Postoperative period begins from the moment of completion of the surgical intervention and continues until the time when the patient's ability to work is fully restored. Depending on the complexity of the operation, this period can last from several weeks to several months. Conventionally, it is divided into three parts: the early postoperative period, lasting up to five days, the late one - from the sixth day until the patient is discharged, and the remote one. The last of them takes place outside the hospital, but it is no less important.

After the operation, the patient is transported on a gurney to the ward and laid on the bed (most often on the back). The patient, delivered from the operating room, must be observed until he regains consciousness after vomiting or excitation, manifested in sudden movements, when leaving it. The main tasks that are solved in the early postoperative period are the prevention of possible complications after surgery and their timely elimination, correction metabolic disorders, ensuring the activity of the respiratory and cardiovascular systems. The patient's condition is facilitated by using analgesics, including narcotic ones. Great importance has an adequate selection which, at the same time, should not oppress vital functions body, including consciousness. After relatively simple operations (for example, appendectomy), anesthesia is usually required only on the first day.

The early postoperative period in most patients is usually accompanied by an increase in temperature to subfebrile values. Normally, it falls by the fifth or sixth day. May remain normal in older people. If she rises to high numbers, or only from 5-6 days, this is a sign of an unsuccessful completion of the operation - as well as severe pain at the site of its implementation, which after three days only intensify, not weaken.

The postoperative period is fraught with complications from of cardio-vascular system- in particular, in persons and if the blood loss during its implementation was significant. Sometimes there is shortness of breath: in elderly patients, it can be moderately pronounced after surgery. If it manifests itself only on days 3-6, this indicates the development of dangerous postoperative complications: pneumonia, pulmonary edema, peritonitis, etc., especially in combination with pallor and severe cyanosis. Among the most dangerous complications include postoperative bleeding - from a wound or internal, manifested by a sharp pallor, increased heart rate, thirst. If these symptoms appear, you should immediately call a doctor.

In some cases, after surgery, suppuration of the wound may develop. Sometimes it manifests itself already on the second or third day, however, most often it makes itself felt on the fifth or eighth day, and often after the patient is discharged. In this case, redness and swelling of the sutures are noted, as well as sharp pain during their palpation. However, with deep suppuration, especially in elderly patients, its external signs, in addition to pain, may be absent, although purulent process can be quite extensive. To prevent complications after surgery, adequate patient care and strict adherence to all medical prescriptions are necessary. In general, how the postoperative period will proceed and what its duration will be depends on the age of the patient and his state of health and, of course, on the nature of the intervention.

Before full recovery patient after surgical treatment it usually takes several months. This applies to any kind surgical operations- including, and plastic surgery. For example, after such a seemingly relatively simple operation as rhinoplasty, the postoperative period lasts up to 8 months. Only after this period has passed, it is possible to assess how successfully the nose correction surgery went and how it will look.

After intervention in the body of a sick patient, a postoperative period is required, which is aimed at eliminating complications and providing competent care. This process is carried out in clinics and hospitals, it includes several stages of recovery. At each of the periods, attentiveness and care for the patient by a nurse is required, as well as a doctor's supervision to exclude complications.

What is the postoperative period

In medical terminology, the postoperative period is the time from the end of the operation to full recovery sick. It is divided into three stages:

• early period - before discharge from the hospital;
• late - after two months after the operation;
• the remote period is the final outcome of the disease.

How long does it take

The end of the postoperative period depends on the severity of the disease and individual features body of the patient, aimed at the process of recovery. Recovery time is divided into four phases:

• catabolic - an increase in the excretion of nitrogenous wastes in the urine, dysproteinemia, hyperglycemia, leukocytosis, weight loss;
• period of reverse development - the influence of hypersecretion of anabolic hormones (insulin, growth hormone);
• anabolic - restoration of electrolyte, protein, carbohydrate, fat metabolism;
• a period of healthy weight gain.

Targets and goals

Follow-up after surgery is aimed at restoring normal activities of the patient. The objectives of the period are:

• prevention of complications;
• recognition of pathologies;
• patient care - the introduction of analgesics, blockades, providing vital important functions, dressings;
• preventive actions to fight intoxication, infection.

