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Surgery > post op > Flashcards

post op Flashcards

1
Q

cellulitis presentation

A

can occur form any breach of the skin

will appear read slightly swollen warm to touch
might blanch

staph and strep (gram negative) most common

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2
Q

tx of cellulitis

A

MSSA –>keflex (cephalexin) 7-10 days (no purulent)

if it is purulent, MRSA is suspected

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3
Q

subcutaneous abscess workup

A

want packing to help heal from inside out

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4
Q

lymphatic fluid with liquified fat under incision presenting post surgery complication

A

seroma

no erythema or acute pain and seen after breast surgery or sentinal node biopsy

can get this from overactivity

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5
Q

complications of seroma

A

can become so large that it is painful

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6
Q

preventions of seroma

A

can send to patients home with JP drains especially after a surgery in the axilla

20cc for 2 days in a row can take out the JP

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7
Q

sutures or staples are removed POD

A

5

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8
Q

sutures over creases and extremities are left on for

A

2 weeks

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9
Q

hwo does the timing of the fever influence the etiology of cause

A

fever that starts POD#5 is surgical infection

fever that lasts 5 days post op is surgical in

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10
Q

immediate fever causes

A

bactermia

catheter with bladder infection

or reaction to the antibiotics

or gangrene

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11
Q

tx of gangrene

A

surgical debridement and antibitocs

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12
Q

acute fever

A

post op day 1 -POD7

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13
Q

unresolved atelectasis can progress

A

to pneumonia

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14
Q

POD 6 the source of elevated temperature is a

A

PE

SOB
Pleuritic CP
CTA dx

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15
Q

wound infection fever usually occurs

A

POD 7-10

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16
Q

sxs of pulmonary aspirations

A

basilar rales
hypoxia
tachypnea

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17
Q

prevention of pulmonary aspiration

A

pre-op fasting

patient positioning

careful intubation and extubation

H2 blocker or PPI before intubation-

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18
Q

causes of postop pneumonia

what type of organism is most commonly the culprit

A

aspiration

stelectasis

copious secretions

usually gram negative

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19
Q

sxs of pneumonia post op

A

fever
tachypnea
increased screations
CXR confirms consolidations

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20
Q

tx of post op PNA

A

culture sputume and treatment if anbx

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21
Q

respiratory management to prevent atelectasis, aspiration, and PNA

everyone get’s this that is admitted

A

Encourage coughing

Frequent change in position

Get out of bed!

I/S incentive spirometer (5x a day)

Deep breathing

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22
Q

RF for post op PE

A

Obesity

Age

Lengthy operative procedure (>5 hrs)

Birth control pills

Malignancy

Trauma

Immobilization

Paralysis
IBS, Crohn’s
Chronic heart dz
Coagulation disorders

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23
Q

longer surgery is usually

A

mroe than 5 or 6 hours on the table

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24
Q

infectous causes of post op fever

A

— SSI, pneumonia (especially VAP), UTI, and intravascular catheter-associated infection are the most common infectious causes of postoperative fever.

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25
Q

sxs of PE postop

A

Cough

Dyspnea

Pleuritic chest pain

Apprehension!
Tachypnea
Tachycardia
P02 less than 70

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26
Q

MC non infectious cause of postop fever

A

Medications are the most common noninfectious cause of fever. Antimicrobials and heparin are the medications most commonly associated with postoperative fever, at least in part because they are used so frequently in the postoperative period

27
Q

we would be concerned for urinary retention if

A

pain and fullness over bladder with distension

unable to void after 6 hours

28
Q

treatment for urinary retention

A

Bladder scan

if residual is greater than 500 cc, patient is catheterized

29
Q

ileus post op usually occurs as a result of

A

After abdominal surgery, the colon ceases to function for a period of time 3-5 days due to:

	bowel manipulation
	intra-abd infection
	pancreatitis
	pneumonia
	peritonitis
	narcotics
30
Q

ileus sxs

A

Abd distension

N/V

Obstipation (failure to pass gas and stool)

Abd pain

31
Q

tx of a ileus

A

Full liquid diet until 1st BM

Patience

32
Q

how do you know if ileus has resolved

A

Flatulence

Sharp, colicky pain

33
Q

Cellulitis

A

Tissue center with blood supply

Will resolve with antibiotics

34
Q

Subcutaneous abscess

A

Necrotic center without blood supply

Pus

Will not heal unless pus is drained

35
Q

Lymphatic fluid with liquefied fat under incision

A

Seroma

36
Q

seromas are of concern in these types of sugeries

A

Concern in breast surgery

ventral hernia repairs

Axillary and groin dissection

Edema

37
Q

fluid from seromas is usually

erythema? pain?

