Post op complications

Question 1

4 interventions to improve surgical outcomes

Answer 1

• pre-op: info and optimise organ function
• stress reduction: regional anaesthesia, minimal invasive ops, normothermia, pharmacology
• pain relief, prophylaxis for nausea/ vomiting (anti emetic)
• modification of perioperative care: early mobilisation, minimal use of tubes/ drains/ catheters, oral nutrition

Question 2

5 principle categories of surgical complications

Answer 2

• predisposed by concurrent disease
• anaesthesia (local and general)
• general complications of ops
• complications of any surgical condition
• complications of specific disorder

Question 3

5 general complications of operation

Answer 3

• haemorrhage
• infection related to op site
• impaired healing
• surgical injury
• inadvertent operative trauma

Question 4

3 complications of local anaesthesia;

Answer 4

• injection site (pain, haematoma, infection, delayed sensation)
• vasoconstrictors (ischaemic necrosis)
• systemic effects (allergy, toxicity)

Question 5

8 complications of general anaesthesia

Answer 5

• direct trauma
• inherited disorders
• idiosyncratic allergic responses
• slow recovery
• awareness
• fluid balance
• hypothermia
• inadvertent trauma

Question 6

2 types of haemorrhage

Answer 6

• early post-op

- late post-op (secondary haemorrhage)

Question 7

4 infections related to op site

Answer 7

• minor wound infections
• wound cellulitis/ abscess
• gas gangrene
• late infective complications

Question 8

5 respiratory complications

Answer 8

• atelectasis
• pneumonia/ bronchopneumonia
• aspiration pneumonitis
• aspiration pneumonia
• acute respiratory distress syndrome

Question 9

2 causes of impaired healing

Answer 9

wound dehisence

incisional hernia

Question 10

4 fluids/ electrolytes to monitor

Answer 10

sodium
potassium
urea
creatine

Question 11

7 reasons to monitor fluids/ electrolytes

Answer 11

dehydration
overload
hyponatraemia
hypokalaemia
urinary retention
UTI
acute renal failure

Question 12

5 ways to prevent pressure sores

Answer 12

• special bed surfaces to spread load
• relieving pressure on heels
• regular change of position
• regular checking of pressure areas
• management of incontinence

Question 13

9 common post op problems

Answer 13

• pain
• pyrexia
• tachycardia
• cough, shortness of breath, tachypnoea
• collapse/ rapid deterioration
• nausea, vomiting
• disorders of bowel function
• poor urine output
• changes in mental state

Question 14

types/ causes of pyrexia

Answer 14

infective: wound/ chest/ UT/ cannulation site infection

non-infective: transfusion reaction, DVT, haematoma, PE

Question 15

4 causes of tachycardia

Answer 15

pain/ anxiety
infection
circulatory disturbance
arrythmia

Question 16

poss causes of

a. overt shortness of breath SOB/ tachypnoea
b. shortness of breath
c. sudden onset SOB

Answer 16

poss causes of

a. overt shortness of breath SOB/ tachypnoea: pneumonia, broncho-pneumonia, aspiration, lobar collapse, pneumothorax
b. shortness of breath: atelectasis, abdominal distension, cardiac failure, fluid overload
c. sudden onset SOB: pulmonary embolus, adult respiratory distress, hyperventilation

Question 17

7 causes of collapse/ rapid deterioration

Answer 17

hypovolaemic shock
systemic sepsis
MI
PE
hypoxia
CVA
drugs

Question 18

4 causes of nausea/ vomiting

Answer 18

drugs
bowel obstruction
systemic disorders
haematemesis

Question 19

8 causes of change in mental state

Answer 19

disorientation due to change in environment
dehydration
hyponatraemia
hypoxia (chest infection, heart failure)
UTI
drugs (opiates)
uraemia
hypoglycaemia

Question 20

7 factors contributing to post op morbidity

Answer 20

pain
stress response/ organ dysfunction
nausea, vomiting, ileus
hypoxia, sleep disturbances
fatigue
immobilisation, semi starvation
drains/ nasogastric tubes, restrictions