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Adult and Ped Test 7 > Post Op Complications > Flashcards

Post Op Complications Flashcards

1
Q

What are the three major stages for post op period?

A

a. Immediate post-op, 1-3 hours, PACU, or Recovery Room
b. Intermediate Phase : the remainder of hospitalization
c. Convalescent (late) Phase: discharge to full recovery

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2
Q

What are the most common causes of death in the immediate post-op period?

A

a. Acute pulmonary, CV and fluid derangements. Can be discharged from PACU after 1-3 hours , as those risks return to near baseline.
b. If there is a complication: then you want to support your patient, assess and treatment pain, detect and prevent complications

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3
Q

What Post-Op orders need to be considered?

A

ADC Van Diml

i. Admit to _____
ii. Diagnosis
iii. Condition
iv. Vitals
v. Activity
vi. Nursing orders
vii. Diet
viii. IV fluids
ix. Medications
x. Labs

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4
Q

What prophylaxis treatments do you need to consider post-op

A

DVT, wound, GI stress ulcer, Respiratory, Bowel

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5
Q

What should you use for DVT prophylaxis?

A

Sequential compression devides, LMWH, mobilize

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6
Q

What should you use for Wound prophylaxis?

A

a. Give 24 hours of IV antibiotics post-op

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7
Q

What should you use for GI stress ulcer prophylaxis

A

PPIs, H2Bs, antacids

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8
Q

What should be used for Resp phrophylaxis

A

Incentive spirometry 10x/hour, mobilized

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9
Q

What should be used for bowel prophylaxis?

A

Mobilize, stool softener, MOM

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10
Q

What are wound complications with fluid in the wound?

A

Hematoma: collection of blood and clot in close wound due to poor hemostais. creates a pressure effect

Seroma: thought to be due to a disruption in lymph fluid. Increases risk of infection

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11
Q

What is the number one preventing factor for wound complications

A

Hand washing

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12
Q

What are some of the signs of wound complications?

A

Warmth, spreading redness, induration, tenderness, pus/drainnage, increasing pain over time, foul smell.

Treatment is antibiotics and allowing for drainage, often will need to return to OR for irrigation and debridement

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13
Q

What is a dehiscence?

A

a. Partial or total disruption of wound layers (superficial skin/dermis vs deep fascia

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14
Q
  1. What is evisceration
A

all layers rupture and abdominal contents extrude. Can be due to closure issues by sutures, increased abdominal pressure, deficient wound healing.

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15
Q

What is the most common single cause of morbidity after major surgical procedures?

A

a. Respiratory complications
b. Second most common cause of post-op death in age >60. Much more common in patients with upper chest or upper abdominal surgeries.

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16
Q

What is the most common pulmonary complication

A

a. Atelectasis
b. First 48 hours: causes 90% of all episodes of fever. (other symptoms being tachypnea, tachycardia). Usually due to the collapse of dependent bronchioles due to SHALLOW BREATHING and FAILURE TO HYPERVENTILATE.

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17
Q

How can you prevent atelectasis?

A

Positive pressure, nebulized meds, percussion, NT suction

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18
Q

When is aspiration more likely

A

More likely with NG tube or ETT. Certain drugs, decreased LOC, trauma, pregnancy. Prevent this by causing NPO 6 hours pre-op.

19
Q

How do you treat aspiration?

A

BAL, IVF, steroids, antibiotics, pulmonary consult.

20
Q

What is the most common respiratory complication that cause people do DIE?

A

pneumonia.
signs include fever, tachypnea, hypoxia, CXR consolidation
tx= give abx, do suctions/mobilization/nebulizer

21
Q

What are the risk factors for getting pneumonia postop?

A

prolonged vent support, peritoneal infections, atelectasis, aspiration

22
Q

What are the organisms most frequently isolated?

A

GN bacilli: Klebisiella and Pseudomonas.

23
Q

What is a pleural effusion?

