Notes in the care of pediatric patients before and after surgery for umbilical hernia - abdominal wall

The article is professionally consulted Master, Doctor Phan Ngoc Hai - Department of Pediatrics - Neonatology - Vinmec Danang International General Hospital. Dr. Hai used to work at the Neonatology Department of Da Nang Obstetrics and Gynecology Hospital and Hoan My Da Nang Hospital. His strength is in general pediatric examination and treatment, neonatal examination and treatment, pediatric resuscitation.

Caring for patients after surgery for umbilical hernia - abdominal wall plays a very important role in the success of the operation, in order to detect and manage physiological disorders and complications caused by anesthesia or surgery. art.

The success of umbilical hernia surgery - open abdominal surgery depends largely on the postoperative care regimen. Accordingly, the period after surgery for abdominal wall hernia is the period when many physiological disorders appear in children, including complications in breathing, circulation, irritation, pain, kidney dysfunction, disorders of blood clotting ability, hypothermia, ... occur due to anesthesia or surgery. It is important in the process of caring for patients after surgery for hernia is never to leave a child without anesthesia lying alone without supervision.

Caring for a newborn after surgery requires a close collaboration between the doctor and the patient's family. Medical staff must be qualified, highly trained to be able to handle any situation encountered. In addition, families also need to be guided to carry out some necessary monitoring to prevent and detect early complications that may be dangerous for the child.

The time the newborn after surgery for umbilical hernia - opening the abdominal wall must stay in the recovery room for about 2-4 hours. During this time, the patient is in the stage of getting out of anesthesia, so all life functions gradually recover in terms of consciousness, spirit, movement, sensation to respiratory and circulatory function. Specifically as follows:
Nervous system: During 15 - 30 minutes after surgery for umbilical hernia, the patient may be in deep sleep, or not yet awake, still dozing. Some babies who come out of anesthesia earlier are often in a state of excitement, crying, unable to control their actions, but their limbs are still numb and difficult to move, especially the lower limbs; Respiratory system: The function of the respiratory muscles is gradually restored, but the capacity is generally still weak. Some side effects of anesthetics can lead to patients having difficulty breathing, breathing slow or fast and shallow, respiratory muscles pull forcefully, when breathing, there is a hiss or groans, baby's lips are purple or pale. bland; Circulatory system: Often, pediatric patients after surgery for abdominal wall hernia will experience blood loss and fluid loss, leading to a decrease in circulating volume. This condition, together with the effects of anesthetics, makes the child more susceptible to vasomotor disorders. Clinically, it can be observed that the skin is blue, the mucous membranes of the eyes become pale, the extremities are less pink, the pulse is rapid, and the blood pressure decreases; Body temperature: Slightly reduced during recovery. Body temperature usually fluctuates in the range of 36 ± 0.2 oC, then shows signs of gradually increasing to normal temperature. Some babies may have a fever right after surgery; Other signs to watch out for are muscle tremors, pain, vomiting, and urinary retention. During this period, the patient's family should pay attention to the following issues:
Closely monitor for signs related to the child's life function. Pale or purple skin color and lips are signs that your baby is hypoxic. In addition, pay attention to whether the baby's chest is moving, there is a phenomenon of strong breathing that causes contractions in the chest and neck muscles, or hear a whining, hissing sound are all signs that the patient is breathing hard. , should immediately notify the medical staff. Note, the position of the child during recovery should be placed on the back of the head (pillow under the shoulder), head tilted to one side to avoid vomiting, reflux into the respiratory tract;
Check for paleness in the extremities or palms. If the child has a drainage, it is necessary to monitor the color of the drainage, usually it will be pale pink, if there is bright red blood or a strong flow rate, it is a phenomenon of internal bleeding. This condition is very dangerous for the patient's life due to reduced blood circulation, it is necessary to notify the doctor immediately. Pay attention when the child has a phenomenon of irritation, convulsion, keep the child's limbs, avoid letting the child drowsy use his hand to pull the drain or struggle too hard, causing bleeding or draining;
Besides, it is necessary to actively restore consciousness, sensation and movement for children: About 15 - 30 minutes after leaving the recovery room, it may be necessary to slightly stimulate the child to recover consciousness soon, massage gently squeeze the lower extremities to relieve numbness after surgery;
Keep the child warm by using a blanket or placing a screwed warm water bottle next to the patient when the weather turns cold;

Actively change the patient's position as soon as the child wakes up gently. In addition, the patient's limbs can be massaged to relieve fatigue and enhance blood circulation;
Pay attention to the child's pain or, if the child has spoken and understood, ask when the pain started to appear so that the medical staff can be informed to take the pain medication as prescribed and check the ability drug response.

