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Monday, January 21, 2008

After Surgery

  • Waking Up in the Intensive Care Unit (ICU)
After the surgery, the patient will wake up in the intensive care unit after the anesthesia wears off.
This is what the patient should expect:
  1. Some pain and discomfort, which medication will help to relieve.
  2. A tube will be inserted through the patient's nose. This tube will run down the patient's throat and into his stomach. This tube will keep the stomach empty, to help prevent nausea and vomiting.
  3. A tube may be inserted into the patient's throat to help him get enough oxygen. It will be connected to a breathing machine called a ventilator. The patient should try to relax and let the machine breathe for him. The patient will not be able to talk with this tube in place, but he will only need it for a few days. Nurses will do everything they can to help the patient communicate. The patient's throat may feel sore or scratchy for a few days afterward.
  4. The patient will be asked to cough periodically to keep his lungs clear. If it hurts to cough, the patient should ask someone to support his abdomen.
  5. The patient will have an IV line in his arm or neck under the collarbone, which will be used to give fluids and medication for the first few days after surgery.
  6. For several days after surgery, the patient will have a catheter in his bladder to drain urine. He may feel uncomfortable, and may feel that he has to urinate constantly, but it is only temporary.
  7. During surgery, several drains will be placed in or near the incision. These drains will be removed 5 to 10 days after surgery.
The length of a hospital stay will depend on a patient's progress। A patient is encouraged to talk to someone on his transplant team if he is uneasy or uncomfortable.

  • Medical Management in the Acute Care Team
After the patient's medical condition has stabilized, he will be transferred from the ICU to the acute care unit. During the patient's stay on this unit, his laboratory studies, medications, nutritional status and exercise tolerance will be monitored. soon as the patient is able, discharge instructions will begin to prepare him for going home.
  • Clinic and Follow-Up Visits
Upon leaving the hospital, the patient will receive a schedule of follow-up clinic visits for lab tests and checkups. The purpose is to track your progress and detect potential complications as early as possible. On days when the patient is scheduled for follow-up visits, he should bring his medication list and his surgery handbook. He will be given specific instructions for routine lab work or special tests that he might need.
  • Lab Tests
A usual lab test monitors blood count, clotting, kidney function, liver function, electrolytes, and medication levels in the patient's blood. Other tests may be ordered as necessary.
Lab tests Tests for BLOOD COUNT:

  1. WBC tell if the patient's white blood cells have increased (usually a sign of infection) or decreased (indicating a lower defense against infection).

  2. HCT measures the hematocrit, which is the percentage of red blood cells in the blood. Red blood cells carry oxygen to all parts of the body. When a patient's HCT is low, he may feel tired or have little energy.

  • PLT measures the level of platelets. Platelet cells form a blood clot when the body is injured. Low platelet levels may cause someone to bruise easily and to bleed for a longer time when injured.

    Creatinine and BUN tell how well the kidneys work by measuring levels of creatinine and blood urea nitrogen, waste products normally removed from the blood by the kidneys.
    Tests for LIVER FUNCTION:
    1. Bili measures the level of bilirubin, a normal byproduct when hemoglobin from red blood cells breaks down. The liver removes bilirubin from the blood and excretes it in the bile. When the liver is not functioning normally, bilirubin levels can increase, often resulting in jaundiced (yellowed) skin and eyes.
    2. Alk Phos measures alkaline phosphatase, which is made in the bones, liver, pancreas, and intestines and removed from the blood by the liver.
    3. AST, ALT, and GGTP test enzymes that are made in the liver. These tests tell how well the liver is working.
    Tests for ELECTROLYTES (dissolved minerals):
    1. Ca measures calcium, which is necessary for strong bones and teeth, blood clotting, and heart and nerve function.
    2. PO4 measures phosphate, which works closely with calcium to strengthen bones.
    3. Mg measures magnesium, which is necessary for normal functioning of muscles and for blood clotting.
    4. K measures potassium, which is needed for normal heart and muscle function.
    5. Na measures sodium, which helps maintain the balance of salt and water in the body.
    Other blood tests:
    Drug levels measure PROGRAF or SANDIMMUME in the blood. PROGRAF or SANDIMMUNE blood levels must be checked regularly to avoid levels that are too high or too low. High levels could lead to toxicity or over-immunosuppression, and low levels may lead to rejection.
    NOTE: The desired level (normal range) will differ for each person, depending on the combination of immunosuppressive medications and the length of time since the transplant.
    Glu measures glucose, levels of sugar in the blood; some medications may produce a diabetes-like condition in which blood-sugar levels are too high.
    • Additional Tests and Procedures
    • Monitoring at Home
    • Resuming Normal Activities
    • Avoiding Infection
    • Communicating with the Healthcare Team
    Via: USC

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