āĻāĻā§āύ?â
āϰā§āĻā§ āĻŦāϞā§āύâ
âāĻāĻžāϞā§āĨ¤â
āĻāϰāĻĒāϰ āύā§āĻā§ āϞā§āĻāĻž āĻšā§â
**Patient is stable.**
āĻāĻŋāύā§āϤ⧠âāĻāĻžāϞā§â āĻāĻĨāĻžāĻāĻŋ āĻāĻāύā§āĻ āϝāĻĨā§āώā§āĻ clinical information āύā§āĨ¤
āĻāĻāĻāύ postoperative āϰā§āĻā§āϰ āĻ
āĻŦāϏā§āĻĨāĻž āĻŦā§āĻāϤ⧠āĻšāϞ⧠āĻāĻĒāύāĻžāĻā§ **āĻĻā§āĻāϤ⧠āĻšāĻŦā§, āĻļā§āύāϤ⧠āĻšāĻŦā§, āĻĒāϰā§āĻā§āώāĻž āĻāϰāϤ⧠āĻšāĻŦā§ āĻāĻŦāĻ āϤāĻĨā§āϝ āĻŽāĻŋāϞāĻŋā§ā§ āϏāĻŋāĻĻā§āϧāĻžāύā§āϤ āύāĻŋāϤ⧠āĻšāĻŦā§āĨ¤**
# # āϰā§āĻā§āϰ āĻāĻžāĻā§ āϝāĻžāĻā§āĻžāϰ āĻāĻā§
Ward round āĻļā§āϰ⧠āĻšāĻā§āĻžāϰ āĻāĻā§ āύāĻŋāĻā§āϰ āĻĒā§āϰāϏā§āϤā§āϤāĻŋ āύāĻŋāύāĨ¤
āϰā§āĻā§āϰâ
âĸ āύāĻžāĻŽ āĻ āĻŦā§āϏ
âĸ āϰā§āĻ āύāĻŋāϰā§āĻŖā§
âĸ āĻā§ āĻ
āĻĒāĻžāϰā§āĻļāύ āĻšā§ā§āĻā§
âĸ āĻāĻ postoperative day āĻāϤ
âĸ āĻ
āĻĒāĻžāϰā§āĻļāύā§āϰ āϏāĻŽā§ āĻā§āύ⧠āĻāĻāĻŋāϞāϤāĻž āĻšā§ā§āĻāĻŋāϞ āĻāĻŋ āύāĻž
âĸ drain, catheter, NG tube āĻŦāĻž stoma āĻāĻā§ āĻāĻŋ āύāĻž
âĸ āĻāϤ āϰāĻžāϤā§āϰ āϏāĻŽāϏā§āϝāĻž
âĸ āϏāϰā§āĻŦāĻļā§āώ vital signs
âĸ fluid balance āĻ urine output
âĸ āĻā§āϰā§āϤā§āĻŦāĻĒā§āϰā§āĻŖ investigation
āĻāϏāĻŦ āύāĻž āĻā§āύ⧠āϰā§āĻā§āϰ āĻĒāĻžāĻļā§ āĻĻāĻžāĻā§āĻžāύ⧠āĻŽāĻžāύ⧠āĻ
āϰā§āϧā§āĻ āϤāĻĨā§āϝ āύāĻŋā§ā§ āϏāĻŋāĻĻā§āϧāĻžāύā§āϤ āύā§āĻā§āĻžāĨ¤
āĻāĻāĻāĻŋ āĻā§āĻ pocket notebook āĻŦāĻž patient list āϏāĻā§āĻā§ āϰāĻžāĻā§āύāĨ¤ āϰāĻžāϤā§āϰ duty doctor āĻŦāĻž nurse-āĻāϰ āĻāĻžāĻ āĻĨā§āĻā§ āĻā§āύ⧠āύāĻŋāύâāϰāĻžāϤ⧠āĻā§āĻŦāϰ, hypotension, vomiting, bleeding, low urine output, pain āĻŦāĻž breathing difficulty āĻšā§ā§āĻāĻŋāϞ āĻāĻŋ āύāĻžāĨ¤
# # āĻĒā§āϰāĻĨāĻŽā§ āϰā§āĻā§āĻā§ āĻĻā§āĻā§āύ
āĻŦā§āĻĄā§āϰ āĻāĻžāĻā§ āĻāĻŋā§ā§ āĻļā§āϧ⧠monitor āύā§, āĻāĻā§ āϰā§āĻā§āĻā§ āĻĻā§āĻā§āύāĨ¤
āϰā§āĻā§ āĻāĻŋ āϏā§āĻŦāĻžāĻāĻžāĻŦāĻŋāĻāĻāĻžāĻŦā§ āĻāĻĨāĻž āĻŦāϞāĻā§āύ?
