What is the post-operative management plan for a patient on post-operative day 1 after laparoscopic appendectomy (lap appy) for acute appendicitis, who is stable, tolerating a regular diet, experiencing pain 4/10, and has not had a bowel movement yet?

Post-Operative Day 1 Progress Note: Laparoscopic Appendectomy

Subjective

[PATIENT], a 24-year-old female, is POD#1 status post laparoscopic appendectomy for acute appendicitis. She reports pain 4/10 (improved from 7/10 on POD#0), taking oral oxycodone with adequate relief. She passed flatus this morning but has not yet had a bowel movement. She denies fever, chills, nausea, or vomiting. She ambulated to the bathroom 3 times with nursing assistance.

Objective

• Vital Signs: Afebrile, hemodynamically stable
• Activity: Ambulating to bathroom with assistance
• Diet: Tolerating regular diet
• GI Function: Passing flatus, no bowel movement yet, voiding without difficulty
• Pain: 4/10 on oral oxycodone (down from 7/10 POD#0)
• Wound: [Examine port sites for erythema, drainage, or signs of infection]

Assessment

POD#1 status post uncomplicated laparoscopic appendectomy for acute appendicitis with appropriate postoperative recovery trajectory.

Plan

Pain Management

• Continue oral oxycodone as needed for pain control, as the patient demonstrates adequate pain relief with current regimen (4/10 pain score) 1
• Transition to non-opioid analgesics (acetaminophen, NSAIDs) as pain improves to minimize opioid exposure 2

Diet & Activity

• Continue regular diet as tolerated, given successful tolerance overnight without nausea or vomiting 1, 2
• Advance ambulation independently as pain allows; early mobilization accelerates recovery after laparoscopic appendectomy 2, 3

Bowel Function Monitoring

• Passing flatus is an excellent prognostic sign; expect bowel movement within 24-48 hours given return of gastrointestinal function 2, 3
• No intervention needed at this time; continue monitoring for first bowel movement

Discharge Planning

• Target discharge today (POD#1) if patient meets criteria: adequate pain control on oral medications, tolerating regular diet, ambulating independently, and stable vital signs 1, 4, 5
• Laparoscopic appendectomy patients typically have hospital stays of 2-3 days, but uncomplicated cases can be safely discharged within 24 hours 1, 6, 3
• Outpatient laparoscopic appendectomy protocols demonstrate safety with low readmission rates (1.2%) and minimal complications in selected patients 1, 5

Antibiotic Management

• Discontinue antibiotics if this was uncomplicated appendicitis with adequate source control at surgery 4
• If complicated appendicitis (perforation, abscess), continue antibiotics for no more than 3-5 days postoperatively 4

Wound Care

• Inspect port sites for signs of infection (erythema, drainage, warmth); laparoscopic approach has significantly lower surgical site infection rates (3.8%) compared to open appendectomy (14%) 6, 3
• Provide wound care instructions for home management

Discharge Instructions

• Return precautions: fever >38.5°C, worsening abdominal pain, inability to tolerate oral intake, signs of wound infection, or inability to void 5
• Activity: gradual return to normal activities over 1-2 weeks; avoid heavy lifting >10 lbs for 2 weeks 1, 2
• Follow-up appointment in 2 weeks for wound check and clinical assessment

Special Considerations

• No interval appendectomy needed as this was definitive surgical management 4
• No routine follow-up imaging or colonoscopy required for this 24-year-old patient with uncomplicated appendicitis (only indicated for patients ≥40 years old with complicated appendicitis due to higher malignancy risk) 7, 4

Expected discharge: Today (POD#1) if discharge criteria met by afternoon rounds 1, 5, 2