Post-op Complications Flashcards
Hematoma- Eti
- Blood or clot in wound
- Aspirin and LMWH increases risk
- D/t imperfect hemostasis
Hematoma- Timeline
Day 5-8 post-op
Hematoma- Sx
- Elevation and discoloration of wound edges
- May resorb
- Discomfort, pressure and swelling at site
Hematoma- Tx
- Evacuate clot
- Ligate bleeding vessels
Seroma- Eti
Fluid collection at wound site
- Common in mastectomy
- Lymph removal
Seroma- Timeline
Day 5-8 post-op
Seroma- Sx
- Painless swelling below wound
- Yellow needle aspirate
Seroma- Tx
- Needle aspriation
- Compression
- Allow small seromas to resorb
Dehiscence/ Evisceration- Eti
Dehiscence- partial to total disruption of wound layers
- Evisceration- Rupture of all layers of abd wall, extrusion of viscera
- Immunosuppression, steroids, cancer
Dehiscence/ Evisceration- Time
5-8 days postop
Dehiscence/ Evisceration- Sx
- Serosanguineous discharge from wound
- Popping sensation
Dehiscence/ Evisceration- Tx
Dehiscense = reclosure
- Keep stitches in at least 2 weeks
- Corset and compression
- Clean, return to abdomen and re-close
Atelectasis- Eti
- Most common pulm complication
- Partial or total collapse of lung
Atelectasis- Time
Within 48 hrs post-op
Atelectasis- Sx
- Ventilation perfusion mismatch
- Decreased o2
- Rales, elevated diaphragm
- Decreased breath sounds
- Tachypnea, cardia
Atelectasis- Tx
- Commonly self limited
- Clear airway though coughing, nasotrach suction
- Bronchodilators or mucolytics
- Suction
Atelectasis- Prevent
- Early mobilization
- Position changes
- Incentive spirometer
Fat embolism- Eti
- Fat particles in pulm vasc bed
- Fractures of long bones or joint replacements- risk
Fat embolism- Time
12-72 hrs post op
Fat embolism- Sx
- Neuro dysfxn
- Resp insufficiency
- Petechiae to axillae, chest and proximal arms
Fat embolism- Tx
- Supportive O2 unti sx resolve
- positive end-expiratory pressure
Air embolism- Eti
- Insertion of catheter with air induction
- Lodges in rt atrium
Air embolism- Time
- Soon after IV insertion
Air embolism- Sx
Hypotension
- JVD
- Tachycardia
Air embolism- Tx
Aspirate air with syringe
- Place pt rt side up, head down to dislodge air
Fecal impation- Eti
- Common due to post-op illius and opioid use
- Common in elderly, toxic megacolon and paraplegia
Fecal impation- Sx
Anorexia
- Constipation or diarrhea
- Marked dissension of abd
Fecal impation- Tx
Manual removal of fecal impaction
- enemas and poly-ethelene glycol
Urinary retention- Eti
- Common under spinal anesthesia
- Inhibition of bladder contraction
- Pelvic and perineal operations
Urinary retention- Sx
Severe urgency
- Suprapubic pain
- Distended, palpable bladder
Urinary retention- Tx
Catheter
Anemia- Eti
- Gastric operations
- Intrinsic factor made by stomach
Anemia- Sx
- Fatigue, paresthesias
- brittle nails
- Chelosis
- Pica
Anemia- Tx
Supplement with B12 or folate
- Packed RBCs
IV phlebitis- Eti
Inflammation at IV entry site
IV phlebitis- Time
Day 3 post-op
IV phlebitis- Sx
- Induration
- Edema
- Tenderness
IV phlebitis- Tx
Remove catheter, rotate insertion site
Fever- Eti
- 40% pts after surg
- 48 hrs = catheter, pneumonia, UTI
- > 5 days abscess, sepsis
Fever- Sx
- Febrile
- Diaphoresis
- Chills
- Muscle and HA
- Weak, confused
Fever- Tx
- Tx underlying cause
- CT abd/ pelvis
DVT/ PE- Eti
- 21 fold risk
- Resp failure > 3 days post op
- 20% surg pts
- 50-60% hip or knee pts
DVT/ PE- Sx
- PE: Acute onset dyspnea
- Chest pain
- Hemoptysis
- Tachy
- AMS
- DVT- unilateral, mid-calf pain
- Low grade fever
DVT/ PE- Tx
Anticoagulation
- Routine DVT prophylaxis if moderate or high risk