Describe postoperative care in gynaecological surgery. 

Local care

The vulval pad should be observed and replaced with a sterile one as necessary. Any heavy loss is recorded on the chart, and if severe the doctor should be informed.

Care of the bladder

Special care of the bladder is vital after gynaecological surgery, because of the close proximity of the urethra (in vaginal operations) or the ureters and the bladder itself (in abdominal operations).

A fluid intake and output chart must always be kept accurately in order to check that the urinary system is resuming its normal function.

If there is no indwelling catheter, as after most abdominal operation, micturation is usually re-established within 12 to 16 hours.

Accuracy in measurement and recording of fluid balance is vital in order for the nurse to assess at a glance at the chart whether the patient is passing urine normally, or if there is retention, or retention with overflow.

If there is an indwelling catheter, as in most vaginal operations involving the anterior vaginal wall, management will depend upon the surgeon’s wishes. Usually the bladder is drained continuously, thus preventing distension and drain on the new suture line. Clear urine should begin to drain shortly after the patient returns to the ward; this must be checked frequently because kinking of the catheter or tubing causes back pressure and harmful distension, as well as intense discomfort.

The morning after operation

By the morning after the operation the patient should be in the upright position supported by pillows.

At sometime during the first 24 hours she will be assisted out of bed helped to walk a few steps. She will probably enjoy some tea and toast at breakfast time, although this should be withheld if there is vomiting or if bowel sounds are not beginning to re-establish themselves.

During the day, a bed bath should be given and pressure areas attended to; the hair should be brushed and combed, the teeth cleaned and the bed made as necessary.

A vulval toilet should be performed to help the patient to feel fresh. She will appreciate having the area swabbed with an antiseptic solution. Each swap is used once only, working from above downwards and from the labia majora inwards ______ _______ _______ ___ _______ _________.
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