Post-op Care: Complications Flashcards
List some possible post-op complications
During/immediate
- haemorrhage
- basal atelectasis
- cardiac/resp arrest
- hypoglycaemia
Early
- Pain
- SOB
- Poor urine output
- Confusion
- Wound dehiscence
- Constipation
- Diarrhoea
- N+V
- Lung collapse
Late
- need for further surgery
- bowel obstruction
- keloid formation
- incisional hernia
How would you approach a post-op pt with SOB?
A-E assessment
Investigations = routine bloods, blood cultures, ABG, CXR
Sats - oxygen
Listen to the chest
CURB-65 score (severity of CAP)
Abx
How would you approach a post-op pt with poor urine output?
US bladder scan - identify post-void residual urine vol
Check for underlying reversible causes
Adequate pain control
Significant retention will require catheterisation - then TWOC (trial without catheter)
How would you approach a post-op pt with confusion?
AMT abbreviated mental test or MMSE mini-mental state exam to quantify current cognitive function and compare with any previous scores
Confusion assessment method may also be used to further quantify any delirium
Review recent obs, drug chart
Look for signs of infection
Assess level of pain
Check for signs of constipation or urinary retention
Neurological exam - rule out stroke, subdural haematoma
Investigations = FBC, U+Es, TFT, glucose, blood cultures, wound swabs, urinalysis, CXR, CT head
How would you approach a post-op pt with wound pathology?
Wound swabs
Blood tests = FBC, CRP, blood cultures
Removal of sutures/clips = drainage of pus, wound packing
Empirical Abx
Wound dehiscence = swabs, bloods for infection markers, return to theatre, surgical debridement, Abx, re-suturing using deep retention sutures, if closure is not possible packing with saline-soaked gauze
How would you approach a post-op pt with diarrhoea?
A-E assessment - rehydration
Routine bloods
Stool culture - c.diff requires IV fluid rehydration and oral metronidazole
Is it associated with moderate to severe cramping, foul smell, fever, vomiting or pain?
How would you approach a post-op pt with N+V?
A-E assessment
High risk of aspiration so careful airway assessment and protection with NG tube may be needed
Prophylactic = reduce opiates, volatile gases, give antiemetics
Conservative = adequate fluid hydration, adequate analgesia, ensure no obstructive cause
Pharmaceutical = metaclopramide
Investigate causes = surgery, drugs, infection, post-op ileus, bowel obstruction, hypercalcaemia, uraemia, DKA, opioids, raised ICP, anxiety
