For patients with traditional open surgery mechanical venitlation is needed for the first 16 to 24 hours. After extubation assessing, TCDB every 1to 2 hours, Incisional support, pain control. Cardiovascular: particularly hypotension during surgery d/t pressure placed on the posterior heart, usually responds well to IV fluid administration, Monitor for fluid volume overload esp. elderly, crackles, edema, increased jugular venous pressure. Observe for A-fib d/t vagus nerve irritation during surgery. Wound management: patient usually has multiple incisions and drains. Provide direct wound support during coughing and deep breathing to prevent dehisences. Wound infection can occur 4 to 5 days after surgery. Leaking from the anastomosis is a dreaded complication that can occur in 2 to 10 days, look for fever, fluid accumulation, early signs of shock (tachycardia, tachypnea, altered mental status). Do not irrigate or reposition and NG tube in patients who have undergone esophageal surgery unless requested by the surgeon. Drainage should change from bloody to yellowish green by the end of the first post op day. Oral nasal care every 2 to 4 hoursStart diet with liquids, advance as tolerated, place in an upright position, and supervise all initial swallowing efforts. The food storage area of the stomach has been radically altered and the only defense against reflux is gravity. Teach importance of 6 to 8 small meals daily, fluids should be taken between meals rather than with meals to prevent diarrhea. Diarrhea can occure 20 minutes to 2 hours after meals and can be managed with immodium before meals. Diarrhea result of vagotomy syndrome, which develops as a result of interrupted vagal fibers to the abdominal organs during surgery.