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Surgery LO's > Common Post-Operative Presentations > Flashcards

Common Post-Operative Presentations Flashcards

1
Q

What are the causes of dyspnoea/hypoxia post-operatively?

A 
Previous lung disease
Atelectasis
Aspiration
Pneumonia
LVF
PE
Pneumothorax
Pain leading to hypoventilation
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2
Q

Give an example of something that can cause pneumothorax post-operatively

A

CVP line insertion

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3
Q

What investigations may be done into post-op dyspnoea/hypoxia?

A

FBC
ABG
CXR
ECG

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4
Q

How is post-op dyspnoea/hypoxia managed?

A

Sit up
Give oxygen
Manage cause

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5
Q

What are the post-renal causes of post-op reduced urine output?

A

Blocked/malsited catheter

Acute urinary retention

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6
Q

What are the pre-renal causes of post-op reduced urine output?

A

Hypovolaemia

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7
Q

What are the renal causes of post-op reduced urine output?

A

NSAIDs

Gentamicin

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8
Q

What is anuria usually due to post-op?

A

Blocked or malsited catheter

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9
Q

What is oliguria usually due to post-op?

A

Inadequate fluid replacement

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10
Q

Where can information be gathered from in post-op reduced urine output?

A

Operation history
Obs chart - urine output
Nephrotoxin

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11
Q

What should be looked for in examination in post-op reduced urine output?

A

Assess fluid status
Examine for palpable bladder
Inspect drips, drains, stoma, CVP

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12
Q

How should post-op urine output be managed?

A

Fluid 50ml saline and aspirate back

Fluid challenge

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13
Q

What are the causes of post-op nausea and vomiting?

A

Obstruction
Ileus
Emetic drugs, e.g. opioids

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14
Q

What should be considered in patients with post-op nausea and vomiting?

A

NGT
AXR
Ondansetron 4mg IV TDS

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15
Q

What is it important to know with low sodium post-operatively?

A

What was the pre-op level

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16
Q

What are the common causes of reduced sodium post-op?

A

SIADH

Over administration of IV fluids

17
Q

What can cause SIADH post-operatively?

A

Pain
Nausea
Opioids
Stress

18
Q

How should acute reduced sodium post-op be managed?

A

Slow correction of 1mM/hour

19
Q

How should chronic reduced sodium post-op be managed?

A

Slow correction of 15mM/day

20
Q

How is post-op hypotension immediate managed?

A

Tilt bed head down, give oxygen

Assess fluid status

21
Q

What are the categories of causes of post-op hypotension?

A

Cardiogenic
Hypovolaemic
Obstructive
Distributive

22
Q

What are the cardiogenic causes of post-op hypotension?

A

MI

Fluid overload

23
Q

What are the hypovolaemic causes of post-op hypotension?

A

Inadequate replacement of fluid losses

Haemorrrhage

24
Q

What are the obstructive causes of post-op hypotension?

A

PE

25
Q

What are the distributive causes of post-op hypotension?

A

Sepsis

Neurogenic shock

26
Q

How is post-op hypotension caused by hypovolaemia managed?

A

Fluid challange - 250-500ml colloid over 15-30 mins

27
Q

How is post-op hypotension caused by haemorrhage managed?

A

Return to theatre

28
Q

How is post-op hypotension caused by sepsis managed?

A

Fluid challenge

Start Abx

29
Q

How is post-op hypotension caused by fluid overload management?

A

Furosemide

30
Q

How is post-op hypotension with a neurogenic cause managed?

A

Noradrenaline infusion

31
Q

Should you continue anti-hypertensives during the peri-operative period?

A

Continue anti-hypertensives during peri-operative

32
Q

What are the causes of post-operative hypertension?

A

Pain
Urinary retention
Previous HTN

33
Q

How is post-operative hypertension managed?

A

Manage cause

Maya use labetalol 50mg IV every 5 mins (200mg max)

34
Q

What are the features of post-operative acute confusional state?

A

Agitation
Disorientation
Attempts to leave hospital

35
Q

What are the common causes of post-op acute confusional state>

A 
Drugs
Sensory deficits
Low oxygen states
Infection 
Urinary retention or constipation
Ictal 
Dehydration or poor nutrition
Metabolic problems
36
Q

Give 3 examples of low oxygen states that may lead to an acute confusional state

A

MI
Stroke
PE

37
Q

Give 4 examples of metabolic problems that can cause post-op acute confusional state

A

Sodium derangement
AKI
Glucose derangement
Ethanol withdrawal

38
Q

How is post-acute confusional state managed?

A

May need sedation with midazolam or haldol
Nurse in well-lit environment
Management of cause

Surgery LO's (10 decks)

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