Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery literally enochs + stuff that I can't remember > 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What would determine whether a patient goes to immediate post op or to a recovery room?

A

Whether they are in patient or out patient
immediate postop: out patient
recovery room: in patient

i wrote this in so literally wont be a question lol i just wanna know

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Who is the main provider during the immediate post operative period?

A

anesthesiologist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Who must dictate the operative note?

A

Surgeon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

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

A

a week

remains markedly diminished for 12-14 hours post op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Who is pulmonary function depression worse in?

A

elderly
smokers
obesity
pre existing lung diease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

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

A

Atelectasis, managed by incentive spirometry and early mobilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
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

LR or D5/0.5%NS are most commonly used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When is blood transfusion indicated postop?

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

Must obtain consent before giving blood!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the MC blood transfusion?

A

packed RBCs

general rule: 1 unit of RBCs increases Hg by 1 g/dL and Hct by 3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MC postop pain control

A

Opiates via IV or PCA

Usually transition to oral after 48h

goal: adequate pain control; minimal side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

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

Ketorolac (Toradol)-NSAID
Tylenol

A

Reducing the amt of opioid required

Multimodal pain therapy is key

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why might a NG tube be used postop?

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

Diminished peristalsis 24h postop is common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What Pauda prediction score is high risk for DVT?

A

> = 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What can be used for DVT prophylaxis

chemical vs mechanical

A
  • Medications: MC Lovenox (LMWH) or SQ Heparin
  • Compression Stockings
  • Early ambulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the key factor in differentiating postop fever?

A

Its onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

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

A

Atelectasis

Also the most common post operative pulmonary complication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is atelectasis? How would a patient with Atelectasis present?

A

Collapse of the bronchioles
Caused by shallow breathing and failure to hyperinflate the lungs

fever, tachypnea, tachycardia
hypoxemia after 48 h postop
Diminished breath sounds at bases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the risk factors for atelectasis?

A

Smokers/COPD/Elderly

increase secretions can lead to obstructions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the main complications associated with atelectasis?

smokers/elderly/COPD patients are so HIP

A
  • Hypoxia
  • Infection of atelectasis segment
  • PNA if persisting > 72h
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Tx of atelectasis

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

prevention: early mobilization, incentive spirometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Clinical features of PNA
+ what would you see on exam

A
  • 3-5days post op fever
  • fever, tachypnea, SOB, increased respiratory secretions are common.

exam: auscultatory crackles or dimished breath sounds, dullness to percussion if consolidation is present
labs: leukocytosis
CXR: infiltrates or consolidation on CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the MCC of pulmonary related postop death?

A

PNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Tx of postop PNA
what if its resistant?
what about vanc?

PNA post op RULE #1 killa

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

resistant organisms: pip/taz, cefepime, imipenem
MRSA: vanc, linezolid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

after what surgery are small pleural effusions common + s/sx

A

small effusion common after abdominal/thoracic surgery
s/s: cough, sob, chest pain, ….surprise surprise…fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

PE findings for pleural effusion

A
  • Dullness to percussion
  • Decreased tactile fremitus
  • Asymmetrical chest expansion (delayed expansion on side of effusion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Tx of pleural effusions

A
  • Small/no resp compromise: do nothing
  • Symptoms/PNA: drain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When is risk of pneumothorax highest postop?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Clinical presentation of Pneumothorax:
What would you see (hear) on an exam?

A

Sudden SOB, CP/tightness, hypoxia, tachycardia, tachypnea
Exam:
* Unequal breath sounds
* Hyperresonance with percussion
* decreased wall expansion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Tx of pneumothorax

A

Thoracostomy

35
Q

What increases the risk of a UTI post op?

A

prolonged cath (>2days)

36
Q

MCC of UTI (organism)

A

E. coli

37
Q

S/Sx of UTI
+ how is it diagnosed

A

dysuria
hematuria
frequency
fever
N/V
Malodorous urine

Dx: Urinalysis w/ culture

38
Q

Tx of UTI postop

A
  • Rocephin
  • Cipro

common cause of postop fever 48h

39
Q

Risk factors of Urinary retention

A
  • pelvic/perineal surgery
  • Spinal anesthesia
  • Over distention of urinary bladder
  • h/o BPH/prostate tumor
40
Q

S/Sx of Urinary retention
+what may you see on an exam?

A

oliguria/anuria
abdominal/pelvic discomfort
Exam: palpation of lower abdomen may demonstrate distended bladder

41
Q

Dx of urinary retention

A

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

42
Q

Treatment of urine retention

A

Bladder catheterization (foley)

43
Q

What is a hematoma? +how does it present

A

collection of blood d/t inadequate hemostasis
clinical appearance: swelling, discoloration, bruising pain/discomfort, blood leaking through incision

44
Q

Risk factors for hematoma postop

A
  • AC
  • Coagulopathies
  • Marked postop HTN
  • Vigorous cough/straining
45
Q

Where are some common sites where hematomas occur?

A

Thyroid
Joints
Breast

46
Q

Tx of hematoma

A
  • Small: let it resorb on its own
  • Compression dressings
  • Evacuation or ligation
47
Q

What two hematoma locations are extremely dangerous?

A
  • Neck (cut off air supply)
  • Spine (compress spinal cord)
48
Q

What is a seroma? +appearance

A
  • collection of serous fluid (typically from lymphatics)
  • Not pus or blood
  • Swelling, discomfort, leakage of serous fluid from incision
49
Q

Where are seromas MC postop?