Early postoperative period

From the second to the seventh day after the operation, the early postoperative period lasts. During these days, doctors eliminate complications (pneumonia, respiratory and renal failure, jaundice, fever, thromboembolic disorders). This period affects the outcome of the operation, which depends on the state of kidney function. Early postoperative complications are almost always characterized by impaired renal function due to the redistribution of fluid in the sectors of the body.

Renal blood flow decreases, which ends on 2-3 days, but sometimes the pathologies are too serious - fluid loss, vomiting, diarrhea, homeostasis disturbance, acute kidney failure. Protective therapy, replenishment of blood loss, electrolytes, stimulation of diuresis help to avoid complications. Common causes development of pathologies in early period after surgery, shock, collapse, hemolysis, muscle damage, burns are considered.

Complications

Complications of the early postoperative period in patients are characterized by the following possible manifestations:

• dangerous bleeding- after surgery large vessels;
• abdominal bleeding - with intervention in the abdominal or chest cavity;
• pallor, shortness of breath, thirst, frequent weak pulse;
• divergence of wounds, damage to internal organs;
• dynamic paralytic obstruction of the intestines;
• persistent vomiting;
• the possibility of peritonitis;
• purulent-septic processes, the formation of fistulas;
• pneumonia, heart failure;
• thromboembolism, thrombophlebitis.

Late postoperative period

After 10 days from the moment of operation, the late postoperative period begins. It is divided into hospital and home. The first period is characterized by an improvement in the patient's condition, the beginning of movement around the ward. It lasts 10-14 days, after which the patient is discharged from the hospital and sent for home postoperative recovery, a diet, vitamins and activity restrictions are prescribed.

Complications

There are the following late complications after surgery that occur while the patient is at home or in the hospital:

• postoperative hernia;
• adhesive intestinal obstruction;
• fistulas;
• bronchitis, intestinal paresis;
• repeated need for surgery.

Causes of complications in later dates after surgery, doctors call the following factors:

• a long period of being in bed;
• underlying risk factors – age, disease;
• impaired respiratory function due to prolonged anesthesia;
• violation of asepsis rules for the operated patient.

Nursing care in the postoperative period

Important role in patient care after surgery nursing care, which continues until the patient is discharged from the department. If it is not enough or it is performed poorly, this leads to poor outcomes and lengthening recovery period. The nurse must prevent any complications, and if they occur, make efforts to eliminate them.

The tasks of the nurse for postoperative care of patients include the following responsibilities:

• timely administration of drugs;
• patient care;
• participation in feeding;
• hygiene care for skin and oral cavity;
• monitoring the deterioration of the condition and providing first aid.

From the moment the patient enters the ward intensive care the nurse begins her duties:

• ventilate the room;
• eliminate bright light;
• arrange the bed for a comfortable approach to the patient;
• monitor the patient's bed rest;
• prevent coughing and vomiting;
• monitor the position of the patient's head;
• feed.

How is the postoperative period

Depending on the condition after the operation of the patient, the stages of postoperative processes are distinguished:

• strict bed resting period - it is forbidden to get up and even turn in bed, it is forbidden to carry out any manipulations;
• bed rest - under the supervision of a nurse or an exercise therapy specialist, it is allowed to turn in bed, sit down, lower your legs;
• ward period - it is allowed to sit on a chair, walk for a short time, but examination, feeding and urination are still carried out in the ward;
• general mode - self-service by the patient himself, walking along the corridor, offices, walks in the hospital area is allowed.

Bed rest

After the risk of complications has passed, the patient is transferred from the intensive care unit to the ward, where he should be in bed. Goals bed rest are:

• limitation of physical activation, mobility;
• adaptation of the organism to the syndrome of hypoxia;
• pain reduction;
• restoration of strength.

Bed rest is characterized by the use of functional beds, which can automatically support the patient's position - on the back, stomach, side, reclining, half-sitting. Nurse cares for the sick during this period - changes linen, helps to cope physiological needs(urination, defecation) with their complexity, feeds and conducts hygiene procedures.