āύāĻžāĻāĻŋ āĻā§āĻŽāĻā§āĻŽ, āĻ
āϏā§āĻĨāĻŋāϰ, āĻāĻžāĻŽāĻā§āύ, āĻļā§āĻŦāĻžāϏāĻāώā§āĻā§ āĻāĻā§āύ?
āĻāĻāĻāύ āϰā§āĻā§āϰ āĻā§āĻšāĻžāϰāĻž āĻ
āύā§āĻ āϏāĻŽā§ monitor-āĻāϰ āĻāĻā§ complication-āĻāϰ āϏāĻāĻā§āϤ āĻĻā§ā§āĨ¤
āύāĻŋāĻā§āĻā§ āĻĒāϰāĻŋāĻā§ āĻāϰāĻŋā§ā§ āĻĻāĻŋāύ āĻāĻŦāĻ āĻŦāϞā§āύâ
âāĻāĻŽāĻŋ āĻāĻ āϏāĻāĻžāϞ⧠āĻāĻĒāύāĻžāϰ āĻ
āĻŦāϏā§āĻĨāĻž āĻĻā§āĻāϤ⧠āĻāϏā§āĻāĻŋāĨ¤ āϰāĻžāϤ⧠āĻā§āύ⧠āϏāĻŽāϏā§āϝāĻž āĻšā§ā§āĻāĻŋāϞ āĻāĻŋ?â
āĻāĻ āĻā§āĻ āĻŦāĻžāĻā§āϝāĻāĻŋ āϰā§āĻā§āĻā§ āĻāĻļā§āĻŦāϏā§āϤ āĻāϰ⧠āĻāĻŦāĻ rapport āϤā§āϰāĻŋ āĻāϰā§āĨ¤
# # āϰā§āĻā§āϰ āύāĻŋāĻā§āϰ āĻāĻžāώāĻžā§ āĻ
āĻāĻŋāϝā§āĻ āĻļā§āύā§āύ
āϤāĻžāϰāĻĒāϰ āύāĻŋāϰā§āĻĻāĻŋāώā§āĻāĻāĻžāĻŦā§ āĻāĻŋāĻā§āĻā§āϏ āĻāϰā§āύâ
âĸ āĻŦā§āϝāĻĨāĻž āĻā§āĻĨāĻžā§ āĻāĻŦāĻ āĻāϤāĻāĻž?
âĸ āĻŦā§āϝāĻĨāĻž āĻāĻā§āϰ āϤā§āϞāύāĻžā§ āĻāĻŽā§āĻā§, āύāĻžāĻāĻŋ āĻŦā§ā§ā§āĻā§?
âĸ āĻŦāĻŽāĻŋ āĻŦāĻž āĻŦāĻŽāĻŋ āĻŦāĻŽāĻŋ āĻāĻžāĻŦ āĻāĻā§ āĻāĻŋ?
âĸ āĻĒā§āĻ āĻĢāĻžāĻāĻĒāĻā§ āĻāĻŋ?
âĸ āĻā§āϝāĻžāϏ āĻŦāĻž āĻĒāĻžā§āĻāĻžāύāĻž āĻšā§ā§āĻā§ āĻāĻŋ?
âĸ āĻĒā§āϰāϏā§āϰāĻžāĻŦ āĻ āĻŋāĻāĻŽāϤ⧠āĻšāĻā§āĻā§ āĻāĻŋ?
