Common Post-Operative Presentations Flashcards
What are the causes of dyspnoea/hypoxia post-operatively?
Previous lung disease Atelectasis Aspiration Pneumonia LVF PE Pneumothorax Pain leading to hypoventilation
Give an example of something that can cause pneumothorax post-operatively
CVP line insertion
What investigations may be done into post-op dyspnoea/hypoxia?
FBC
ABG
CXR
ECG
How is post-op dyspnoea/hypoxia managed?
Sit up
Give oxygen
Manage cause
What are the post-renal causes of post-op reduced urine output?
Blocked/malsited catheter
Acute urinary retention
What are the pre-renal causes of post-op reduced urine output?
Hypovolaemia
What are the renal causes of post-op reduced urine output?
NSAIDs
Gentamicin
What is anuria usually due to post-op?
Blocked or malsited catheter
What is oliguria usually due to post-op?
Inadequate fluid replacement
Where can information be gathered from in post-op reduced urine output?
Operation history
Obs chart - urine output
Nephrotoxin
What should be looked for in examination in post-op reduced urine output?
Assess fluid status
Examine for palpable bladder
Inspect drips, drains, stoma, CVP
How should post-op urine output be managed?
Fluid 50ml saline and aspirate back
Fluid challenge
What are the causes of post-op nausea and vomiting?
Obstruction
Ileus
Emetic drugs, e.g. opioids
What should be considered in patients with post-op nausea and vomiting?
NGT
AXR
Ondansetron 4mg IV TDS
What is it important to know with low sodium post-operatively?
What was the pre-op level
What are the common causes of reduced sodium post-op?
SIADH
Over administration of IV fluids
What can cause SIADH post-operatively?
Pain
Nausea
Opioids
Stress
How should acute reduced sodium post-op be managed?
Slow correction of 1mM/hour
How should chronic reduced sodium post-op be managed?
Slow correction of 15mM/day
How is post-op hypotension immediate managed?
Tilt bed head down, give oxygen
Assess fluid status
What are the categories of causes of post-op hypotension?
Cardiogenic
Hypovolaemic
Obstructive
Distributive
What are the cardiogenic causes of post-op hypotension?
MI
Fluid overload
What are the hypovolaemic causes of post-op hypotension?
Inadequate replacement of fluid losses
Haemorrrhage
What are the obstructive causes of post-op hypotension?
PE
What are the distributive causes of post-op hypotension?
Sepsis
Neurogenic shock
How is post-op hypotension caused by hypovolaemia managed?
Fluid challange - 250-500ml colloid over 15-30 mins
How is post-op hypotension caused by haemorrhage managed?
Return to theatre
How is post-op hypotension caused by sepsis managed?
Fluid challenge
Start Abx
How is post-op hypotension caused by fluid overload management?
Furosemide
How is post-op hypotension with a neurogenic cause managed?
Noradrenaline infusion
Should you continue anti-hypertensives during the peri-operative period?
Continue anti-hypertensives during peri-operative
What are the causes of post-operative hypertension?
Pain
Urinary retention
Previous HTN
How is post-operative hypertension managed?
Manage cause
Maya use labetalol 50mg IV every 5 mins (200mg max)
What are the features of post-operative acute confusional state?
Agitation
Disorientation
Attempts to leave hospital
What are the common causes of post-op acute confusional state>
Drugs Sensory deficits Low oxygen states Infection Urinary retention or constipation Ictal Dehydration or poor nutrition Metabolic problems
Give 3 examples of low oxygen states that may lead to an acute confusional state
MI
Stroke
PE
Give 4 examples of metabolic problems that can cause post-op acute confusional state
Sodium derangement
AKI
Glucose derangement
Ethanol withdrawal
How is post-acute confusional state managed?
May need sedation with midazolam or haldol
Nurse in well-lit environment
Management of cause