A

Clear or yellow liquid from incision

No erythema or acute pain

38
Q

prevention of a seroma should look like

A

Close subcutaneous layers to avoid dead space

lymphatic fluid collecting is the problem here

Use drains and don’t remove prematurely

25cc for two days in a row to remove

39
Q

Most common surgical complication due to lack of coagulation of vessels during surgery

A

Risk when patient is anti-coagulated with heparin or patient is an aspirin user

40
Q

hematomas are of particular concern when pt is taking

A

Risk when patient is anti-coagulated with heparin or patient is an aspirin user

41
Q

Hematoma increases risk of

A

Hematoma increases risk of infection

Neck hematomas can compromise airways

42
Q

5 signs and sxs of infection

A

i. Fever
ii. N/V/D possibly
iii. Erythema
iv. Edema
v. Exudate (fluid/pus at incision site)

43
Q

how to tx a seroma

A

can leave it alone or aspirate

20 gauge syringe and suck out a lot

might need to culture if it doesn’t look clear

wear a binder or sports bra

DO NOT RADIATE A SEROMA

44
Q

Dressing over closed wounds should be removed on ______ postop day if dry

A

Dressing over closed wounds should be removed on 3rd postop day if dry

45
Q

treatment for itching associated with wound adhesives

A

Treatment is remove offending agent and use of hydrocortisone 1% cream and benadryl cream if itchy

46
Q

5 “w”s

5 causes of post op fever

A 
wind -atelectasis 
water- UTI or PNA from atelectasis 
wound - look at dressings post op  (7)
walking-PE/dvt
wonder -check all the drugs your pt is on

refers to acute fever complications

47
Q

definition of a post op fever

A

greater than 30 degress

or 100.4 on two consecutive post op days

OR
102.2 on any post op day

48
Q

how to we classify post op fevers

A

immediate
acute
subacute
delayed

49
Q

immediate fever occurs when

A

immediately after surgery or within hours

post op day 0 (day of surgery)
or POD 1

50
Q

what are the three causes of immediate fever

A

malignant hypothermia
bacteremia (w/ 30 of beginning)

gas gangrene (greater than 40) 
due to C. Diff

transfusion reaction

51
Q

malignant as the source of an immediate fever is usually caused by….

A

reaction to anesthesia or muscle relaxants

managed by anesthesiaologists

52
Q

immediate fever bacteremia is usually b/c of

A

urinary tract infection with a catheter

three blood cultures and antibiotics

managed by anesthesiolgist

53
Q

gas gangrene as the source of an immediate fever is usually caused by….

what is the treatment

A

fever greater than 40
(104)

severe wound pain
usually because of C diff

debridement and antibiotic

54
Q

transfusion reaction is usually seen

A

6 hours post op

stop transfusi

55
Q

RF for atelectasis

A

i. Elderly
ii. Overweight
iii. Smokers
iv. Hx of respiratory dz

56
Q

tx atelectasis with fever

A

incentive spirometery

pain control

early ambulation

chest physiotherapy

semi -recumbent position

57
Q

POD 3 fever

A

unresolved atelectasis
PNA
or UTI

58
Q

POD 5 fever

A

thrombophlebitis

can be asymptomatic or sxs

dx with Doppler

59
Q

subacute

A

week 1-7

seep infection
pelvic or abdominal
CT or reexplanation

60
Q

sxs of atelectasis (acute)

A

i. None or
ii. Elevation of diaphragm
iii. Scattered rales
iv. Decreased breath sounds

61
Q

injury to bowel with bowel leak is seen with what sxs

A

fever

tachycardia

hypotensive

low u/o (urinary output)

abd tenderness out-of-proportion to p

rocedure vs abd ttp app to proc

62
Q

RF for Pulmonary aspirations

A

GERD

Eating before surgery

Pregnant women

Small bowel or colon obstruction

63
Q

why are pregnant women at greater risk for pulmonary aspirations

A

– high intra-abdominal pressure and decreased gastric motility

64
Q

how do H2 blockers prevent pulmonary aspiration

A

reducing acidity of stomach contents thus preventing chemical pneumonitis

Surgery (18 decks)

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