Ch. 11 The post-op patient Flashcards
What is the recovery period?
From cessation of anesthesia to P return of normal vital signs and consciousness
What is stage 1 if heat loss
transferred from core to the skin
What is stage 2 of heat loss
lost to the environment by conduction, convection, radiation, evaporation
When should you consider rewarming a patient?
97.6F
Rewarming techniques
-Passive external (blankets)
-active external (warming devices)
-active core (warmed fluids)
What should you beware of when monitoring rewarming
after-drop
What heating method should not be used
electric heating pads
Emergence delirium is when the P has returned to stage _
2
Risks of emergence delirium
-severe trauma
-dehiscence
-hyperthermia
-disruption in clinic
Tx of emergence delirium
-careful approach
-tranquilizers
Anesthesia related causes of prolonged recovery
-excessive anesthesia depth
-breed predisposition
Patient related causes of prolonged recovery
-hypotension, poor perfusion, shock
-liver or kidney diseases
-intracranial disease
-hypoglycemia
-hypothermia
Therapeutic measures of prolonged recovery
-physical stimulation
-ventilation
-fluid therapy
-reversal agents
-warming devices
-dextrose
What should be done if direct pressure for 5-10 minutes doesn’t stop hemorrhage
bandage, notify surgeon
The following are signs of _ _:
-Pale MM
-Slowed CRT
-Rapid RR
-Abdominal bloating
-Swelling at/around sx site
-Hypotension
internal bleeding
Diagnosis of hemorrhage
abdominocentesis, thoracocentesis
Causes of hemorrhage
-Coagulation disorder (breeds, chronic liver dz)
-Dislodged ligature
-Post-sx perfusion
Tx of hemorrhage
reoperate
transfusion or autotransfusion
Tx of hematoma at incision site
-warm, moist compresses
-suction & pressure bandage
-drain
What is a seroma
-serum collects b/w skin and muscle
-typically due to excessive movement
-potential abscess formation
Dx of a seroma
-aspiration
-differential via Diff-Quik type stain
Tx of seromas
-warm, most compresses
-suction and pressure bandage
-possibly sx drain
What is loss of sutures allowing sx site to open
postoperative dehiscence
Risks of postop dehiscence
contamination, serious potentially fatal
Causes of postop dehiscence
-excessive licking and chewing at site (self trauma
-infection
-blunt trauma
What does sx site infection look like
swollen, red, draining
What does infection at sx site cause
delayed healing
Tx of sx site infection
-possible sx debridement and restoring
-systemic antibiotics
-warm, moist compresses
-dilute antiseptic solution at site
What may mimic infection of sx site
allergic reaction to suture material
What are the phases of wound healing
-Inflammatory
-Debridement
-Repair (fibroblastic)
-Maturation
Factors affecting healing
-host factors
-wound characteristics
-external factors
Duration and degree of contamination are classes _ through _
1-3
Degrees of contamination
-clean
-clean contaminated
-contaminated
-infected or dirty
Types of wound cleansing
lavage and debridement
Types of debridement
-Surgical
-Dry to dry bandage
-Wet to dry bandage
-Enzymatic solutions
Types of wound dressing
-Semi occlusive
-Occlusive
-Antimicrobial agents
What type of drain is described?
Gravity and overflow gradients
passive drains
What type of drain is described?
-Negative-pressure gradients
-Fenestrated
Active drain
Types of wound closure
-Primary
-Delayed primary
-Secondary
-Secondary intention (contraction, epithelialization)
What does bandages, splints, casts, and slings do
-protect wounds
-speed healing
-immobilize extremities
What are the 3 layers of bandages
-primary (contact)
-secondary (padded)
-tertiary (outer)
What should be monitored with bandages, splints, casts, and slings
extremities for blood flow
When are urinary catheters placed post op
back sx, some orthopedic procedures,
What should be monitored with urinary catheters
patency and leaking
When should urinary catheter collection system be replaced
every 24 hrs
When should a urinary catheter be replaced
every 3-5 days
Methods of physical rehabilitation
-massage
-cryotherapy or thermotherapy
-bandaging
-range of motion excursuses (passive, active)
-exercise
Post op pain indicators
-increased HR and RR
-elevated blood pressure
-longer CRT
Drugs best for managing wind-up pain
morphine, ketamine, lidocaine