Following a special diet

The postoperative period is characterized by adherence to a special diet, which depends on the volume and nature of surgical intervention:

1. After operations on the gastrointestinal tract, enteral nutrition is carried out for the first days (through a probe), then broth, jelly, crackers are given.
2. When operating on the esophagus and stomach, the first food should not be taken for two days through the mouth. Produce parenteral nutrition- subcutaneous and intravenous intake of glucose, blood substitutes through a catheter, nutritional enemas are made. From the second day, broths and jelly can be given, on the 4th add croutons, on the 6th mushy food, from the 10th common table.
3. In the absence of violations of the integrity of the digestive organs, broths, pureed soups, kissels, baked apples.
4. After operations on the colon, conditions are created so that the patient does not have a stool for 4-5 days. Food low in fiber.
5. When operating on the oral cavity, a probe is inserted through the nose to ensure the intake of liquid food.

You can start feeding patients 6-8 hours after the operation. Recommendations: observe water-salt and protein metabolism provide enough vitamins. A balanced postoperative diet for patients consists of 80-100 g of protein, 80-100 g of fat and 400-500 g of carbohydrates daily. For feeding, enteral mixtures, dietary canned meat and vegetables are used.

Intensive observation and treatment

After the patient is transferred to the recovery room, intensive monitoring begins and, if necessary, treatment of complications is carried out. The latter are eliminated with antibiotics, special medicines to maintain the operated organ. The tasks of this stage include:

• assessment of physiological parameters;
• food intake according to the doctor's prescription;
• compliance with the motor regime;
• drug administration, infusion therapy;
• prevention of pulmonary complications;
• wound care, collection of drainage;
• laboratory research and blood tests.

Features of the postoperative period

Depending on which organs have undergone surgical intervention, the features of patient care in the postoperative process depend:

1. Organs abdominal cavity- monitoring the development of bronchopulmonary complications, parenteral nutrition, prevention of paresis of the gastrointestinal tract.
2. Stomach, duodenum, small intestine - parenteral nutrition for the first two days, inclusion of 0.5 liters of liquid on the third day. Aspiration of gastric contents for the first 2 days, probing according to indications, removal of sutures on days 7-8, discharge on days 8-15.
3. gallbladder – special diet, removal of drainage, it is allowed to sit for 15-20 days.
4. Colon- the most sparing diet from the second day after the operation, there are no restrictions on fluid intake, the appointment vaseline oil inside. Extract - for 12-20 days.
5. Pancreas - preventing the development of acute pancreatitis, monitoring the level of amylase in the blood and urine.
6. Organs chest cavity- the heaviest traumatic operations threatening blood flow disturbance, hypoxia, massive transfusions. For postoperative recovery it is necessary to use blood products, active aspiration, massage chest.
7. Heart - hourly diuresis, anticoagulant therapy, drainage of cavities.
8. Lungs, bronchi, trachea - postoperative fistula prevention, antibiotic therapy, local drainage.
9. Genitourinary system - postoperative drainage urinary organs and tissues, correction of blood volume, acid-base balance sparing high-calorie food.
10. Neurosurgical operations - restoration of brain functions, respiratory capacity.
11. Orthopedic-traumatological interventions - compensation for blood loss, immobilization of the damaged part of the body, is given physiotherapy.
12. Vision - 10-12 hours of bedtime, walks with next day taking regular antibiotics after a corneal transplant.
13. In children - postoperative pain relief, elimination of blood loss, support for thermoregulation.

In elderly and senile patients

For a group of elderly patients postoperative care in surgery is characterized by the following features:

• elevated position of the upper body in bed;
• early turning;
• postoperative breathing exercises;
• humidified oxygen for breathing;
• slow intravenous drip saline solutions and blood;
• careful subcutaneous infusions due to poor absorption of fluid in the tissues and to prevent pressure and necrosis of skin areas;
• postoperative dressings to control wound suppuration;
• the appointment of a complex of vitamins;
• skin care to avoid the formation of bedsores on the skin of the body and limbs.

