Post-op Complications

Question 1

Hematoma- Eti

Answer 1

• Blood or clot in wound
• Aspirin and LMWH increases risk
• D/t imperfect hemostasis

Question 2

Hematoma- Timeline

Answer 2

Day 5-8 post-op

Question 3

Hematoma- Sx

Answer 3

• Elevation and discoloration of wound edges
• May resorb
• Discomfort, pressure and swelling at site

Question 4

Hematoma- Tx

Answer 4

• Evacuate clot

- Ligate bleeding vessels

Question 5

Seroma- Eti

Answer 5

Fluid collection at wound site

• Common in mastectomy
• Lymph removal

Question 6

Seroma- Timeline

Answer 6

Day 5-8 post-op

Question 7

Seroma- Sx

Answer 7

• Painless swelling below wound

- Yellow needle aspirate

Question 8

Seroma- Tx

Answer 8

• Needle aspriation
• Compression
• Allow small seromas to resorb

Question 9

Dehiscence/ Evisceration- Eti

Answer 9

Dehiscence- partial to total disruption of wound layers

• Evisceration- Rupture of all layers of abd wall, extrusion of viscera
• Immunosuppression, steroids, cancer

Question 10

Dehiscence/ Evisceration- Time

Answer 10

5-8 days postop

Question 11

Dehiscence/ Evisceration- Sx

Answer 11

• Serosanguineous discharge from wound

- Popping sensation

Question 12

Dehiscence/ Evisceration- Tx

Answer 12

Dehiscense = reclosure

• Keep stitches in at least 2 weeks
• Corset and compression
• Clean, return to abdomen and re-close

Question 13

Atelectasis- Eti

Answer 13

• Most common pulm complication

- Partial or total collapse of lung

Question 14

Atelectasis- Time

Answer 14

Within 48 hrs post-op

Question 15

Atelectasis- Sx

Answer 15

• Ventilation perfusion mismatch
• Decreased o2
• Rales, elevated diaphragm
• Decreased breath sounds
• Tachypnea, cardia

Question 16

Atelectasis- Tx

Answer 16

• Commonly self limited
• Clear airway though coughing, nasotrach suction
• Bronchodilators or mucolytics
• Suction

Question 17

Atelectasis- Prevent

Answer 17

• Early mobilization
• Position changes
• Incentive spirometer

Question 18

Fat embolism- Eti

Answer 18

• Fat particles in pulm vasc bed

- Fractures of long bones or joint replacements- risk

Question 19

Fat embolism- Time

Answer 19

12-72 hrs post op

Question 20

Fat embolism- Sx

Answer 20

• Neuro dysfxn
• Resp insufficiency
• Petechiae to axillae, chest and proximal arms

Question 21

Fat embolism- Tx

Answer 21

• Supportive O2 unti sx resolve

- positive end-expiratory pressure

Question 22

Air embolism- Eti

Answer 22

• Insertion of catheter with air induction

- Lodges in rt atrium

Question 23

Air embolism- Time

Answer 23

• Soon after IV insertion

Question 24

Air embolism- Sx

Answer 24

Hypotension

• JVD
• Tachycardia

Question 25

Air embolism- Tx

Answer 25

Aspirate air with syringe | - Place pt rt side up, head down to dislodge air

Question 26

Fecal impation- Eti

Answer 26

- Common due to post-op illius and opioid use | - Common in elderly, toxic megacolon and paraplegia

Question 27

Fecal impation- Sx

Answer 27

Anorexia - Constipation or diarrhea - Marked dissension of abd

Question 28

Fecal impation- Tx

Answer 28

Manual removal of fecal impaction | - enemas and poly-ethelene glycol

Question 29

Urinary retention- Eti

Answer 29

- Common under spinal anesthesia - Inhibition of bladder contraction - Pelvic and perineal operations

Question 30

Urinary retention- Sx

Answer 30

Severe urgency - Suprapubic pain - Distended, palpable bladder

Question 31

Urinary retention- Tx

Answer 31

Catheter

Question 32

Anemia- Eti

Answer 32

- Gastric operations | - Intrinsic factor made by stomach

Question 33

Anemia- Sx

Answer 33

- Fatigue, paresthesias - brittle nails - Chelosis - Pica

Question 34

Anemia- Tx

Answer 34

Supplement with B12 or folate | - Packed RBCs

Question 35

IV phlebitis- Eti

Answer 35

Inflammation at IV entry site

Question 36

IV phlebitis- Time

Answer 36

Day 3 post-op

Question 37

IV phlebitis- Sx

Answer 37

- Induration - Edema - Tenderness

Question 38

IV phlebitis- Tx

Answer 38

Remove catheter, rotate insertion site

Question 39

Fever- Eti

Answer 39

- 40% pts after surg - 48 hrs = catheter, pneumonia, UTI - > 5 days abscess, sepsis

Question 40

Fever- Sx

Answer 40

- Febrile - Diaphoresis - Chills - Muscle and HA - Weak, confused

Question 41

Fever- Tx

Answer 41

- Tx underlying cause | - CT abd/ pelvis

Question 42

DVT/ PE- Eti

Answer 42

- 21 fold risk - Resp failure > 3 days post op - 20% surg pts - 50-60% hip or knee pts

Question 43

DVT/ PE- Sx

Answer 43

- PE: Acute onset dyspnea - Chest pain - Hemoptysis - Tachy - AMS - DVT- unilateral, mid-calf pain - Low grade fever

Question 44

DVT/ PE- Tx

Answer 44

Anticoagulation | - Routine DVT prophylaxis if moderate or high risk