A
  • Breasts
  • Axilla
  • Inguinal
50
Q

Tx of seromas

A
  • Needle aspiration
  • Compression dressings
  • surgical exploration if recurrent
51
Q

what is a wound dehiscence?

A

complete or partial disruption of any or all layers of incision

if all layers repture and expose internal organs its called evisceration

52
Q

Where is wound dehiscence MC?

A

Abdomen

53
Q

Primary risk factors for wound dehiscence

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

mmmm no thx

54
Q

When does wound dehiscence tend to occur?

A

POD 5-8

55
Q

Tx of wound dehiscence

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

Small areas that aren’t full thickness may be managed with meticulous wound care and avoid operative intervention

56
Q

MCC of wound infection (organism)

A

S. aureus

57
Q

Types of SSI

Superficial, deep, organ

A

superficial-skin and subcutaneous tissue
Deep: fascia, muscle, tissues
Organ/open space

58
Q

4 types of surgical wounds

A
  • Clean: no hollow viscus entered, no break in aseptic technique
  • Clean-contaminated: hollow viscus entered but controlled, primary wound closure
  • Contaminated: uncontrolled spillage from viscus, major break in aseptic tech
  • Dirty: untreated, uncontrolled spillage, pus in operative wound, open dirty traumatic wound
59
Q

When do SSI tend to present?

Surgical site infection

A

POD 5-6

60
Q

SSI host risk factors

probably not learning but i’m gonna try

A

DM
Hypoxemia
Immunosuppresive drugs
Cigarette smoking
Malnutrition
Poor skin hygiene/contaminated or infected wounds

they literally make sense, i now see why enoch didnt put them in his cards lol

61
Q

How do you treat SSI?

A

Culture, Abx, surgical debridement

62
Q

SSI prevention? this slide had a lot but im just asking for the abx prophylaxis

A

MC: cefazolin, ceftriaxone, cefoxitin
with colorectal or appendix-add flagyl or clinda

63
Q

When is ileus normal postop?

A

First 24-72h

64
Q

What usually causes GI obstruction postop?

A

Adhesions/blockage

65
Q

how would someone with ileus/obstruction present? +what would you see on exam?

A

abd distenstion
abd pain
absence of flatus
N/V (bilious emesis)
Exam:
* protuberant tense abdomen
* tympanic abd to percussion
* lack of bowel sounds after 2 min (high pitched tinkering intermittent sounds)

66
Q

What is the treatment for Ileus/obstruction post op?

A

NG tube decompression
Bowel rest/NPO
need for adhesiolysis

67
Q

What would KUB XR show for GI obstruction?

A

Air fluid levels with distinct dilation above area of obstruction

68
Q

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

A

Intussusception

69
Q

Alright what do we know about fecal impaction
MC in:
results from:
S/Sx:
Dx
Tx:

literally one slide so it wont be a question but im crazy

A

MC: elderly
results from: post op ileus, opiods, reduced mobility
Dx: Rectal exam/KUB Xray
Tx: manual removal, bowel regimen

70
Q

When is acute pancreatitis and cholecystitis MC postop?

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

more likely to develop into infected necrotizing pancreatitis

71
Q

What 3 areas increase risk of a postop hepatic injury?

A
  • Surgery of upper ab
  • Biliary tract
  • Pancreas
72
Q

What can cause jaundice post op + how do you treat it?

A

Drugs, blood transfusion ractions, damage to liver, obstruction d/t injury of bile ducts
Tx: Discontinue drugs, blood transfusion, fluid replacemnt
GI consult-ERCP, stenting

73
Q

What is postop C Diff colitis mainly caused by?

A

Postop abx use

Pseudomembranous colitis, abx associated colitis

Dx w stool culture

74
Q

What surgery is highest risk for a CVA postop?

A

CEA (Carotid endarterectomy)

Most commonly result from prolonged ischemia/poor perfusion

75
Q

What are postop dysrhythmias MC due to?

A
  • Electrolyte disturbances/drug toxicity
  • Potential sign of an MI
76
Q

There is one slide on MI but i dont think it matters

A

literally

77
Q

When is phlebitis fever MC postop?
What can it lead to?
How can you prevent it?

A

72h
can lead to infection and thrombosis
prevent with good aseptic technique!!! (Idk she bolded this)

Tx: removal of catheter/warm compress/NSAIDS

78
Q

S/Sx of Phlebitis

A

induration, edema, and tenderness, erythema, drainage, pronounced pain with infection

79
Q

What is Virchow’s triad?

A
  • Endothelial injury
  • Hypercoagulability
  • Venous stasis
80
Q

DVT
Risk factors
S/Sx
Diagnosis
Complications
Tx
Prevention

A

wont be a question

81
Q

When is fat embolism most common?

A

Postop for orthopedic sx or long bone fx

tiny fat globules entering blood stream through bone marrow

82
Q

PE S/Sx, Dx, Tx

its literally one slide

A

S/Sx: tachycardic, tachypneic, hypotensive, hypoxic, chest pain
Dx: STAT CTA
Tx: antiCoagulation therapy, embolectomy

83
Q

When to discharge a patient (8 things)

A

the fact that this class only has one exam has me wanting to memorize everything lol

Convalescent phase begins once patient is home

Surgery literally enochs + stuff that I can't remember (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions