-
Adequate CNS oxygen delivery:
Supplemental oxygen to keep saturation> 90%, preferably> 95% Treatment to raise systolic blood pressure> 2/3 baseline or> 90 mmHg Transfusion to keep hematocrit> 30%
-
Fluid/electrolyte balance:
Treatment to restore serum sodium, potassium, glucose to normal limits (glucose <300 mg/dl, <16.5 mmol/L for diabetics) Treat fluid overload or dehydration detected by examination or blood tests
-
Treatment of severe pain:
Around-the-clock acetaminophen (1 gram four times daily) Early-stage break-through pain: low-dose subcutaneous morphine, avoid meperidine Late-stage break-through pain: oxycodone as needed
-
Elimination of unnecessary medications:
Discontinue/minimize benzodiazepines, anticholinergics, antihistamines Eliminate drug interactions, adverse effects, modify drugs accordingly Eliminate medication redundancies
-
Regulation of bowel/bladder function:
Bowel movement by postoperative day 2 and every 48 hours D/c urinary catheter by postoperative day 2, screen for retention or incontinence Skin care program for patients with established incontinence
-
Adequate nutritional intake:
Dentures used properly, proper positioning for meals, assist as needed Supplements: 1 can Ensure,* 3 cans Ensure* for poor oral intake If unable to take food orally, feed via temporary nasogastric tube
-
Early mobilization and rehabilitation:
Out of bed on postoperative day 1 and several hours daily Mobilize/ambulate by nursing staff as tolerated, such as to bathroom Daily physical therapy; occupational therapy if needed
-
Prevention, early detection, and treatment of major postoperative complications:
Myocardial infarction/ischemia—electrocardiogram, cardiac enzymes if needed Supraventricular arrhythmias/atrial fibrillation—appropriate rate control, electrolyte adjustments, anticoagulation Pneumonia/chronic obstructive pulmonary disease—screening, treatment, including chest therapy Pulmonary embolus—appropriate anticoagulation Screening for and treatment of urinary tract infection
-
Appropriate environmental stimuli:
Appropriate use of glasses and hearing aids Provision of clock and calendar If available, use of radio, tape recorder, and soft lighting
-
Treatment of agitated delirium:
Appropriate diagnostic workup/management For agitation, calm reassurance, family presence, and/or sitter For agitation, if absolutely necessary, low-dose haloperidol 0.25–0.5 mg every 4 hours as needed; if contraindicated, use lorazepam at same dose
|