Video

After any surgical intervention, the patient cannot just take it and immediately return to the normal mode of life. The reason is simple - the body needs to get used to the new anatomical and physiological relationships (after all, as a result of the operation, the anatomy and arrangement of organs, as well as their physiological activity, were changed).

A separate case is operations on the abdominal organs, in the first days after which the patient must strictly adhere to the instructions of the attending physician (in some cases, and related specialist consultants). Why does a patient need a certain regimen and diet after abdominal surgery? Why can't you take it and instantly return to your previous way of life?

Mechanical factors that have a negative effect during the operation

The postoperative period is considered to be the period of time that lasts from the end of the surgical intervention (the patient was taken out of the operating room to the ward) and until the disappearance of temporary disorders (inconveniences) that are provoked by the surgical injury.

Let's consider what happens during a surgical intervention, and how the postoperative condition of the patient depends on these processes, and hence his regimen.

Normally, a typical condition for any organ of the abdominal cavity is:

• lie quietly in your rightful place;
• be in contact exclusively with neighboring bodies who also take their rightful place;
• perform tasks prescribed by nature.

During the operation, the stability of this system is violated. Whether removing an inflamed one, sewing up a perforated one, or making a “repair” of an injured intestine, the surgeon cannot work only with the organ that is sick and needs to be repaired. During surgery, the operating doctor is constantly in contact with other organs of the abdominal cavity: touches them with his hands and surgical instruments, pushes them away, moves them. Let such trauma be minimized as much as possible, but even the slightest contact of the surgeon and his assistants with internal organs is not physiological for organs and tissues.

The mesentery is characterized by special sensitivity - a thin connective tissue film, by which the abdominal organs are connected to inner surface abdominal wall and through which nerve branches approach them and blood vessels. Injury to the mesentery during surgery can lead to pain shock(despite the fact that the patient is in a state of medical sleep and does not respond to irritation of his tissues). The expression "Pull the mesentery" in surgical slang has even acquired a figurative meaning - it means causing pronounced inconvenience, causing suffering and pain (not only physical, but also moral).

Chemical factors that act negatively during surgery

Another factor that affects the patient's condition after surgery is medications used by anesthesiologists during operations to provide. In most cases abdominal operations on the abdominal organs are performed under anesthesia, a little less often - under spinal anesthesia.

At anesthesia substances are introduced into the bloodstream, the task of which is to induce a state of drug-induced sleep and relax the anterior abdominal wall, so that it is convenient for surgeons to operate. But in addition to this valuable property for the operating team, such drugs also have “cons” ( side properties). First of all, this is a depressive (depressing) effect on:

• central nervous system;
• muscle fibers of the intestine;
• muscle fibers Bladder.

Anesthetics administered during spinal anesthesia , act locally, without inhibiting the central nervous system, intestines and bladder - but their influence extends to a certain area spinal cord and the nerve endings departing from it, which need some time to “get rid” of the action of anesthetics, return to the previous physiological state and provide innervation of organs and tissues.

Postoperative changes in the intestines

As a result of action medicines, which the anesthesiologists injected during the operation to ensure anesthesia, the patient's intestines stop working:

• muscle fibers do not provide peristalsis ( normal contraction intestinal wall, as a result of which food masses move towards the anus);
• on the part of the mucous membrane, the secretion of mucus is inhibited, which facilitates the passage of food masses through the intestines;
• the anus is spasmodic.

As a result - the gastrointestinal tract after abdominal surgery seems to freeze. If at this moment the patient takes even a small amount of food or liquid, it will immediately be pushed out of the gastrointestinal tract as a result of reflex.

Due to the fact that the drugs that caused short-term intestinal paresis are eliminated (leave) from the bloodstream in a few days, the normal passage of nerve impulses along the nerve fibers of the intestinal wall will resume, and it will work again. Normally, bowel function resumes on its own, without external stimulation. In the vast majority of cases, this occurs 2-3 days after surgery. Deadlines may depend on:

• the volume of the operation (how widely organs and tissues were drawn into it);
• its duration;
• degree of intestinal injury during surgery.

