a p p r o a c h to post operative patient Flashcards
a differential diagnosis
VITAMIN C D E F
vascular infection/inflammation trauma autoimmune metabolic idiopathic neoplastic congenital degenerative endocrine functional
initial approach to patient post surgery to determine how unwell patient is
- look at patient (pale, unconscious, jaundiced, pain)
- look at observation chart (are they scoring on NEWS, tachycardic, hypoxic)
- speak to nurse (especially if this is the first time meeting patient)
is patient well or unwell
if well = history, examination, investigation, management
unwell = A-E
system of 5 for examination
- consent
- inspection
- palpation
- percussion
- auscultation
systems of 5 for history
onset (when, where)
progression (is it getting worse, better)
duration (have you ever had this before, how long)
associated symptoms (urinary, bowel)
risk factors
pmh past surgical history drugs and allergies family social - functional mobility and baseline, morning routine (getting up, washing, walking up stairs, cooking), recent travel, sick contracts in the family
investigations system of 5
bedside tests blood tests microbiology - cultures imaging specialist tests
management in points of 5
- Does the patient need oxygen? titrate to sats
- Fluid balance: IV fluids? Urinary catheter? NBM? NGT?
- Drugs: Analgesia, Anti-emetic, Antibiotics
- VTE prophylaxis - TEDS, LMWH injections
- Escalation - who and where would they be best managed, do they need higher dependency areas
what are the 5 w’s to ask in post operative patient
wind = post op day 2 water walking wound wonder about drugs
wind = cause of post infective fever
ventilator/ instrumentation to the airway
basal atelectasis, air stasis, increase risk of infection
pain = hypoventilation = atelectasis = infection risk
water =
day 3-5
UTI ESP if urinary catheter
walking
day 5-7
VTE risk
due to stress response to surgery and reduced mobility
wound =
day 10
surgical site infection
wonder about drugs/ iatrogenic
cannula sites
blood - transfusion reaction
importance of post op pain
- compassionate care
- reluctant to deep breath - hypoventilation
- reduced mobility = vte risk
SE of morphine/ opiates
resp depression =
constipation = prn laxative
nausea and vomiting = anti emetic
common sources of pyrexia in surgical pt
Chest (infection) Cut (wound infection) Catheter (UTI) Collections (abdomen, pelvic etc.) Calves (DVT) Cannula (infection, if applicable) Central line (infection, if applicable)
examples of empiracle regimes per infection source
Lower Respiratory Tract Co-Amoxiclav 1.2g IV +/- Amikacin
Upper Urinary Tract
Catheter-Association
Co-Amoxiclav 1.2g IV +/- Amikacin
Nitrofurantoin 50mg PO + Change of Catheter
Surgical Site Infection Flucloxacillin 1g IV
Central line (or any vascular catheter infection) Replace line (trial antibiotic line lock with vancomycin if not able to replace line)
NSAID’S contraindications
Interactions with other medications (such as Warfarin)
Gastric ulceration (consider adding a PPI when prescribing NSAIDs long-term)
Renal impairment (use NSAIDs sparingly in those with poor renal function)
Asthma sensitivity (triggers 10% of individuals with asthma)
Bleeding risk (due to their effect on platelet function)
delirium causes
ypoxia (post-operatively)
Infection (commonly UTI or LRTI)
Drug-induced (benzodiazepines, diuretics, opioids, or steroids) or drug withdrawal (alcohol or BZNs)
Dehydration or pain
Constipation or urinary retention
Electrolyte abnormalities (e.g. hyponatraemia, hypernatraemia, or hypercalcaemia)
delirium mnx
- treat cause
- oxygen if hypoxic, laxatives if constipation
- oral fluid intake, provide analgesia as necessary, and monitor bowels.
- sedatives - haloperidol, lorazepam in elderly
