Circulatory – (any history of heart disease?)
pulse – rate, rhythm, strength
heart sounds
circulation in extremities – skin color & temperature, capillary refill, strength of peripheral pulses
elderly – hx of MI or CHF or on digoxin – monitor serum K+ levels carefully (postop ↓K)
Nutrition
Wt to Ht ratio
presence of nausea & / or vomiting, diarrhea (NVD)
signs of dehydration
determine balanced diet
protein
vit C for wound healing
vit B – GI function & metabolism of CHO
vit K – clotting
*↑CHO, ↑protein, ↑calories *
Underweight
diminished reserves of CHO & fat for energy
protein used for energy – nitrogen imbalances
decreased protein for healing – wound separation & infection
can use hyperalimentation for deficiencies
Obese
respiratory complications
V/S fluctuations
wound separation & infection
incisional hernias
thrombophlebitis
complications of anesthesia
fatty tissue lacks circulation
abdominal pain due to pressure, pt can't breathe properly
can't move well, can get thrombophlebitis under anesthesia
harder to access – cut through more fat
anesthesia stored in adipose tissue – absorbed readily & take ↑anesthesia to put pt to sleep
take longer to get over it, anesthesia released from adipose slowly over time
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