Cholycystectomy

1. Infection

1.1. Slightly Elevated WBC of 10.8

1.2. Monitor incision site

1.3. Monitor Vital Signs

2. Pancreatitis

3. Postoperative Pneumonia

3.1. Cough and deep breathing exercises

3.2. Twice daily oral hygiene

3.2.1. Peridex Q12hr

3.3. Ambulation with good pain control

3.3.1. Tyelenol Q4hr PRN

3.3.2. Hydromorphone Inj 0.4mg Q hr PRN

3.4. Head of bed elevation to at least 30 degrees

3.5. Sitting up for meals

4. Atelectasis

4.1. Risk is high within 72 hours after surgery

4.2. PT is 68 y/o, which puts her at risk

4.3. Use Incentive Spirometer Q2hr while awake

4.4. Cough and deep breathing exercises

4.5. Measure pulse ox (if less than 93%, start nasal canula 02 at 2LPM)

5. Nausea and Vomiting

5.1. Administer antiemetics

5.1.1. Zofran 4mg Q6hr PRN IV

5.1.2. Reglan 10mg Q6hr PRN IV

6. Pain

6.1. Acceptable level: 4

6.2. Current level: 4

6.3. If worse, administer PRN pain meds

6.3.1. Tylenol 650mg Q4hr PRN

6.3.2. HYDROmorphone 0.4mg Q hr PRN

7. Risk for Bleeding

7.1. RBC of 10.8 is within range

7.2. Hct 36.6 is within range

7.3. Hgb 11.6 is within range

7.4. Continue monitoring lab results for any changes and monitor incision/wound site for bleeding

8. Blood Clots (DVT)

8.1. Monitor Blood Pressure

8.2. Apply SCDs and ensure usage

8.3. Ambulate PT as much as possible

8.4. Heparin Procine Q12hr 5,000 units INJ

9. Death