âĸ āĻļā§āĻŦāĻžāϏāĻāώā§āĻ, āĻāĻžāĻļāĻŋ āĻŦāĻž āĻŦā§āĻāĻŦā§āϝāĻĨāĻž āĻāĻā§ āĻāĻŋ?
âĸ āĻŽāĻžāĻĨāĻž āĻā§āϰāĻž āĻŦāĻž āĻĻā§āϰā§āĻŦāϞ āϞāĻžāĻāĻā§ āĻāĻŋ?
âĸ āϰāĻžāϤ⧠āĻā§āĻŽ āĻšā§ā§āĻā§ āĻāĻŋ?
âĸ āĻāĻžāĻŦāĻžāϰ āĻŦāĻž āĻĒāĻžāύāĻŋ āύāĻŋāϤ⧠āĻĒāĻžāϰāĻā§āύ āĻāĻŋ?
âāĻŦā§āϝāĻĨāĻž āĻāĻā§?â āĻāĻŋāĻā§āĻā§āϏ āĻāϰāϞā§āĻ āĻšāĻŦā§ āύāĻžāĨ¤ āĻŦā§āϝāĻĨāĻž āĻā§āĻĨāĻžā§, āύāϤā§āύ āĻāĻŋ āύāĻž, āĻā§āϰāĻŽāĻļ āĻŦāĻžā§āĻā§ āĻāĻŋ āύāĻžâāĻāϏāĻŦ āĻāĻžāύāϤ⧠āĻšāĻŦā§āĨ¤
āĻ
āĻĒāĻžāϰā§āĻļāύā§āϰ āĻĒāϰ āĻŦā§āϝāĻĨāĻž āϏā§āĻŦāĻžāĻāĻžāĻŦāĻŋāĻ, āĻāĻŋāύā§āϤ⧠**āĻšāĻ āĻžā§ āĻŦā§ā§ā§ āϝāĻžāĻā§āĻž āĻŦā§āϝāĻĨāĻž āĻāĻāύ⧠āϏā§āĻŦāĻžāĻāĻžāĻŦāĻŋāĻ āϧāϰ⧠āύā§āĻŦā§āύ āύāĻžāĨ¤**
# # Vital signs āĻāĻāύ⧠āĻŦāĻžāĻĻ āĻĻā§āĻŦā§āύ āύāĻž
āϝā§āĻā§āύ⧠postoperative follow-up-āĻāϰ āĻāĻŋāϤā§āϤāĻŋ āĻšāϞ⧠vital signsāĨ¤
āĻĻā§āĻā§āύâ
âĸ Pulse
âĸ Blood pressure
âĸ Respiratory rate
âĸ Temperature
âĸ Oxygen saturation
âĸ āĻĒā§āϰā§ā§āĻāύ āĻšāϞ⧠blood glucose
āĻļā§āϧ⧠āĻāĻāĻāĻŋ reading āύā§, trend āĻĻā§āĻā§āύāĨ¤
Pulse āĻāϤāĻāĻžāϞ ā§Žā§Ļ āĻāĻŋāϞ, āĻāĻ ā§§ā§§ā§ĻâāĻāĻāĻŋ āĻā§āϰā§āϤā§āĻŦāĻĒā§āϰā§āĻŖāĨ¤
BP āϏā§āĻŦāĻžāĻāĻžāĻŦāĻŋāĻ āĻšāϞā§āĻ tachycardia early bleeding, sepsis, pain, dehydration āĻŦāĻž pulmonary complication-āĻāϰ āϏāĻāĻā§āϤ āĻšāϤ⧠āĻĒāĻžāϰā§āĨ¤
Respiratory rate āĻ
āύā§āĻā§āĻ āϞāĻŋāĻā§āύ āύāĻžāĨ¤ āĻ
āĻĨāĻ postoperative deterioration-āĻāϰ āĻĒā§āϰāĻĨāĻŽ āϞāĻā§āώāĻŖāĻā§āϞā§āϰ āĻāĻāĻāĻŋ āĻšāϤ⧠āĻĒāĻžāϰ⧠respiratory rate āĻŦā§ā§ā§ āϝāĻžāĻā§āĻžāĨ¤
# # Fluid balance āĻ urine output
Fluid chart āĻļā§āϧ⧠āύāĻžāϰā§āϏā§āϰ āĻĻāĻžā§āĻŋāϤā§āĻŦ āύā§āĨ¤ āĻāĻāĻāύ surgical intern-āĻāϰ āĻāĻāĻŋ āĻŦā§āĻāϤ⧠āĻšāĻŦā§āĨ¤
āĻĻā§āĻā§āύâ
âĸ āĻāϤ fluid āĻĻā§āĻā§āĻž āĻšā§ā§āĻā§
