Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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
Tx of atelectasis
* Deep breathing/incentive spirometry/coughing * Chest percussion, BDs * Bronchoscopy for severe ## Footnote prevention: early mobilization, incentive spirometry
26
Clinical features of PNA + what would you see on exam
* 3-5days post op fever * fever, tachypnea, SOB, **increased respiratory secretions** are common. ## Footnote exam: **auscultatory crackles** or dimished breath sounds, dullness to percussion if consolidation is present labs: leukocytosis CXR: **infiltrates or consolidation on CXR**
27
What is the MCC of pulmonary related postop death?
PNA
28
Tx of postop PNA what if its resistant? what about vanc? | PNA post op RULE #1 killa
* Obtain culture, then empiric abx * Rocephin, Unasyn, levofloxacin, ertapenem ## Footnote resistant organisms: pip/taz, cefepime, imipenem MRSA: vanc, linezolid
29
after what surgery are small pleural effusions common + s/sx
small effusion common after abdominal/thoracic surgery s/s: cough, sob, chest pain, ....surprise surprise...fever
30
PE findings for pleural effusion
* Dullness to percussion * **Decreased tactile fremitus** * *Asymmetrical* chest expansion (delayed expansion on side of effusion)
31
Tx of pleural effusions
* Small/no resp compromise: do nothing * Symptoms/PNA: drain
32
When is risk of pneumothorax highest postop?
Placement of subclavian central line or in a surgery where diaphragm puncture could occur
33
Clinical presentation of Pneumothorax: What would you see (hear) on an exam?
Sudden SOB, CP/tightness, hypoxia, tachycardia, tachypnea Exam: * Unequal breath sounds * **Hyperresonance with percussion** * **decreased** wall expansion
34
Tx of pneumothorax
Thoracostomy
35
What increases the risk of a UTI post op?
prolonged cath (>2days)
36
MCC of UTI (organism)
E. coli
37
S/Sx of UTI + how is it diagnosed
dysuria hematuria frequency fever N/V Malodorous urine ## Footnote Dx: Urinalysis w/ culture
38
Tx of UTI postop
* Rocephin * Cipro | common cause of postop fever 48h
39
Risk factors of Urinary retention
* pelvic/perineal surgery * Spinal anesthesia * Over distention of urinary bladder * h/o BPH/prostate tumor
40
S/Sx of Urinary retention +what may you see on an exam?
oliguria/anuria abdominal/pelvic discomfort Exam: palpation of lower abdomen may demonstrate distended bladder
41
Dx of urinary retention
Bladder scan of >400 mL PVR (post void residual)
42
Treatment of urine retention
Bladder catheterization (foley)
43
What is a hematoma? +how does it present
collection of blood d/t **inadequate hemostasis** clinical appearance: swelling, discoloration, bruising pain/discomfort, blood leaking through incision
44
Risk factors for hematoma postop
* AC * Coagulopathies * Marked postop HTN * Vigorous cough/straining
45
Where are some common sites where hematomas occur?
Thyroid Joints Breast
46
Tx of hematoma
* Small: let it resorb on its own * Compression dressings * Evacuation or ligation
47
What two hematoma locations are extremely dangerous?
* Neck (cut off air supply) * Spine (compress spinal cord)
48
What is a seroma? +appearance
* collection of serous fluid (typically from lymphatics) * Not pus or blood * Swelling, discomfort, leakage of serous fluid from incision
49
Where are seromas MC postop?
* Breasts * Axilla * Inguinal
50
Tx of seromas
* Needle aspiration * Compression dressings * surgical exploration if recurrent
51
what is a wound dehiscence?
complete or partial disruption of any or all layers of incision ## Footnote if all layers repture and expose internal organs its called evisceration
52
Where is wound dehiscence MC?
Abdomen
53
Primary risk factors for wound dehiscence
* > 60 yo * DM * Immunosuppressed * Liver Ds * Sepsis * Cancer * Obesity * Inadequate closure * Increased intra-ab pressure * Infection ## Footnote mmmm no thx
54
When does wound dehiscence tend to occur?
