Post-Operative Care Note for 29-Day-Old Male After Pyloromyotomy
The most appropriate post-operative care for this 29-day-old male on post-operative day 1 after pyloromyotomy includes early oral feeding with clear liquids, multimodal pain management, and monitoring for complications such as persistent vomiting.
Vital Signs and Monitoring
- Monitor respiratory rate, heart rate, blood pressure, oxygen saturation, and temperature q4h
- Assess surgical site for signs of infection or dehiscence q8h
- Document episodes of vomiting, including frequency, amount, and character
- Monitor urine output to ensure adequate hydration
Feeding Protocol
- Begin clear liquids as soon as patient is fully awake and alert
- Start with small volumes (5-10 mL) every 2-3 hours
- Gradually increase volume by 5-10 mL per feed if tolerated
- Progress to full-strength formula after 24 hours if tolerating clear liquids
- Advance to normal feeding regimen by 48 hours post-op if no persistent vomiting
Pain Management
- Acetaminophen 10-15 mg/kg PO/PR q6h scheduled
- Avoid opioids if possible to prevent ileus and respiratory depression
- If additional analgesia needed, consider low-dose morphine (0.05 mg/kg IV) only for breakthrough pain
Fluid Management
- Maintain IV fluids until tolerating adequate oral intake
- Target near-zero fluid balance to avoid fluid overload 1
- Discontinue IV fluids once oral intake reaches 2/3 of maintenance requirements
- Monitor for signs of dehydration (dry mucous membranes, decreased urine output, weight loss)
Respiratory Care
- Maintain head of bed elevated 30-45 degrees to reduce risk of aspiration
- Provide supplemental oxygen if needed to maintain SpO2 >95%
- Encourage gentle repositioning every 2 hours
Potential Complications to Monitor
- Persistent vomiting (>5 days suggests incomplete pyloromyotomy) 2
- Mucosal perforation (abdominal distention, fever, irritability) 2
- Wound infection (erythema, purulent drainage, fever) 2, 3
- Dehydration and electrolyte imbalances
- Inadequate pain control
Laboratory Studies
- Check electrolytes if persistent vomiting occurs
- CBC with differential if fever develops or signs of infection present
Discharge Planning
- Anticipate discharge when:
- Tolerating full feeds without significant vomiting
- Adequate pain control with oral medications
- No signs of surgical complications
- Parents demonstrate understanding of home care instructions
- Expected length of stay: 24-48 hours if uncomplicated 4
Parent Education
- Explain that some post-operative vomiting is normal and usually resolves within 24-72 hours
- Teach proper feeding techniques (small, frequent feeds)
- Review signs of complications requiring medical attention (persistent vomiting, fever, lethargy, decreased urine output)
- Demonstrate wound care and bathing instructions
- Schedule follow-up appointment in 1-2 weeks