âĸ āĻāϤ oral intake āĻšā§ā§āĻā§
âĸ urine output āĻāϤ
âĸ drain, vomiting āĻŦāĻž NG tube āĻĻāĻŋā§ā§ āĻāϤ loss āĻšā§ā§āĻā§
âĸ patient positive āύāĻž negative balance-āĻ āĻāĻā§
āϏāĻžāϧāĻžāϰāĻŖāĻāĻžāĻŦā§ urine output āĻāĻŽā§ āĻā§āϞ⧠āϏāĻŽā§āĻāĻžāĻŦā§āϝ āĻāĻžāϰāĻŖ āĻāĻžāĻŦā§āύâ
âĸ dehydration
âĸ bleeding
âĸ hypotension
âĸ urinary catheter blockage
âĸ acute kidney injury
âĸ sepsis
Catheter bag-āĻ āĻĒā§āϰāϏā§āϰāĻžāĻŦ āĻāĻā§ āĻāĻŋ āύāĻž āύāĻŋāĻā§ āĻĻā§āĻā§āύāĨ¤ āĻļā§āϧ⧠chart-āĻāϰ āϏāĻāĻā§āϝāĻžāϰ āĻāĻĒāϰ āύāĻŋāϰā§āĻāϰ āĻāϰāĻŦā§āύ āύāĻžāĨ¤
# # Systematic examination āĻāϰā§āύ
āϏāĻŦ āϰā§āĻā§āϰ full examination āĻĒā§āϰāϤāĻŋāĻĻāĻŋāύ āĻĻāϰāĻāĻžāϰ āύāĻž āĻšāϞā§āĻ āĻāĻāĻāĻŋ focused examination āĻāϰā§āϰāĻŋāĨ¤
# # # General examination
âĸ āϰā§āĻā§ alert āĻāĻŋ āύāĻž
âĸ pallor āĻāĻā§ āĻāĻŋ āύāĻž
âĸ dehydration
âĸ jaundice
âĸ peripheral oedema
âĸ cyanosis
âĸ calf swelling āĻŦāĻž tenderness
# # # Chest examination
Postoperative āϰā§āĻā§āϰ chest āĻ
āĻŦāĻļā§āϝāĻ āĻā§āϰā§āϤā§āĻŦ āĻĻāĻŋāύāĨ¤
āĻĻā§āĻā§āύâ
âĸ āĻļā§āĻŦāĻžāϏāĻāώā§āĻ
âĸ oxygen requirement
âĸ air entry
âĸ basal crepitation
âĸ cough āĻŦāĻž sputum
āĻ
āĻĒāĻžāϰā§āĻļāύā§āϰ āĻĒāϰ āĻ
āύā§āĻ āϰā§āĻā§ āĻŦā§āϝāĻĨāĻžāϰ āĻāĻžāϰāĻŖā§ āĻāĻā§āϰ āĻļā§āĻŦāĻžāϏ āύā§āύ āύāĻžāĨ¤ āĻāϰ āĻĢāϞ⧠basal atelectasis āĻŦāĻž chest infection āĻšāϤ⧠āĻĒāĻžāϰā§āĨ¤
āϰā§āĻā§āĻā§ deep breathing āĻ coughing exercise āĻāϰāϤ⧠āĻā§āϏāĻžāĻš āĻĻāĻŋāύāĨ¤
# # # Abdomen
Abdominal surgery āĻšāϞ⧠āĻĻā§āĻā§āύâ
âĸ āĻĒā§āĻ āĻĢā§āϞā§āĻā§ āĻāĻŋ āύāĻž
âĸ tenderness āĻāĻā§ āĻāĻŋ āύāĻž
âĸ guarding āĻŦāĻž rigidity
âĸ bowel sound
âĸ wound condition
âĸ drain output
âĸ stoma colour āĻ output