A

collection of fluid or blood between parietal and visceral pleura, think “inflammation”.

24
Q

How can you treat pleural effusion?

A

if large and compromising pulmonary function, place a chest tube for drainage.

25
Q

PE and DVT are two manifestations of the same disease. The risk factors for the disease are the same…what are they?

A
  1. venous stasis
  2. injury to the vessel wall
  3. hypercoagulability
    This is known as Virchow’s triad
26
Q

Virchow’s triad:

A
  1. venous stasis
  2. injury to the vessel wall
  3. hypercoagulability
27
Q

What are some of the symptoms of PE?

A

dyspnea, chest pain on inspiration, cough, LEG PAIN, increased heart rate, increased respirations.

28
Q

What is a homan’s sign

A

its associated with DVT, although not clinically specific. a positive sign is a forceful dorsiflexion followed by calf pain.

29
Q

What lab findings are present with PE?

A

ECG is abnormal in about 70% of patients, but sinus tachycardia and nonspecific ST and T wave changes are more common. ABG usually shows alkalosis due to hyperventilation. A neg Ddimer can rule out a Pe but if its positive, it cant diagnose it as PE. A CT with angiography is needed to diagnose a PE.

30
Q

what imaging is needed to diagnose a PE

A

CT pulmonary angiography

31
Q

What is the choice of imaging to detect DVT?

A

venous US

32
Q

What is the treatment for PE?

A

start both heparin and warfarin together, then warfarin for 6 months after.

33
Q

what are some risk factors for DVT?

A

female, smoker, obesity, immobility

34
Q

What are some prophylaxis that we can do?

A

compression stockings, early post op ambulation, heparin

35
Q

What are some cardiac complications that can arise?

A
  1. Dysrrhythmias : give pre-op BB to decrease risk. SVTs not usually serious, but if there is Afib/flutter with RVR then you need to get rate control. if in shock, then you need to convert them.
  2. MI–> increased with those who have CV risk factors. Can be asymptomatic.
  3. CHF –> may be a post op MI that was missed. More commonly caused by fluid overload.
36
Q

What are some peritoneal complications?

A

A. Hemopertioneum= most common cause of shock in 1st 24 hours. patient will be:

  1. tachycardic
  2. hypotenisve
  3. decreased UOP
  4. abd exam will show distention, rigidity.
  5. decreased Hgb

B. drain complications

37
Q

What are some GI complications?

A
  1. post op gastric distention
    - tender distended abdomen with HICCUPS
    - tx: NG decopmression
  2. bowel obstruction
    a. mechanical: adhesions, hernia, etc…
    b. paralytic: await gas
    c. you will see air fluid levels on X-ray
38
Q

A patient has abrupt epigastric/back pain, increased amylase and lipase, and a CT scan shows an increased pancreatitis. How might this have happened

A

mechanical trauma after nearby surgery can upset the pancreas. usually from GB/biliary tract surgery. high mortality.

39
Q

What is the most common cause of hepatic dysfunction?

A

hepatocellular insufficiency due to inflammation, drugs, or sepsis.

40
Q

How will hepatic dysfunction appear?

A

mild jaundice to liver failure. look at skin and liver enzymes.

41
Q

What should Cdiff be treated with?

A
  1. remove current abx

2. if needed, then metronidazole and vanco

42
Q

Who needs a foley?

A
  • surgery >3 hrs
  • pelvic surgery
  • unable to ambulate

untreated can lead to build up and hydronephrosis.

43
Q

patient’s who have had a foley for longer than >3d are assumed to have?

A

a UTI

44
Q

Describe how you should think of fevers in order of post-op days

A

wind water wound

  1. 0-2 days: atelectasis is highest concern.
  2. 2-5 days: IV sites, UTI, pneumonia
  3. > 5 days: infection at surgical site or intraabdominal abcess.

Adult and Ped Test 7 (18 decks)

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