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Surgery > Lecture 5: Postoperative Care > Flashcards

Lecture 5: Postoperative Care Flashcards

1
Q

What are the primary goals during the PACU and intermediate phase of postop care?

A
  • Hemostasis
  • Pain control
  • Prevention and early detection of complications
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2
Q

What occurs in between the immediate to intermediate period of postop care?

A
  • Discharge from recovery to floor
  • Admit orders
  • PostOp note + Procedure Note
  • Operative report
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3
Q

Who must dictate the operative note?

A

Surgeon

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4
Q

When does epithelialization of a wound occur and what does this mean for sterile dressings?

A

First 48h, which means sterile dressings must also be changed under sterile technique

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5
Q

What patient education should be provided for wound care?

A
  • Generally want to keep incision dry for a few days
  • Showering is ok
  • Avoid submerging wounds for 2 weeks
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6
Q

How long does it take baseline pulmonary function to return generally postop?

A

a week

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7
Q

What is the MC pulmonary risk post op and management for it?

A

Atelectasis, managed by incentive spirometry and early mobilization

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8
Q

What is the 4:2:1 rule for maintenance fluids?

A
  • 4x10 for first 10kg
  • 2x10 for second 10kg
  • 1x remaining kg
  • I.e 75kg = 40 + 20 + 55 = 115mL/hr x24 = 2760 mL/day
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9
Q

When is blood transfusion indicated postop?

A
  • Hgb < 7 in any pt
  • Hgb < 8 + cardiac/pulm/CVD
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10
Q

MC postop pain control

A

Opiates via IV or PCA

Usually transition to oral after 48h

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11
Q

What is the main purpose of non-opioids in pain control postop?

A

Reducing the amt of opioid required

Multimodal pain therapy is key

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12
Q

Why might a NG tube be used postop?

A
  • N/V
  • Ileus due to anesthesia
  • Abdominal distension

Diminished peristalsis 24h postop is common

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13
Q

What Pauda prediction score is high risk for DVT?

A

> = 4

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14
Q

What is the key factor in differentiating postop fever?

A

Its onset

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15
Q

What are the 5 W’s of an acute postop fever?

A
  • Wind: Atelectasis/PNA, 24-48h postop, CXR
  • Water: UTI, 3-5d postop, UA with culture
  • Wound: Superficial vs deep, 5-7d postop, Visual/CT
  • Walking: DVT => PE, 7-10d postop, Venous doppler/CT scan PE
  • Wonder Drugs: Anytime, dx of exclusion

Increasing in onset timing

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16
Q

What is the MCC of fever 24-48h postop?

A

Atelectasis

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17
Q

What are the risk factors for atelectasis?

A

Smokers/COPD/Elderly

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18
Q

What are the main complications associated with atelectasis?

A
  • Hypoxia
  • Infection of atelectasis segment
  • PNA if persisting > 72h
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19
Q

Tx of atelectasis

A
  • Deep breathing/incentive spirometry/coughing
  • Chest percussion, BDs
  • Bronchoscopy for severe
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20
Q

Clinical features of PNA

A
  • 3-5days pstop fever
  • Tachypnea, SOB, increased respiatory secretions are common.
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21
Q

What is the MCC of pulmonary related postop death?

A

PNA

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22
Q

Tx of postop PNA

A
  • Obtain culture, then empiric abx
  • Rocephin, Unasyn, levofloxacin, ertapenem
23
Q

PE findings for pleural effusion

A
  • Dullness to percussion
  • Decreased tactile fremitus
  • Asymmetrical chest expansion
24
Q

Tx of pleural effusions

A
  • Small: no nothing
  • Symptoms/PNA: drain
25
Q

When is risk of pneumothorax highest postop?

A

Placement of subclavian central line or in a surgery where diaphragm puncture could occur

26
Q

Tx of pneumothorax

A

Thoracostomy

27
Q

MCC of UTI (organism)

A

E. coli

28
Q

Tx of UTI postop

A
  • Rocephin
  • Cipro

common cause of postop fever 48h

29
Q

Dx of urinary retention

A

Bladder scan of >400 mL PVR (post void residual)

30
Q

Risk factors for hematoma postop

A
  • AC
  • Coagulopathies
  • Marked postop HTN
  • Vigorous cough/straining
31
Q

Tx of hematoma

A
  • Small: let it resorb on its own
  • Compression dressings
  • Evacuation or ligation
32
Q

What two hematoma locations are extremely dangerous?

A
  • Neck
  • Spine
33
Q

Where are seromas MC postop?

A
  • Breasts
  • Axilla
  • Inguinal
34
Q

Tx of seromas

A
  • Needle aspiration
  • Compression dressings
  • Exploration if recurrent
35
Q

Where is wound dehiscence MC?

A

Abdomen

36
Q

Primary risk factors for wound dehiscence

A
  • > 60 yo
  • DM
  • Immunosuppressed
  • Liver Ds
  • Sepsis
  • Cancer
  • Obesity
  • Inadequate closure
  • Increased intra-ab pressure
  • Infection
37
Q

When does wound dehiscence tend to occur?

A

POD 5-8

38
Q

Tx of wound dehiscence

A
  • Moist towels + binder until surgical consult
  • Debridement and reclosure of fascia with secondary intention
39
Q

MCC of wound infection (organism)

A

S. aureus

40
Q

4 types of surgical wounds

A
  • Clean: no hollow viscus entered
  • Clean-contaminated: hollow viscus entered but controlled
  • Contaminated: uncontrolled, major break in aseptic tech
  • Dirty: untreated, uncontrolled
41
Q

When do SSI tend to present?

Surgical site infection

A

POD 5-6

42
Q

When is ileus normal postop?

A

First 24-72h

43
Q

What usually causes GI obstruction postop?

A

Adhesions/blockage

44
Q

What would KUB XR show for GI obstruction?

A

Air fluid levels with distinct dilation above area of obstruction

45
Q

In postop peds pts specifically, what is the MCC of obstruction?

A

Intussusception

46
Q

When is acute pancreatitis and cholecystitisMC postop?

A
  • Biliary tract surgeries
  • Acute pan: after ERCP or cholecystectomy
  • Acute chole: After ERCP or upper GI procedures
47
Q

What 3 areas increase risk of a postop hepatic injury?

A
  • Surgery of upper ab
  • Biliary tract
  • Pancreas
48
Q

What is postop C Diff colitis mainly caused by?

A

Postop abx use

49
Q

What surgery is highest risk for a CVA postop?

A

CEA (Carotid endarterectomy)

50
Q

What are postop dysrhythmias MC due to?

A
  • Electrolyte disturbances/drug toxicity
  • Potential sign of an MI
51
Q

When is phlebitis fever MC postop?

A

72h

52
Q

What is Virchow’s triad?

A
  • Endothelial injury
  • Hypercoagulability
  • Venous stasis
53
Q

When is fat embolism most common?

A

Postop for ortho sx involving long bone fx

Surgery (8 decks)

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