Post-op complications

Question 1

DDx for fever post-op (8)

Answer 1

1. malignant hyper
2. atelectatis - most common
3. bacteremia - within 45 minutes
4. pneumonia - if atelectatis not resolved
5. UTI - 3 days
6. DVT - POD 5
7. wound infection - POD 7
8. abscess - POD 10-15

Question 2

DDx for chest pain (2)

Answer 2

1. peri-op MI - during or first few days post-op

2. PE - sudden pleuritic with SOB

Question 3

2 pulm. complication

Answer 3

1. aspiration

2. intra-op tension pneumo

Question 4

5 DDx for disorientation/coma

Answer 4

1. hypoxia - ABGs
2. ARDS - pulmonary infltrates with no evidence of CHF
3. DTs
4. hyponatremia - ADH or wrong fluids
5. hypernatremia - look for unreplaced urine outputs

Question 5

3 possible urinary issues

Answer 5

1. retention - may need in/outs
2. zero output - look for block
3. low output - either fluid deficit or AKI
   - can test with a bolus
   - or look at urine Na - if low, kidneys likely okay

Question 6

3 DDx for abdo distension

Answer 6

1. illeus
2. early mech obstruction
3. ogilvie (illeus of colon)

Question 7

4 possible wound complications

Answer 7

1. dehiscence
2. evisceration
3. infecitons
4. fistulas of GI

Question 8

6 common lyte issues

Answer 8

1. hypernatremia - lost water and can fix with slow d5w
2. hyponatremia - ADH or inappropriate fluids
3. hypokalemia
   - slow if lost through GI or renal (lasix)
   - fast through over correction in ketoacidosis
4. hyperkalemia
   - can’t renally excrete
   - crushed cells
5. met. acidosis
   - extra acids - lactate, keto
   - loss of buffer
   - renal inability to excrete acid
6. met. alkalosis
   - loss of gastric juices
   - too much bicarb
7. resp acidosis or alk - ventilation issues