A signal about the resumption of bowel function is the discharge of gases from the patient. This is very important point, indicating that the intestine coped with operational stress. No wonder surgeons jokingly call gas discharge the best postoperative music.

Postoperative changes in the CNS

Drugs administered to provide anesthesia, after a while, are completely removed from the bloodstream. However, during their stay in the body, they manage to affect the structures of the central nervous system, affecting its tissues and inhibiting the passage of nerve impulses through neurons. As a result, in a number of patients after surgery, disorders of the central nervous system are observed. The most common:

• sleep disturbance (the patient falls asleep heavily, sleeps lightly, wakes up from exposure to the slightest stimulus);
• tearfulness;
• depressed state;
• irritability;
• violations from outside (forgetting people, events in the past, small details of some facts).

Postoperative skin changes

After surgery, the patient for some time is forced to stay exclusively in lying position. In those places where bone structures covered with skin practically without a layer of soft tissues between them, the bone presses on the skin, causing a violation of its blood supply and innervation. As a result, necrosis occurs at the pressure site. skin- so called . In particular, they are formed in such parts of the body as:

Postoperative changes in the respiratory system

Often large abdominal operations are performed under endotracheal anesthesia. For this patient is intubated - that is, in the upper Airways introduce an endotracheal tube connected to the machine artificial respiration. Even with careful insertion, the tube irritates the mucous membrane of the respiratory tract, making it sensitive to an infectious agent. Another negative point of IVL ( artificial ventilation lung) during surgery - some dosing imperfection gas mixture coming from the ventilator into the respiratory tract, as well as the fact that normally a person does not breathe such a mixture.

In addition to factors that negatively affect the respiratory system: after the operation, the excursion (movement) of the chest is not yet complete, which leads to congestion in the lungs. All these factors in total can provoke the occurrence of postoperative.

Postoperative vascular changes

Patients who suffered from vascular and blood diseases are prone to formation and detachment in the postoperative period. This is facilitated by a change in the rheology of the blood (its physical properties), which is observed in the postoperative period. A contributing factor is also that the patient is in a supine position for some time, and then begins motor activity- sometimes abruptly, as a result of which the separation of an existing blood clot is possible. Basically, they are subject to thrombotic changes in the postoperative period.

Postoperative changes in the genitourinary system

Often, after abdominal surgery, the patient is unable to urinate. There are several reasons:

• paresis muscle fibers the walls of the bladder due to exposure to drugs that were administered during surgery to ensure drug-induced sleep;
• spasm of the sphincter of the bladder for the same reasons;
• difficulty urinating due to the fact that this is done in an unusual and unsuitable position for this - lying down.

Diet after abdominal surgery

Until the intestines work, the patient cannot eat or drink. Thirst is relieved by applying a piece of cotton wool or a piece of gauze moistened with water to the lips. In the vast majority of cases, bowel function resumes on its own. If the process is difficult, drugs that stimulate peristalsis (Prozerin) are administered. From the moment of resumption of peristalsis, the patient can take water and food - but you need to start with small portions. If gases have accumulated in the intestines, but cannot come out, they put a gas tube.

The dish that is first given to the patient after the resumption of peristalsis is a lean thin soup with a very small amount of boiled cereals that do not provoke gas formation (buckwheat, rice), and mashed potatoes. The first meal should be in the amount of two to three tablespoons. After half an hour, if the body has not rejected food, you can give two or three more spoons - and so on increasing, up to 5-6 meals of a small amount of food per day. The first meals are aimed not so much at satisfying hunger as at "accustoming" gastrointestinal tract to his traditional work.

You should not force the work of the digestive tract - let better patient will be hungry. Even when the intestines have begun to work, the hasty expansion of the diet and the load on the gastrointestinal tract can lead to the fact that the stomach and intestines cannot cope, this will cause that, due to shaking of the anterior abdominal wall, will negatively affect the postoperative wound . The diet is gradually expanded in the following sequence:

• lean soups;
• mashed potatoes;
• creamy cereals;
• soft-boiled egg;
• soaked crackers from white bread;
• boiled and mashed vegetables;
• steam cutlets;
• unsweetened tea.