Postoperative abdomen āĻāĻŋāĻā§āĻāĻž tender āĻšāϤ⧠āĻĒāĻžāϰā§āĨ¤ āĻāĻŋāύā§āϤ⧠worsening tenderness, guarding, rigidity, increasing distension āĻŦāĻž persistent tachycardiaâāĻāϏāĻŦ āĻā§āϰā§āϤā§āĻŦāĻĒā§āϰā§āĻŖ warning signāĨ¤
# # Surgical wound āĻĻā§āĻāĻžāϰ āύāĻŋā§āĻŽ
āĻĒā§āϰāϤāĻŋāĻĻāĻŋāύ dressing āĻā§āϞ⧠wound āĻĻā§āĻāĻž āĻĒā§āϰā§ā§āĻāύ āύāĻžāĻ āĻšāϤ⧠āĻĒāĻžāϰā§āĨ¤ āĻāĻŋāύā§āϤ⧠dressing-āĻāϰ āĻāĻĒāϰ āĻĻāĻŋā§ā§ āĻĻā§āĻā§āύâ
âĸ soakage āĻāĻā§ āĻāĻŋ āύāĻž
âĸ blood, pus āĻŦāĻž bile-like discharge
âĸ dressing āϏāϰ⧠āĻā§āĻā§ āĻāĻŋ āύāĻž
âĸ surrounding skin āϞāĻžāϞ āĻŦāĻž āĻĢā§āϞ⧠āĻāĻā§ āĻāĻŋ āύāĻž
âĸ wound pain āĻŦāĻžā§āĻā§ āĻāĻŋ āύāĻž
āĻĄā§āϰā§āϏāĻŋāĻ āĻā§āĻāĻž āĻĨāĻžāĻāϞ⧠āĻļā§āϧ⧠āύāϤā§āύ āĻāĻ āϞāĻžāĻāĻŋā§ā§ āĻĻā§āĻŦā§āύ āύāĻžāĨ¤ āĻāĻžāϰāĻŖāĻāĻŋ āĻā§āĻāĻā§āύāĨ¤
Wound dehiscence āϏāύā§āĻĻā§āĻš āĻšāϞ⧠āϰā§āĻā§āĻā§ āĻāĻžāĻļāĻŋ āĻĻāĻŋāϤ⧠āĻŦāϞāĻŦā§āύ āύāĻž āĻŦāĻž āĻā§āώāϤ āύāĻžā§āĻžāĻāĻžā§āĻž āĻāϰāĻŦā§āύ āύāĻžāĨ¤ Senior-āĻā§ āĻĻā§āϰā§āϤ āĻāĻžāύāĻžāύāĨ¤
# # Drain-āĻāϰ āĻŦā§āϝāĻžāĻĒāĻžāϰ⧠āĻļā§āϧ⧠âDrain in situâ āϞāĻŋāĻāĻŦā§āύ āύāĻž
Drain assessment-āĻ āϞāĻŋāĻā§āύâ
âĸ drain type āĻ location
âĸ output āĻāϤ
âĸ colour āĻā§
âĸ serous, sanguineous, bilious, purulent āύāĻžāĻāĻŋ faeculent
âĸ tube kink āĻŦāĻž blocked āĻāĻŋ āύāĻž
âĸ suction āĻāĻžāĻ āĻāϰāĻā§ āĻāĻŋ āύāĻž
āĻāĻāĻāύ āϰā§āĻā§āϰ drain output āĻāϤāĻāĻžāϞ ā§Ģā§Ļ ml serous āĻāĻŋāϞ, āĻāĻ ā§Šā§Ļā§Ļ ml fresh bloodâāĻāĻāĻŋ āĻāϰā§āϰāĻŋ āϤāĻĨā§āϝāĨ¤
# # NG tube, catheter āĻ stoma
NG tube āĻĨāĻžāĻāϞ⧠āĻĻā§āĻā§āύâ
âĸ output āĻāϤ
âĸ colour āĻ nature
âĸ tube position āĻ āĻŋāĻ āĻāĻā§ āĻāĻŋ āύāĻž
âĸ blockage āĻāĻā§ āĻāĻŋ āύāĻž
Urinary catheter āĻĨāĻžāĻāϞā§â
