Download Bowel Resection - L`Hôpital d`Ottawa

Clinical Pathway – Bowel Resection
Pre-Admission
Consult
• Anesthetist
Tests
• Blood test
• Electrocardiogram if
required
• Chest X-ray if required
Day of Admission
Post-op on day of admission
• Blood test if required
• Antibiotic
• Patient Controlled Analgesia (IV PCA) or
Epidural infustion for pain management
• Antibiotic (prevent infection)
• Anti-nausea medications
• Anticoagulant (blood thinner)
• Patient’s own medications if required
• Intravenous
• TED stockings
Assessment
&
Treatment
• Vital signs (Blood Pressure, Heart &
Respiratory Rate, Temperature, Bowel &
Breath Sounds)
• Oxygen if needed
• Intravenous
• Abdominal incisions
• Drain/drainage
• TED stockings
Activity
• Sit at side of bed
Medication
• Measure legs for support
stockings (TEDs)
Nutrition
• Urinary catheter
Elimination
Patient
Teaching/
• Pre-op instructions
• Bowel preparation
• Skin preparation
Discharge
Planning
• Plan for a hospitalization
of 5 days including day of
surgery
• Pre-op instructions
• Deep breathing and coughing exercises
• Ankle exercises
©The Ottawa Hospital – L’Hôpital d’Ottawa
Clinical Pathway – Bowel Resection
Post-op Day 1
Post-op Day 2
Consult
Tests
• Blood test
• Blood test
Medication
• IV PCA or Epidural infusion for pain
management
• Antibiotic
• Anti-nausea medication
• Anticoagulant
• Patient’s own medications if required
• IV PCA discontinued and oral pain medication
started
• Anti-nausea medication
• Anticoagulant
• Patient’s own medications if required
• Vital signs
• Oxygen if needed
• Intravenous
• Abdominal dressing
• Drain/ drainage
• TED stockings
• Vital signs
• Oxygen if needed
• Intravenous discontinued if drinking well
• Abdominal dressing removed and left open to
air
• Drain removed (if present)
• TED stockings
Activity
• Sit in chair 2 times
• Walk in hall 3 times at least
Nutrition
• Surgery diet
• Eat what you feel you can manage
• Surgery diet
• Urinary catheter
• Urinary catheter removed
(if present)
• Up to bathroom
• Deep breathing and coughing exercises
• Ankle exercises
• Pain management
• Activity
• Deep breathing and coughing exercises
• Ankle exercises
• Pain management
• Activity
Assessment
&
Treatment
Elimination
Patient
Teaching/
Discharge
Planning
©The Ottawa Hospital – L’Hôpital d’Ottawa
Clinical Pathway – Bowel Resection
Post-op Day 4
Discharge Day
Post-op Day 3
Consult
Tests
• Blood test if required
Medication
• Oral pain medication
• Anti-nausea medication
• Patient’s own medications if required
• Oral pain medication
• Anti-nausea medication
• Patient’s own medications if required
Assessment
&
Treatment
• Vital signs
• Oxygen if needed
• Abdominal incision
• TED stockings
• Vital signs
Activity
• Walk in hall 3 times at least
• Activity as tolerated
Nutrition
• Surgery diet
• Surgery diet
Elimination
• Passing gas per rectum
Patient
Teaching/
Discharge
Planning
• Deep breathing and coughing exercises
• Ankle exercises
• Pain management
• Activity
Review post-op instructions with the nurse:
• Activity
• Medications
• Wound care
• Diet
• When to cal the doctor
• Follow-up visit
• Discharge
tomorrow by 10:00 a.m.
©The Ottawa Hospital – L’Hôpital d’Ottawa