POD 5-8
55
Tx of wound dehiscence
* Moist towels + binder until surgical consult * Debridement and reclosure of fascia with secondary intention ## Footnote Small areas that aren't full thickness may be managed with meticulous wound care and avoid operative intervention
56
MCC of wound infection (organism)
S. aureus
57
Types of SSI | Superficial, deep, organ
superficial-skin and subcutaneous tissue Deep: fascia, muscle, tissues Organ/open space
58
4 types of surgical wounds
* 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
When do SSI tend to present? | Surgical site infection
POD 5-6
60
SSI host risk factors | probably not learning but i'm gonna try
DM Hypoxemia Immunosuppresive drugs Cigarette smoking Malnutrition Poor skin hygiene/contaminated or infected wounds ## Footnote they literally make sense, i now see why enoch didnt put them in his cards lol
61
How do you treat SSI?
Culture, Abx, surgical debridement
62
SSI prevention? this slide had a lot but im just asking for the abx prophylaxis
MC: cefazolin, ceftriaxone, cefoxitin with colorectal or appendix-add flagyl or clinda
63
When is ileus normal postop?
First 24-72h
64
What usually causes GI obstruction postop?
Adhesions/blockage
65
how would someone with ileus/obstruction present? +what would you see on exam?
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
What is the treatment for Ileus/obstruction post op?
NG tube decompression Bowel rest/NPO need for adhesiolysis
67
What would KUB XR show for GI obstruction?
Air fluid levels with distinct dilation above area of obstruction
68
In postop peds pts specifically, what is the MCC of obstruction?
Intussusception
69
Alright what do we know about fecal impaction MC in: results from: S/Sx: Dx Tx: ## Footnote literally one slide so it wont be a question but im crazy
MC: elderly results from: post op ileus, opiods, reduced mobility Dx: Rectal exam/KUB Xray Tx: manual removal, bowel regimen
70
When is acute pancreatitis and cholecystitis MC postop?
* Biliary tract surgeries * Acute pan: after ERCP or cholecystectomy * Acute chole: After ERCP or upper GI procedures ## Footnote more likely to develop into infected necrotizing pancreatitis
71
What 3 areas increase risk of a postop hepatic injury?
* Surgery of upper ab * Biliary tract * Pancreas
72
What can cause jaundice post op + how do you treat it?
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
What is postop C Diff colitis mainly caused by?
Postop abx use | Pseudomembranous colitis, abx associated colitis ## Footnote Dx w stool culture
74
What surgery is highest risk for a CVA postop?
CEA (Carotid endarterectomy) ## Footnote Most commonly result from prolonged ischemia/poor perfusion
75
What are postop dysrhythmias MC due to?
* Electrolyte disturbances/drug toxicity * Potential sign of an MI
76
There is one slide on MI but i dont think it matters
literally
77
When is phlebitis fever MC postop? What can it lead to? How can you prevent it?
72h can lead to infection and thrombosis prevent with good aseptic technique!!! (Idk she bolded this) ## Footnote Tx: removal of catheter/warm compress/NSAIDS
78
S/Sx of Phlebitis
induration, edema, and tenderness, erythema, drainage, pronounced pain with infection
79
What is Virchow's triad?
* Endothelial injury * Hypercoagulability * Venous stasis
80
DVT Risk factors S/Sx Diagnosis Complications Tx Prevention
wont be a question
81
When is fat embolism most common?
Postop for orthopedic sx or long bone fx | tiny fat globules entering blood stream through bone marrow
82
PE S/Sx, Dx, Tx | its literally one slide
S/Sx: tachycardic, tachypneic, hypotensive, hypoxic, chest pain Dx: STAT CTA Tx: antiCoagulation therapy, embolectomy
83
When to discharge a patient (8 things)
the fact that this class only has one exam has me wanting to memorize everything lol ## Footnote 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.
© 2025 Bold Learning Solutions. Terms and Conditions