âĸ urine colour
âĸ output
âĸ catheter draining freely āĻāĻŋ āύāĻž
âĸ āĻĒā§āϰā§ā§āĻāύ āĻāĻāύāĻ āĻāĻā§ āĻāĻŋ āύāĻž
Stoma āĻĨāĻžāĻāϞā§â
âĸ colour pink/red āĻāĻŋ āύāĻž
âĸ black āĻŦāĻž dusky āĻšā§ā§āĻā§ āĻāĻŋ āύāĻž
âĸ output āĻļā§āϰ⧠āĻšā§ā§āĻā§ āĻāĻŋ āύāĻž
âĸ bleeding, retraction āĻŦāĻž prolapse āĻāĻā§ āĻāĻŋ āύāĻž
âĸ bag leakage āĻāϰāĻā§ āĻāĻŋ āύāĻž
āĻāĻāĻāĻŋ stoma āĻļā§āϧ⧠âfunctioningâ āϞāĻŋāĻā§ āĻļā§āώ āĻāϰāĻŦā§āύ āύāĻžāĨ¤
# # Investigation āĻĻā§āĻā§āύ, āĻļā§āϧ⧠collect āĻāϰāĻŦā§āύ āύāĻž
Morning follow-up-āĻāϰ āϏāĻŽā§ āϰā§āĻā§āϰ relevant investigation review āĻāϰā§āύāĨ¤
āϝā§āĻŽāύâ
âĸ Hb āĻāĻŽāĻā§ āĻāĻŋ āύāĻž
âĸ WBC āĻŦāĻžā§āĻā§ āĻāĻŋ āύāĻž
âĸ CRP trend
âĸ serum creatinine
âĸ electrolytes
âĸ blood glucose
âĸ LFT
âĸ drain fluid report
âĸ culture result
Report āĻšāĻžāϤ⧠āύāĻŋā§ā§ āĻļā§āϧ⧠senior-āĻāϰ āĻāĻžāĻā§ āϝāĻžāĻā§āĻžāϰ āĻŦāĻĻāϞ⧠āύāĻŋāĻā§ āĻāĻžāĻŦā§āύâ
âāĻāĻ āϰāĻŋāĻĒā§āϰā§āĻ āϰā§āĻā§āϰ āĻŦāϰā§āϤāĻŽāĻžāύ āĻ
āĻŦāϏā§āĻĨāĻžāϰ āϏāĻā§āĻā§ āĻŽāĻŋāϞāĻā§ āĻāĻŋ?â
# # Diet, mobilisation āĻ prophylaxis
Postoperative care-āĻāϰ āĻā§āϰā§āϤā§āĻŦāĻĒā§āϰā§āĻŖ āĻ
āĻāĻļâ
âĸ āϰā§āĻā§ āĻā§ āĻāĻžāĻā§āĻā§āύ
âĸ oral intake āϏāĻšā§āϝ āĻāϰāĻā§āύ āĻāĻŋ āύāĻž
âĸ IV fluid āĻāĻāύāĻ āĻĒā§āϰā§ā§āĻāύ āĻāĻŋ āύāĻž
âĸ patient mobilised āĻšā§ā§āĻā§āύ āĻāĻŋ āύāĻž
âĸ chest physiotherapy āĻšāĻā§āĻā§ āĻāĻŋ āύāĻž
âĸ DVT prophylaxis āĻāϞāĻā§ āĻāĻŋ āύāĻž
âĸ pain control āĻĒāϰā§āϝāĻžāĻĒā§āϤ āĻāĻŋ āύāĻž
âĸ antibiotic review āĻĒā§āϰā§ā§āĻāύ āĻāĻŋ āύāĻž
âBed restâ āĻ
āύā§āĻ āϏāĻŽā§ safest plan āύā§āĨ¤ āĻĻā§āϰā§āĻāĻĻāĻŋāύ āĻļā§ā§ā§ āĻĨāĻžāĻāϞ⧠chest infection, DVT, muscle weakness āĻ pressure sore-āĻāϰ āĻā§āĻāĻāĻŋ āĻŦāĻžā§ā§āĨ¤
