LAPAROTOMY

							                                           Laparotomya
Preoperative care:
 Admission order:                                        a
                                                             Laparotomy is suitable for patients with uterine myomas,
   1.     On GYN routine                                      ovarian tumors, and adnexal mass
   1.     Vital sign (TPR, BP) as ordinary               b
                                                             Prophylactic antibiotics: ex : cefamezine 1 vial IV
                                                         c
                                                             5% G/W 2000ml+ N/S 500ml daily
 Stat order :                                            d
                                                             First or second generation of cephalosporin
   1.     CBC/DC, PT, APTT, or ABO/Rh                          ex: cefamezine 1 vial q.8h. IV × 1 day
   2.     Chest x-ray ; EKG ; Urine routine              e
                                                             Meperidine 1-1.5 mg/kg q.8h.
   3.     Na, K, BUN, Cr, GOT, GPT, Glucose                  NSAIDs : ex: ketorolac 30mg IV or IM q.6h.
   4.     Sign inform consent                                               (15 mg for renal impairment patient)
   5.     Change underwear                               f
                                                             Order renew with oral medicine
   6.     Shaving & enema                                         Antibiotics : ex : keflex (250mg) q.i.d.
   7.     Nulla per os                                            NSAIDs : ex : ponstan , panadol (500mg) t.i.d.-q.i.d.
   8.     Voiding before operation                       g
                                                             Check pathology report for suspected malignancy, if
   9.     5% G/W 1000ml IV Drip                                   confirmed advance therapy should be given.
                     b
   10.    Antibiotics before operation within 30 mins
   11.    Sent patient to operating room on call




Postoperative care :
 ( op. day )
 Post-op order:
   1.     Vital sign q.30’×IV; q.1h.×II, q.2h.×II,
          if stable then ordinary
   2.     Nulla per os
   3.     Fluid supplementc 2-3L
   4.     Antibiotics treatmentd in selective patient
   5.     Wound care q.o.d. if clean wound ,
   6.     Foley care q.d.
   7.     Pain controle
   8.     Record drainage q.8h.if needed


 Stat order :
   1.     Recheck CBC(/DC), or others
   2.     Hour urine × 6 times
   3.     Record I/O q.8h. × 1 day
(Post-op day 1 )
  1.    Follow-up vital sign, laboratory data
  2.    Remove foley if I/O balance
  3.    Order renewf if the patient’s condition is stable
  4.    Drainage care if needed
(Post-op day 2 & later )
  1.    Wound care (or remove stitches)
  2.    Remove drainage if needed
  3.    Follow-up pathology reportg
  4.    Discharge the patient while the patient’s general condition is stable
  5.    Arrange next OPD follow-up