What to always ask on general surgery

Sometimes we forget to ask a question to our patients and then have to run back and ask and see how it fits into the context of lab data or imaging. 

Often times you're just told to go do something, but the reason why isn't explained.  It's easy to go through a rotation and not know the reason behind a decision. 

0. Allergies.  Some patients may interpret "allergy"  in the context of seasonal allergies. ALWAYS ask what medicine they're allergic to, and of highest importance, what effect it causes. Latex allergies are important to find

Because 0 comes before everything. 

1. Pain control.  Always important to ask because the team may decide to increase the dose, switch to a stronger medicine use a PCA etc.  Pain and discomfort should be minimized for many reasons, humane, and physiological. 

2.  If a patient has been eating and if they feel like they're ready to start clears or a regular diet.  Patient must have their GI tract "waking back up"  and have normal bowel sounds.  The "in" of "ins and outs."  I also count any fluid the patient has taken in by IV as "in."

3.  Bowel movements.  Don't just ask the yes/no question, but type/character, etc. Important for patients who had small bowel surgery like Crohn's patients, patients with bowel resections, GI bleeds.

4.  The mini ROS: shortness of breath (important for COPD, cardiac pts, atelectasis), dizziness (neuro/cardiac), vomiting, fever, nausea

5.  The surgical site: redness, tenderness, dehiscence, drainage.

6.  Ambulation: if your pt has been strong enough to get out of bed and walk. Ambulation for me is always a checkpoint in a hospital stay: it means a patient feels strong, isn't dizzy, isn't too sick, CV/respiratory system is okay, etc. 

7.  Urine output.  This needs to be higher on my list but I'm writing on my phone. This tells you about renal health and volume status. If urine output seems low, ask the nurses because sometimes urine output is unmeasured but still reported ad an event.

8.  Overnight events. This is always reported first thing in the morning!

As a checklist:

Overnight events
Fever
Chills
Nausea
Vomiting
Dizziness
Shortness of breath
Tolerating diet/Intake
Bowel movements
Urine output
Swelling in legs/calf tenderness
Discomfort at surgical sites

Always remember to ask about the adjectives: colour of a draining fluid, character of a wound. Also ask how long it has been since a symptom began, the frequency and number of bodily functions, and so on.

I hope that serves as a mini primer, surgery patients on the floor generally are not too complicated.  Good luck!