# # āĻāĻāύ āϏāĻā§āĻā§ āϏāĻā§āĻā§ senior-āĻā§ āĻĄāĻžāĻāĻŦā§āύ?
āύāĻŋāĻā§āϰ āϝā§āĻā§āύ⧠āĻāĻāĻāĻŋ āĻĨāĻžāĻāϞ⧠āĻ
āĻĒā§āĻā§āώāĻž āĻāϰāĻŦā§āύ āύāĻžâ
âĸ āύāϤā§āύ tachycardia
âĸ hypotension
âĸ āĻļā§āĻŦāĻžāϏāĻāώā§āĻ āĻŦāĻž oxygen saturation āĻāĻŽā§ āϝāĻžāĻā§āĻž
âĸ urine output āĻāĻŽā§ āϝāĻžāĻā§āĻž
âĸ āϤā§āĻŦā§āϰ āĻŦāĻž āĻŦāĻžā§āϤ⧠āĻĨāĻžāĻāĻž āĻŦā§āϝāĻĨāĻž
âĸ āĻĒā§āĻ āĻŦā§āĻļāĻŋ āĻĢāĻžāĻāĻĒāĻž āĻŦāĻž guarding
âĸ repeated vomiting
âĸ fresh bleeding
âĸ drain-āĻ bile, faecal material āĻŦāĻž āĻŦā§āĻļāĻŋ blood
âĸ āĻā§āĻŦāϰā§āϰ āϏāĻā§āĻā§ clinical deterioration
âĸ wound dehiscence
âĸ stoma dusky āĻŦāĻž black āĻšāĻā§āĻž
âĸ patient confused āĻŦāĻž unusually drowsy
Senior-āĻā§ āĻĢā§āύ āĻāϰāĻžāϰ āϏāĻŽā§ āĻļā§āϧ⧠āĻŦāϞāĻŦā§āύ āύāĻžâ
âSir, patient is not good.â
āĻŦāϞā§āύâ
âSir, postoperative day 2 after right hemicolectomy. Pulse 118, BP 90/60, urine output 15 ml/hour, drain has 200 ml fresh blood in the last hour. I am concerned about postoperative bleeding.â
