M37 perforated viscus. POD3 for exploratory laparoscopy, repair of perforated rectum, incidental appendectomy

Nutrition: DAT (as of Nov 23)

Intake presentation: Abdominal pain in RLQ, blood in stools, dysuria, no nausea or vomiting

Concepts

Allergies: None known

Psychosocial

Treatments

Potential complications

Comorbidities: none known

Lab trends: HIGH WBC HIGH neut LOW lymph

Anxiety and depression related to hospitalization and surgery recovery

Impaired sexual function

Infection

Acute pain

Wound dehiscence

Bleeding

Impaired bowel function

Nausea/vomiting

Elimination: reduced elimination common following abdominal surgery; repair of perforated rectum may be impacted by straining. Monitor for return and ease of bowel function

Infection: high risk of infection following abdominal surgery due to bowel microbiota, reduced nutrition, reduced elimination, impaired immunity.

Wound care/inflammation: Honeycomb dressing remains in place for up to 3 weeks - monitor for leakage, loose dressing, inflammation, signs of infection

Infection prophylaxis

Foley out Nov 22

Midline honeycomb dressing

AAT

IV saline locked

Nothing per rectum

ERAS

DVT prophylaxis

Pain management

Multimodal analgesia

Fluid balance

Diet transition

Mobility