Management Flashcards

Question

What is the management of post-op constipation?

Answer 1

Adequate hydration Sufficient dietary fibre, Treating the underlying cause Encouraging early mobilisation Opioid induced - stimulant laxative e.g Senna

Answer 2

It is HAP O2 therapy aiming for >94% Aiming for 98-92% if risk of hypercapnic respiratory failure Adequate hydration and sufficient dietary fibre, treating the underlying cause, and encouraging early mobilisation.

Answer 3

Stop any offending drug D (Diuretics) A (ACEi/ARBs) M (Metformin) - accumulation= lactic acidosis N (NSAIDs) also LMWH and Aminoglycoside antibiotics Assess patient's fluid status Pre-renal - give I.V Fluid bolus Reassess fluid status after 15mins, monitoring urine output after each bolus Repeat until patient is euvolaemic Regular U&Es to look at serum creatinine

Answer 4

Uncontrolled pain Constipation Infection Anesthetic agents

Answer 5

Withdrawal of any causative agents SIgnificant retention will require catheterisation Then a Trial Without catheter should be done , if they enter retention again a new catheter should be inserted

Answer 6

Delirium Sepsis Acute urinary retention

Answer 7

Ensure adequate hydration Make to check urine output Antibiotics - Nitrofurantoin , Co-amoxiclav if signs of peritonitis After getting the MCS can change antibiotic depending on the sensitivity Change any long-term urethral or suprapubic catheter in-situ in the presence of a UTI

Answer 8

Paraesthesia Muscle weakness Nausea and vomiting Palpitations

Answer 9

Continuous cardiac conitoring 10ml of 10% Calcium Gluconate - stabilises the cardiac membrane Variable rate insulin with ( typically 200ml of 20% glucose with 10U of insulin over 30mins) - drives K+ into cells, dextrose prevents hypoglycaemia Salbutamol nebulisers - drives K+ into cells Resistant hyperkalaemia potentially warranting haemodialysis

Answer 10

Correct with Na+ levels at a suitable rate with oral rehydration, not too quickly due to risk cerebral oedema

Answer 11

Sweating Tingling lips or extremities, Tremor Dizziness Slurred speech Pallor Confusion Tachycardia Tachypnoea Focal neurology Reduced consciousness

Answer 12

Post-gastrectomy or gastric bypass surgery

Answer 13

A-E approach If the patient is conscious, give oral glucose (such as 10g GlucoGel) Monitor the capillary blood glucose levels every 1-2hrs until stable and ensure patient eats complex carbohydrates (e.g. bread) to maintain their BM If the patient is unconscious, start by protecting their airway and start high flow O2. Gain intravenous access and give intravenous glucose (such as 100ml of 20% dextrose IV) Can also give IM Glucagon If can't gain IV access

Answer 14

Treatment of underlying cause Mild - Oral K+ supplements Moderate-Severe or unable to take oral supplements - IV K+ replacement Daily U&Es

Answer 15

Intravenous fluids (such as 0.9% sodium chloride) for better control over oral Monitor renal function and electrolyte levels regularly,

Answer 16

Neurological signs, such as malaise, headache, and confusion, before progressing to reduced consciousness and seizures

Answer 17

Remove any sutures and clips Drain pus if required Take a wound swab Pack the wound Empirical antibiotics, change depending on results of swab MCS

Answer 18

Superficial - simple wound care , wound packing with sterile saline soaked gauze More extensive wound dehiscence may require negative pressure wound therapy to aid in healing. Full wound dehiscence A to E approach Analgesia Broad spectrum Antibiotics Cover wound with saline-soaked gauze Urgent return to theatre for resuturing

Answer 19

Increasing age Diabetes mellitus Steroids Smoking Obesity or malnutrition Emergency surgery Length of operation (>6hrs) Wound infection Prolonged ventilation Poor tissue perfusion (e.g. post-operative hypotension)