āĻāĻāĻžāĻ structured escalationāĨ¤
# # Morning follow-up note āĻā§āĻāĻžāĻŦā§ āϞāĻŋāĻāĻŦā§āύ?
āĻļā§āϧ⧠āϞāĻŋāĻāĻŦā§āύ āύāĻžâ
âPatient stable. Dressing done.â
āĻāĻāĻāĻŋ āĻāĻžāϞ⧠note āĻšāϤ⧠āĻĒāĻžāϰā§â
**POD 2 following laparotomy and bowel resection. Patient alert, pain controlled, no vomiting. Pulse 92/min, BP 118/70 mmHg, SpOâ 97% on room air, afebrile. Abdomen soft, mild expected incisional tenderness, no guarding. Wound dressing clean and dry. Drain 40 ml serous output over 24 hours. Urine output adequate. Tolerating oral fluids, no flatus yet. Plan: continue analgesia, encourage mobilisation and breathing exercise, monitor drain and urine output, review FBC and electrolytes.**
āĻāĻĒāύāĻžāϰ note āĻĻā§āĻā§ āĻĒāϰāĻŦāϰā§āϤ⧠āĻāĻŋāĻāĻŋā§āϏāĻ āϝā§āύ āϰā§āĻā§āϰ āĻŦāϰā§āϤāĻŽāĻžāύ āĻ
āĻŦāϏā§āĻĨāĻž āĻāĻŦāĻ plan āĻŦā§āĻāϤ⧠āĻĒāĻžāϰā§āύāĨ¤
# # āĻļā§āώ āĻāĻĨāĻž
āĻāĻāĻāύ āĻāĻžāϞ⧠surgical intern āĻļā§āϧ⧠senior-āĻāϰ āύāĻŋāϰā§āĻĻā§āĻļ āĻĒāĻžāϞāύ āĻāϰā§āύ āύāĻžāĨ¤ āϤāĻŋāύāĻŋ āϰā§āĻā§āϰ āĻĒāϰāĻŋāĻŦāϰā§āϤāύ āϧāϰā§āύ, āϤāĻĨā§āϝ āϏāĻāĻā§āϰāĻš āĻāϰā§āύ, āĻā§āĻāĻāĻŋ āĻāĻŋāύāϤ⧠āĻĒāĻžāϰā§āύ āĻāĻŦāĻ āϏāĻŽā§āĻŽāϤ⧠āϏāĻžāĻšāĻžāϝā§āϝ āĻāĻžāύāĨ¤
Morning follow-up āĻā§āύ⧠routine tick-box exercise āύā§āĨ¤
āĻāĻāĻŋ āĻĒā§āϰāϤāĻŋāĻĻāĻŋāύ āϏāĻāĻžāϞ⧠āϰā§āĻā§āϰ āĻļāϰā§āϰ āĻāĻĒāύāĻžāĻā§ āϝāĻž āĻŦāϞāĻā§, āϏā§āĻāĻŋ āĻŽāύ āĻĻāĻŋā§ā§ āĻļā§āύāĻžāĨ¤
**āĻāĻāĻāĻŋ missed tachycardia, āĻāĻāĻāĻŋ āύāĻž āĻĻā§āĻāĻž drain output āĻŦāĻž āĻāĻāĻāĻŋ āĻ
āĻŦāĻšā§āϞāĻŋāϤ low urine outputâāĻāĻāύ⧠āĻāĻāύ⧠āĻŦā§ complication-āĻāϰ āĻĒā§āϰāĻĨāĻŽ āϏāĻāĻā§āϤ āĻšāϤ⧠āĻĒāĻžāϰā§āĨ¤**
āϤāĻžāĻ āϰā§āĻā§āϰ āĻĒāĻžāĻļā§ āĻĻāĻžāĻā§āĻŋā§ā§ āĻļā§āϧ⧠āĻĒā§āϰāĻļā§āύ āĻāϰāĻŦā§āύ āύāĻžâ
âāĻā§āĻŽāύ āĻāĻā§āύ?â
āύāĻŋāĻā§āĻā§āĻ āĻĒā§āϰāĻļā§āύ āĻāϰā§āύâ
**âāĻāĻ āϰā§āĻā§ āĻāĻŋ āϏāϤā§āϝāĻŋāĻ āĻāĻā§āϰ āĻā§ā§ā§ āĻāĻžāϞā§?â**
â **āĻĒā§āϰāĻĢā§āϏāϰ āĻĄāĻž. āϤāĻĒā§āĻļ āĻā§āĻŽāĻžāϰ āĻĒāĻžāϞ**
MBBS (DMC), FCPS (Surgery), MS (Surgical Oncology)
āϏāĻžāϰā§āĻāĻŋāĻā§āϝāĻžāϞ āĻ
āύāĻā§āϞāĻāĻŋāϏā§āĻ āĻ āĻŦā§āϰā§āϏā§āĻ āϏāĻžāϰā§āĻāύ
āĻĒā§āϰāĻžāĻā§āϤāύ āĻŦāĻŋāĻāĻžāĻā§ā§ āĻĒā§āϰāϧāĻžāύ, āϏāĻžāϰā§āĻāĻžāϰāĻŋ
āĻĄā§āϞā§āĻāĻž āĻŽā§āĻĄāĻŋāĻā§āϞ āĻāϞā§āĻ āĻ āĻšāĻžāϏāĻĒāĻžāϤāĻžāϞ