• oily;
• acute;
• salty;
• sour;
• fried;
• sweet;
• fiber;
• legumes;
• coffee;
• alcohol.

Postoperative activities related to the work of the central nervous system

Changes in the central nervous system due to the use of anesthesia can disappear on their own in the period from 3 to 6 months after surgical intervention. Longer-term disorders require consultation with a neurologist and neurological treatment.(often outpatient, under the supervision of a doctor). Non-specialized activities are:

• maintaining a friendly, calm, optimistic atmosphere in the environment of the patient;
• vitamin therapy;
• non-standard methods - dolphin therapy, art therapy, hippotherapy ( beneficial effect communication with horses).

Prevention of bedsores after surgery

In the postoperative period, it is easier to prevent than to cure. Preventive measures should be carried out from the first minute the patient is in the supine position. It:

• rubbing risk areas with alcohol (it must be diluted with water so as not to provoke burns);
• circles under those places that are prone to pressure sores (sacrum, elbow joints, heels), so that the risk zones are as if in limbo - as a result of this, bone fragments will not put pressure on skin areas;
• massaging tissues in risk areas to improve their blood supply and innervation, and hence trophism (local nutrition);
• vitamin therapy.

If bedsores still occur, they are fought with the help of:

• drying agents (brilliant green);
• drugs that improve tissue trophism;
• wound healing ointments, gels and creams (like panthenol);
• (to prevent infection).

Prevention of postoperative

The most important prevention of congestion in the lungs is early activity.:

• getting out of bed as early as possible;
• regular walks (short but frequent);
• gymnastics.

If due to circumstances (large volume of surgery, slow healing postoperative wound, fear of the occurrence of a postoperative hernia) the patient is forced to stay in a supine position, measures are taken to prevent stagnation in the respiratory organs:

Prevention of thrombus formation and separation of blood clots

Before surgery, aged patients or those who suffer from vascular diseases or changes in the blood coagulation system are carefully examined - they are given:

• rheovasography;
• determination of the prothrombin index.

During the operation, as well as in the postoperative period, the legs of such patients are carefully bandaged. During bed rest lower limbs should be in an elevated state (at an angle of 20-30 degrees to the plane of the bed). Antithrombotic therapy is also used. Her course is prescribed before the operation and then continued in the postoperative period.

Measures aimed at resuming normal urination

If in the postoperative period the patient cannot urinate, they resort to the good old trouble-free method of stimulating urination - the sound of water. To do this, simply open water faucet in the room so that water comes out of it. Some patients, having heard about the method, begin to talk about the dense shamanism of doctors - in fact, these are not miracles, but just a reflex response of the bladder.

In cases where the method does not help, bladder catheterization is performed.

After surgery on the abdominal organs, the patient in the first days is in a supine position. The timing in which he can get out of bed and start walking is strictly individual and depends on:

• volume of operation;
• its duration;
• patient's age;
• his general condition;
• the presence of comorbidities.

After uncomplicated and non-volume operations (hernia repair, appendectomy, and so on), patients can rise as early as 2-3 days after surgery. Volumetric surgical interventions(for a breakthrough ulcer, removal of an injured spleen, suturing of intestinal injuries, and so on) require a longer lying down for at least 5-6 days - at first the patient may be allowed to sit in bed with his legs dangling, then stand and only then begin to take the first steps.

To avoid the occurrence incisional hernias It is recommended to wear a bandage for patients:

• with a weak front abdominal wall(in particular, with untrained muscles, flabbiness of the muscle corset);
• obese;
• aged;
• those who have already been operated on for hernias;
• women who have recently given birth.

Due attention should be paid to personal hygiene, water procedures, ventilation of the room. Weakened patients who were allowed to get out of bed, but it is difficult for them to do so, are taken to Fresh air in wheelchairs.