At this time, most of the babies are awake, their vital functions have recovered much and are no longer as threatening as the recovery stage, but still need to continue to monitor and care for the baby:
Monitor consciousness , spirit, movement of children. Have the child lie down with the head elevated about 30 degrees. For infants and young children, lay with the head slightly up and tilted to one side. When the patient is out of anesthesia, the patient begins to feel pain, so parents need to be there to encourage and comfort the child and notify the medical staff to take pain medication in time if necessary. Usually, the pain level will gradually decrease in about 3 days after surgery; During the first 24 hours after surgery for abdominal wall hernia, attention should be paid to bleeding at the incision site, especially internal bleeding through drainage. To limit this, it is necessary to pay attention not to let the child move too hard, make sure that the drainage tube is not folded or blocked, the drainage position must be at least 60 cm lower than the patient's position. At first, you can monitor the color and amount of drainage with the medical staff. If there is bright red blood or sudden increase in drainage volume, it should be reported immediately; The child's body temperature begins to rise to a stable level and may appear mild fever due to postoperative recovery, even high fever continuously for some diseases such as peritonitis, intussusception, necrotizing enterocolitis. Therefore, parents need to know some basic knowledge to reduce fever for children: Loosen clothes, remove blankets, take off diapers or pants but still have to wear a thin shirt to avoid pneumonia. Note that fever-reducing medicine should only be used for children when the armpit temperature is 38.5oC or higher. When a child takes fever-reducing medicine, it should be combined with other measures, such as applying cool or warm compresses to the child in some places such as armpits, groin, forehead, palms, and feet. Fever related to surgery alone usually only lasts about 2 days, then it will gradually decrease, but if the baby's body temperature rises gradually 3 days after surgery, it is necessary to take the child to the doctor for re-examination because it is possible that the baby has had other diseases. other infections at the surgical site, acute pharyngitis,...; After surgery for umbilical hernia - abdominal wall opening, pediatric patients often have limited mobility due to pain, so caregivers need to know how to change positions for children in the first 6 hours. Then, have the baby sit up or lie down with his head high before getting up to walk (about 12 hours after surgery) to avoid shock caused by sudden changes in position. If it is possible to exercise early, it will be very good for the baby after surgery, especially in gastrointestinal surgery because intestinal motility will be stimulated to work again soon, thereby reducing the risk of the baby having intestinal obstruction after surgery. Exercise also helps children limit sputum stagnation, avoid lung collapse, and improve circulation. For young children and infants who cannot walk, they should change their passive positions with the support of family members and medical staff. In the first day after surgery for abdominal wall hernia, depending on the patient, you can eat or fast according to the doctor's orders. Normally, for all surgeries involving the abdomen and digestive system, the patient will have to fast until bowel movements return (passable). Accordingly, the child will be given fluids or protein to replace oral nutrition. Parents when starting to feed should choose to start with liquid dishes, little, then solid foods, many. If you find it difficult to eat solid foods, you can give the child water or sugar water to drink before eating. If the baby is vomiting, stop for about 30 minutes - 1 hour before feeding again; Personal hygiene for children after surgery is also very important to limit infection. It is necessary to wipe the body with warm water (to avoid wounds and drainage after surgery), and to clean the teeth daily.

When the patient's condition after surgery for umbilical hernia - abdominal wall opening becomes stable, the doctor will discharge him from the hospital. From now on, parents still need to pay attention to taking care of children:

Take medicine as prescribed and follow the treatment instructions of medical staff; Enhance nutrition for children, starting with a liquid diet, gradually increasing the consistency, giving priority to rich in protein, vitamins and minerals; It is necessary to limit eating and drinking foods and drinks such as orange juice, lemonade, acidic foods, eggs, and fishy foods for about 1 month after open abdominal surgery; The incision will usually heal and can be removed about 10 days after the surgery, but with the type of self-dissolving thread, depending on the location of each child, after about 1-2 months, the suture will completely dissolve. ; About 1 week after surgery, the child can participate in light activities and go to school; Parents need to take their children to the doctor immediately if they detect unusual signs such as fever, pain in the surgical area, swollen stitches, red bruises or pus. In addition, it is necessary to pay attention to arrange the time to take the child to the doctor's appointment for follow-up visits.
As a key area of ​​Vinmec Health system, Pediatrics Department always brings satisfaction to customers and is highly appreciated by industry experts with:
Gathering a team of top doctors and nurses in Pediatrics : consists of leading experts with high professional qualifications (professors, associate professors, doctorates, masters), experienced, worked at major hospitals such as Bach Mai, 108.. Doctors All doctors are well-trained, professional, conscientious, knowledgeable about young psychology. In addition to domestic pediatric specialists, the Department of Pediatrics also has the participation of foreign experts (Japan, Singapore, Australia, USA) who are always pioneers in applying the latest and most effective treatment regimens. . Comprehensive services: In the field of Pediatrics, Vinmec provides a series of continuous medical examination and treatment services from Newborn to Pediatric and Vaccine,... according to international standards to help parents take care of their baby's health from birth to childhood. from birth to adulthood Specialized techniques: Vinmec has successfully deployed many specialized techniques to make the treatment of difficult diseases in Pediatrics more effective: neurosurgery - skull surgery, stem cell transplantation. blood in cancer treatment. Professional care: In addition to understanding children's psychology, Vinmec also pays special attention to the children's play space, helping them to have fun and get used to the hospital's environment, cooperate in treatment, improve the efficiency of medical treatment. To register for examination and treatment with Pediatricians at Vinmec International General Hospital, please click the "Contact Us" button on the website or register online HERE.