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SURGERY > POST-OP COMPLICATIONS > Flashcards

POST-OP COMPLICATIONS Flashcards

1
Q

If a patient just had surgery and you see delirium, fluid overload, hyponatremia, tachycardia, bradycardia, or afib – what should you think?

A

Those are NOT NORMAL in a post-op patient

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2
Q

What’s the main endogenous pyrogen released with a fever?

A

Interleukin 6 (most commonly associated with post-op fever)

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3
Q

What’s a normal temp in Celsius?

A

37

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4
Q

At what point are we concerned about fever in a post op patient?

A

Temp greater than 38.0

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5
Q

What do the 5 W’s explain?

A

Potential causes of fever

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6
Q

What are the 5 W’s?

A

Wind = atelectasis (without air)

Water = UTI

Walking = DVT

Wound = Infection

Wonder drugs

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7
Q

When would someone develop atelectasis?

A

POD 1-2

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8
Q

Why does atelectasis develop?

A

Compression (positional)
Absorptive (pain with deep inspiration)
Or combo of the two with surfactant dysfunction (anesthesia/ventilator)

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9
Q

How do we prevent atelectasis?

A

Incentive spirometry and mobility

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10
Q

How often should they use the incentive spirometer, what do we want them to do?

A

10x/day

We want then to take a good deep breath

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11
Q

If you get a call POD one that a patient has a fever – what do you do?

A

Encourage ambulation and use incentive spirometry

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12
Q

When does atelectasis typically resolve?

A

Within 48 hours

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13
Q

: If we see a fever in a patient, what should we make sure to see if they have?

A

A foley catheter!

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14
Q

When do UTI’s typically present in post-op patients?

A

POD 3-5

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15
Q

When do DVT’s typically present in post-op patients?

A

POD 4-6

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16
Q

How do we prevent DVT?

A

Walking on POD 1

Mechanical: Pneumatic compression or Antiembolism stockings

Chemical: LMWH, warfarin, aspirin

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17
Q

If a patient has a fever 5-7 days after surgery, what are you concerned about?

A

Wound infection or are drugs causing fever

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18
Q

What are some potential etiologies for respiratory failure?

A

Atelectasis, pulmonary edema, alveolar hypoventilation, aspiration, and pneumonia

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19
Q

If our post-op patient has a cough, SOB, fever, and gradual decline in their O2’s – what do you think of?

A

Post-op pneumonia

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20
Q

How do we confirm diagnosis of post-op pneumonia?How do we confirm diagnosis of post-op pneumonia?

A

Auscultation, CXR, and WBC

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21
Q

How do we treat post-op pneumonia?

A

Chest PT and Abx

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22
Q

How could we have prevented post-op pneumonia?

A

Ambulation, cough, and incentive spirometry

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23
Q

What are some common pathogens of ventilator associated pneumonitis?

A

Gram - = Pseudomonas, Serratia

Gram + = MRSA (oxacillin resistance)

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24
Q

How do patients acquire ventilator associated pneumonitis?

A

Ventilator tube, ET tube, and humidification fluid

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25
Q

How do we prevent ventilator pneumonitis?

A

Aseptic technique and Avoid prolonged intubation

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26
Q

How do we treat ventilator pneumonitis?

A

Support (fluid/suction)

Abx

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27
Q

How do we diagnose a DVT in a post-op patient?

A

Venous Doppler

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28
Q

Is a d-dimer helpful in a post-op patient?

A

NO!

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29
Q

How do we prevent VTE’s?

A

Mobility, stockings, pneumatic pressure devices, Anticoag (Heparin, warfarin, aspirin)

30
Q

If a post-op patient has pleuritic chest pain with sudden SOB, fever, sudden hypoxemia, and tachycardia – what should jump to the top of your DDx?

A

PE

31
Q

If your patient had an O2 sat of 98% at 8AM and now at 10AM their O2 sat is 89% - what do you need to do?

A

Confirm the change yourself

See if their rate is Tachycardia

Don’t ignore these changes!

*Think PE

32
Q

How do you treat a PE?

A

Heparin, warfarin, or NOAC’s (factor 10A inhibitors - maybe)

33
Q

Can you ever use tPA in a post-op patient?

A

NO!

34
Q

When do we most commonly see arrhythmias occur in post-op patients?

A

After cardiac and thoracic surgery

35
Q

What are some causes of post-op arrhythmias? (think ACLS)

A

H’s and T’s!!
Hypoxia

Hypovolemia

Hyperthermia

Hypoglycemia

HTN

Electrolytes

Infection

Medications

36
Q

How should we approach a post-op arrhythmia?

A

Reverse cause (can often resolve when we treat the cause)

Consider cardioversion

Don’t stop the beta blocker – even if they are hypotensive! (they can have reflex tachycardia)

37
Q

What’s the most common cause of morbidity and mortality after non-cardiac surgery?

