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Elaina: Surgery > Post-op complications part 2 > Flashcards

Post-op complications part 2 Flashcards

1
Q

what is the term for acute mechanical failure of wound closure?

A

wound dehiscence

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2
Q

what percentage of all post-op infections in hospitalized patients are wound infections?

A

14-16 percent

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3
Q

most post-op wound infections require _________

A

surgical debridement

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4
Q

is induration a normal sign of healing or a sign of infection?

A

induration = normal

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5
Q

signs of wound infection?

A

1) redness
2) swelling
3) localized heat and erythema
4) worsening pain (esp after day)
5) dehiscence
6) tachycardia
7) fever (late)

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6
Q

what types of procedures typically cause clean (no gross contamination) wound infections?

A

non-abdominal (like a hand surgery)

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7
Q

what is the source of infection of a “clean” wound infection?

A

patient skin OR environment, surgical team

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8
Q

are the contaminants seen in “clean” wound infections typically gram negative or gram positive?

A

gram positive (thats what we have living on our skin!)

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9
Q

clean-contaminated (lightly contaminated) wound infections are most likely due to what?

A

endogenous colonization during an elective GI surgery (gallbladder we picked at starts to leak contents)

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10
Q

what type of organisms typically cause “clean-contaminated” infections?

A

polymicrobial, typically gram negative (so tx differently than clean!)

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11
Q

this type of infection is typically caused by a “spill” during elective surgery; ie you go in and poke the gallbladder and its so friable it starts spewing its contents everywhere

A

contaminated wound infection

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12
Q

a perforated gastric ulcer is an example of what type of wound infection?

A

contaminated wound infection

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13
Q

how do we prevent wound infection?

A

ABX must be PRESENT at time of the contamination (given less than 60 minutes from time of incision) active against anticipated pathogens

re-dose 4-6 hours later, no more than 3 post-op doses

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14
Q

an intestinal infarction is most likely to cause what type of wound infection?

A

dirty (infected)

spillage of intestinal contents into the gut

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15
Q

an intra-abdominal abscess drainage will cause what type of wound infection?

A

dirty

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16
Q

which two antibiotics have the strongest association with C. difficile?

A

clindamycin and fluoroquinolones

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17
Q

is c. difficile gram negative or gram positive?

A

gram positive spore forming anaerobic bacillus

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18
Q

c. difficile is carried by _____ percent of adults in hospitals or LTC facilities

A

20-50 percent

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19
Q

what are 5 common facultative anaerobes?

A

1) staph
2) strep
3) enterococcus
4) e. coli
5) listeria

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20
Q

how is c. diff transmitted? why do we have such a hard time eliminating it?

A

fecal/oral

spores are resistant to heat, acid, alcohol, and antibiotics! hand sanitizer alone will not kill c.diff!

21
Q

treatment of c. diff colitis?

A 
PO metronidazole
PO vancomycin (not IV!)

or PO vancomycin PLUS IV metronidazole

22
Q

you may recommend your patient coming in for surgery washes in a _______

A

chlorhexadine bath (broad spectrum topical ABX)

23
Q

are dressings of much help in preventing post operative infection?

A

nope!

24
Q

should we used an open or a closed drain system if we want to prevent post-op infection?

A

closed!

separate stab for exit

25
Q

what is the most frequently acquired nosocomial infection?

A

urinary tract infection

26
Q

what are the 3 biggest risk factors for UTI?

A

1) pre-existing urinary tract contamination
2) urine retention (like BPH) – anesthesia also causes urinary retention!
3) instrumentation

27
Q

what percentage of patients will have bacteriuria less than 48 hours after cath is placed?

A

5 percent develop bacteriuria

1 percent develop UTI

28
Q

this type of UTI presents with dysuria and mild fever

A

cystitis

29
Q

this type of UTI presents with high fever, flank tenderness, and occasionally ileus

A

pyelonephritis

30
Q

what is the best way to prevent UTI in surgical patient?

A

get catheter out ASAP!

31
Q

treatment of UTI in post-op patient?

A

hydration, bladder drainage, specific antibiotics

32
Q

temporary paralysis of a portion of the bowels is known as what?

A

postoperative ileus

33
Q

signs and symptoms of postoperative ileus?

A

nausea, vomiting, vague abdominal discomfort

34
Q

diagnostic modality for postoperative ileus?

A

abdominal x-ray

35
Q

what will we hear on auscultation of a patient’s abdomen with ileus?

A

quiet bowel sounds

36
Q

treatment of postoperative ileus? (3)

A

1) NPO
2) NG tube
3) IVF/nutrition: D5IV – don’t jump to TPN

support and wait!

37
Q

what is the name of the autosomal dominant genetic hypermetabolic condition of muscle?

A

malignant hyperthermia

38
Q

how will a patient with malignant hyperthermia present?

A

1) violent sustained muscle contractions
2) possible masseter rigidity
3) increased body temp (maybe delayed up to 36 hours following trigger)
4) tachycardia
5) cyanosis
6) muscle rigidity

39
Q

what are the two known triggers of malignant hyperthermia?

A

1) extreme stress

2) anesthetic agents (inhaled halothane, succinylcholine)

40
Q

what are 4 life-threatening late effects of malignant hyperthermia?

A

1) compartment syndrome
2) rhabdomyolysis
3) acidosis (metabolic and respiratory)
4) arrhythmias/sudden cardiac arrest (associated with hyperkalemia)

41
Q

an abrupt ______ in ETCO2 may be your first sign of malignant hyperthermia

A

INCREASE in ETCO2

42
Q

how do we prevent malignant hyperthermia?

A

check family history!

a muscle biopsy with stimulated contraction studies may be ordered

43
Q

what is the DOC for treating malignant hyperthermia?

A

DANTROLENE (muscle relaxer which blocks Ca release from sarcoplasmic reticulum, disrupts excitation-contraction coupling)

44
Q

what other two body systems should you provide support for in a malignant hyperthermia episode?

A

renal support

respiratory support

45
Q

you should provide _____ when your patient is in malignant hyperthermia

A

cooling blankets

46
Q

always be sure to search for ________ in your patient with malignant hyperthermia

A

occult compartment syndrome

47
Q

why do we worry so much about patients with renal disease developing bradycardic with volume depletion?

A

their kidneys can’t increase the volume bc they aren’t working

they can go into PEA!

48
Q

is our patient following volume depletion more likely to go into hypernatremia or hyponatremia?

A

hyponatremia; once we volume deplete them they have a surge of ADH production (retain water)

49
Q

how do we fix hyponatremia in our patient?

A

normal saline! has a higher level of sodium in it

Elaina: Surgery (6 decks)

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