Intensive care of the surgical patient

Abstract

Intensive nursing care and treatment is desirable during the post-operative phase of some types of general surgery. The indications for admission of such cases to the Intensive Care Unit are: (1) Elective admission following surgery of an extensive or prolonged nature performed on healthy patients. (2) Elective admission, after surgery of a less complicated variety than Class (1) but performed on poor risk patients. (3) Emergency admission principally required when cardiac or respiratory insufficiency develops unexpectedly during or after surgery. The requirements of patients admitted to such Units varies from close observation to full intensive treatment. Equipment for automatic monitoring and recording of vital signs is desirable but not essential, but a detailed record of all changes occurring in the patient and treatment given should be kept by the nursing staff. Facilities for collection and analysis of aspirates, drainage and urine must be available. Blood gas analysis is particularly important and apparatus for such determinations is preferably located within the Unit. Provision must be made for mechanical ventilation-both therapeutic and prophylactic-and the staff should be fully conversant with one principal ventilator. Four parameters of body function are considered to be of prime importance: (1) tissue perfusion, (2) acid-base status, (3) renal function, and (4) nutrition. The results of close attention to such factors is discussed.