In the early postoperative period, intense pain may occur in the area of ​​the postoperative wound. They are stopped (removed) with painkillers. It is not recommended for the patient to endure pain - pain impulses re-irritate the central nervous system and deplete it, which is fraught in the future (especially in old age) with a variety of neurological diseases.

Question:

The male. 34 years. 73 kg. Without bad habits. I write chaotically, sorry, I myself am already in a state of some kind of psychosis last week. Many questions. Sorry, nerves require action, I really want to help my husband with something else without offending the doctors! They say the hospital is very good, the doctors too. Specialized resuscitation. But I'm still afraid of lack of information and lack of care. There are many sick people. Nurses don't break.

Removed a large almost 4 by 4 by 4 cm neuroma this Tuesday (23.08). Now still in intensive care on a ventilator. He cannot breathe on his own. Swallow too. There is a lack of coordination of the eyes, a part of the face does not work - from the side of the removal of the tumor. The arms and legs work. Responds to contact, hears, fulfills requests. Yesterday was more active than 2 days ago. He communicates with me (they let me in 2 times - he holds my hand, answers questions, tries to put words together with his lips).

After long operation according to the resuscitation doctor, the husband breathed on his own for a couple of hours, then his breathing stopped. Intubated. I had a tracheostomy on Wednesday. At first they tried supportive ventilation, but the indicators began to fall, now he is on full ventilation.

On Fri. They did an MRI and they said it was severe swelling brain stem - as I understand it, the operation zone. In this regard (according to the nurse, after my clarifying question, the preparations were adjusted.)

Tell!

1. How long can swelling last after surgery? Should I ask what specific drugs are given for this and offer, if necessary, to buy something better, more expensive? I already asked the doctor - he still answers like this - "your husband gets everything he needs. You don't need to buy anything."

2. The nurse said yesterday that it is due to cerebral edema negative dynamics, that is, it grows, right? I was scared, but now I'm thinking, can a nurse evaluate such things and in comparison with what is the negative dynamics - is an MRI done right after the operation? What is it compared to?

3. If he breathed on his own after the operation, does this mean that the respiratory functions are not impaired and that the inability to breathe on his own is simply due to edema?

4. Is it possible to turn the husband over? Lie on his side? Sit? Now he is tied, he said, they don’t turn him on his side, the nurse said that this can’t be done, and the doctor on Thu. said that the position of the patient's body necessarily changes. Whom to trust and how to check?

5. My husband's legs are still in bandages - is this normal? I noticed swelling in one of my feet. The nurse said everything was ok. Should I contact someone about this?

6. Exercise therapy. According to the doctor, my husband and I are engaged in exercise therapy. The husband said yesterday that they did not deal with him. The nurse said that they only work on weekdays, not on weekends. Is there any way to find out which specific classes are being held? What exercises are shown? Is it possible to massage? Or just bend your arms and legs?

7. Is it worth arranging for a caregiver/individual post? So that she would carry out all hygiene measures more carefully, do massages, rubdowns, etc. I am very afraid of bedsores.

8. Anti-decubitus mattress. I wanted to order a static mattress. The doctor in intensive care said that it was not necessary, all the mattresses were already good. I looked - I can’t evaluate the quality, but obviously they are not orthopedic. Is it worth asking this question? The husband complains that he is tired of lying on his back, his muscles are numb.

Expert answer:

Good evening!

1. Obey your doctor; trust him what he needs to say;
2. But honey. you should not listen to your sister, discuss all questions with your doctor;
3. Associated with edema;
4. Turning from side to side is required every 2 hours, this is necessary for the prevention of bedsores in the first place; the doctor is right;
5. Foot binding in bedridden patients is necessary to prevent deep vein thrombosis and thromboembolism pulmonary artery; if there is edema, it makes sense to do DS of the leg veins;
6. Passive and, if possible, active exercise therapy is necessary, and vibration massage of the chest is also necessary; find out everything from your doctor;
7. I think that an individual post is necessary - more guarantees that everything will be done as it should;
8. No need for a mattress; turns are needed! on the back they usually hold little; in addition, correct laying of the limbs is necessary for the prevention of joint contractures;