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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
When is risk of pneumothorax highest postop?
Placement of subclavian central line or in a surgery where diaphragm puncture could occur
26
Tx of pneumothorax
Thoracostomy
27
MCC of UTI (organism)
E. coli
28
Tx of UTI postop
* Rocephin * Cipro | common cause of postop fever 48h
29
Dx of urinary retention
Bladder scan of >400 mL PVR (post void residual)
30
Risk factors for hematoma postop
* AC * Coagulopathies * Marked postop HTN * Vigorous cough/straining
31
Tx of hematoma
* Small: let it resorb on its own * Compression dressings * Evacuation or ligation
32
What two hematoma locations are extremely dangerous?
* Neck * Spine
33
Where are seromas MC postop?
* Breasts * Axilla * Inguinal
34
Tx of seromas
* Needle aspiration * Compression dressings * Exploration if recurrent
35
Where is wound dehiscence MC?
Abdomen
36
Primary risk factors for wound dehiscence
* > 60 yo * DM * Immunosuppressed * Liver Ds * Sepsis * Cancer * Obesity * Inadequate closure * Increased intra-ab pressure * Infection
37
When does wound dehiscence tend to occur?
POD 5-8
38
Tx of wound dehiscence
* Moist towels + binder until surgical consult * Debridement and reclosure of fascia with secondary intention
39
MCC of wound infection (organism)
S. aureus
40
4 types of surgical wounds
* Clean: no hollow viscus entered * Clean-contaminated: hollow viscus entered but controlled * Contaminated: uncontrolled, major break in aseptic tech * Dirty: untreated, uncontrolled
41
When do SSI tend to present? | Surgical site infection
POD 5-6
42
When is ileus normal postop?
First 24-72h
43
What usually causes GI obstruction postop?
Adhesions/blockage
44
What would KUB XR show for GI obstruction?
Air fluid levels with distinct dilation above area of obstruction
45
In postop peds pts specifically, what is the MCC of obstruction?
Intussusception
46
When is acute pancreatitis and cholecystitisMC postop?
* Biliary tract surgeries * Acute pan: after ERCP or cholecystectomy * Acute chole: After ERCP or upper GI procedures
47
What 3 areas increase risk of a postop hepatic injury?
* Surgery of upper ab * Biliary tract * Pancreas
48
What is postop C Diff colitis mainly caused by?
Postop abx use
49
What surgery is highest risk for a CVA postop?
CEA (Carotid endarterectomy)
50
What are postop dysrhythmias MC due to?
* Electrolyte disturbances/drug toxicity * Potential sign of an MI
51
When is phlebitis fever MC postop?
72h
52
What is Virchow's triad?
* Endothelial injury * Hypercoagulability * Venous stasis
53
When is fat embolism most common?
Postop for ortho sx involving long bone fx

Surgery (8 decks)

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