periop/postop

Question 1

second mc complication in surgery

Answer 1

nerve damage due to positioning

Question 2

5 P’s of writing orders

Answer 2

pain (mild to severe controlled w meds or position)

pee (urination)- urinary cath q6prn; indwelling cats can lead to infx and may lead to oliguria after removal bc pt has been relying on cath

poop (BM)- constipation can cause urinary problems

puking (nausea)

pyrexia (fever)

Question 3

what should there be evidence of prior to feeding following abd operations

Answer 3

evidence of peristalsis- bowel sounds, passing gas

Question 4

what is POD1

Answer 4

first day after an operation

Question 5

tmax

Answer 5

max temp w/in last 24hr

Question 6

tachycardia, metabolic acidosis, hyperthermia, hypercapnia

Answer 6

malignant hyperthermia (postop anesthesia problem)

102.5

Question 7

tx of malignant hyperthermia

Answer 7

IV dantrolene

Question 8

goal of surgical drains

Answer 8

dec infx rate and dec healing time

Question 9

indications for surgical drains

Answer 9

eliminate dead space; evacuate accum of gas, bile, pus, blood, or fluid; prevent accumulation of gas, bile, pus, blood, or fluid

Question 10

penrose (passive drain)

Answer 10

latex and dependent on capillary action; drainage is related to surface area

Question 11

adv of penrose drain

Answer 11

allow drainage, help obliterate dead space, soft/malleable (less painful)

Question 12

disadv of penrose drain

Answer 12

very irritating, allow bacterial ingress, can’t be connected to suction, gravity dependent

Question 13

jackson pratt (active drain)

Answer 13

soft w multiple perforations; bulb that can recreate low neg pressure vacuum; designed so tissues are not sucked into tube

Question 14

hemovac (active drain)

Answer 14

needle for placement (needs to be cut out in order for suction to work); accordion like reservoir (evacuator); more volume capacity than JP; placed away from incision so wound can heal

Question 15

adv of active drain

Answer 15

keep wound dry (efficient fluid removal), can be placed anywhere, prevent bacterial ascension, help appose skin to wound bed (quicker wound healing)

Question 16

disadv of active drain

Answer 16

high negative pressure may injure tissue; drain clogged by tissue

Question 17

why are there complications and failures of drains

Answer 17

poor drain selection, poor drain placement, poor post op management

breakdown of anastomotic site; erosion into hollow organs; incisional dehiscence/hernia (poor placement); premature removal (accum of fluid); dec mobility (DVT/PE, inc hospital stay)

Question 18

which drain is more likely to be assoc w an infx

Answer 18

pinrose- ascending bacterial invasion; foreign body reaction; dec local tissue resistance; bacterial hiding places; poor placement (fluid accum, drain kinked), poor postop manag

Question 19

causes of inefficient drainage

Answer 19

exiting in non dependent locale (passive drains); kinked tube; obstructed; poor drain selection (diameter too small to remove viscous fluid)

Question 20

when should drain be removed

Answer 20

when drainage ceases

Question 21

obligatory urine output for adult

Answer 21

generally 50ml/hr

Question 22

the 5 W’s for postop fever

Answer 22

wind (24-48hr, atelectasis); water (3d, UTI); wound (5-7d, infx); walking (7-10d, DVT); wonder drugs

Question 23

w/u for postop fever (>101.5)

Answer 23

PE (lungs,heart, site, calf tenderness, Homans); cxr; UA; blood cx (2 sep sites); cbc