A

Myocardial Infarction

38
Q

If a post-op patient has unexplained SOB, tachycardic, hypotension, with possible HF – what do we think of?

A

MI!

39
Q

How do you treat the MI in your post-op patient?

A

Consult surgeon and cardiology

40
Q

If a post-op patient has dyspnea, hypoxemia with normal CO2 tension, and CXR with increased markings – what do you think of?

A

Heart Failure

41
Q

How do you treat heart failure in your post-op patient?

A

diuretic, inotropic support, ventilator support (if needed)

42
Q

What are some early causes of perioperative stroke?

A

Manipulation of heart and aorta

Particulate release from ECMO

43
Q

What are some late causes of perioperative stroke?

A

Emboli from Afib, supply/demand MI, coagulopathy

44
Q

What are the 7 risk factors to a perioperative stroke?

A

Advanced age, Non-elective surgery, Female sex, EF less than 40%, Vascular disease, DM, and Cr greater than 2

45
Q

How do we prevent a perioperative stroke?

A

Avoid acute or aggressive BB (don’t increase doses, or start people not on BB on them)

Statins

46
Q

How do we treat a perioperative stroke?

A

ASA, embolectomy, and intra-arterial tPA

47
Q

What would cause a wound to dehiscence?

A

Mechanical force, tissue ischemia due to tight suturing, poor suturing technique, and local infection

48
Q

What are some of the signs we look for wound infection?

A

Redness, swelling, localized heat/erythema, increased/worsening pain (at incision site), dehiscence, tachycardia, and fever (late)

49
Q

What are the 4 classifications of risks for wound infections?

A

Clean

Clean-contaminated

Contaminated

Dirty

50
Q

How do we prevent wound infections?

A

Limit pre-op hospitalization

Pre-op shower and/or Chorhexadine bath

Hair removal immediately before surgery

Avoidance of adhesive drapes

Decreased op time

51
Q

What is the source of a clean-contaminated wound? What type of bacteria?

A

Source = endogenous colonization (elective GI surgeries)

Contaminate = Polymicrobial (gram neg)

52
Q

What is the source of a contaminated wound infection?

A

Gross-contamination (the gallbladder spills out every time it’s touched during removal)

53
Q

How do we prevent contaminated wound infections?

A

Give pre-op Abx less than 60 minutes before procedure

54
Q

What is the source for a dirty wound infection?

A

Established post-op infection

55
Q

What’s a common nosocomial infection?

A

C. diff (CDAD)

56
Q

What’s the MOST common nosocomial infection?

A

UTI

57
Q

What abx are C. diff most commonly associated with?

A

Clinda and Floro

58
Q

What should we always remember about C. diff?

A

Spores are resistant to heat, acid, alcohol, and abx → we must wash it down the drain

59
Q

If you see a patient with diarrhea, what must you ALWAYS DO? Why?

A

WASH YOUR HANDS!

C. diff is resistance to hand sanitizer!! → we must wash it down the drain

60
Q

How do we treat C. diff?

A

Metronidazole and/or Vanco PO → because C. diff is in the gut! Not in the veins

61
Q

If a patient has dysuria with a mild fever – what do we think of?

A

Cystitis

62
Q

If we see high fever, flank tenderness – what do we think of?

A

Pyelo

63
Q

How do we prevent UTI’s?

A

Get the catheter out ASAP!!

64
Q

How do we treat UTI’s?

A

Specific Abx, bladder drainage, and hydration

65
Q

If a patient has temporary paralysis of a portion of the bowels (often after surgery/great stress) – what is it known as? When do we see this occur?

A

Post-operative Ileus

Occurs after abd surgery

66
Q

If a patient has N/V with vague abdominal discomfort. On PE you note quiet bowel sounds – what do you think of? What diagnostic study should you get?

A

Post-op ileus

Get Abd Xray

67
Q

How do we treat paralytic ileus?

A

NPO, NG tube, IVF

68
Q

If a patient has an abrupt increase in ETCO2, increased body temp, with muscle rigidity – what do you think of?

A

Malignant Hyperthermia

69
Q

What is malignant hyperthermia?

A

Hypermetabolic condition of muscle – intracellular Ca binding to sarcoplasmic reticulum (violent/sustained muscle contractions) → leads to muscle necrosis and Rhabdo

70
Q

What are some late effects of malignant hyperthermia?

A

Compartment syndrome, rhabdo, acidosis (metabolic and respiratory), and arrhythmias (due to increased K)

71
Q

How do we treat Malignant Hyperthermia?

A

D/C triggering agent, dantroline, cooling blankets (don’t want them to shiver, because it will make it worse!), renal and respiratory support

72
Q

What are some other aberrancies we will see in post-op patients?

A

Delirium (elderly with new environment), orthostasis (due to volume depleted prior to surgery + Narcotics), tachycardia, bradycardia, hyponatremia (volume depleted, stress from surgery cause increase in ADH + LR fluids have low sodium levels), and Afib

SURGERY (6 decks)

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