Post Op Cx Flashcards
What commonly causes respiratory complications?
- general anaesthesia
- post-op pain
- immobility
Define the following terms
Hypoxia
Hypercapnia
Hypocapnia
T1RF
T2RF
- PaO2 <10.5kPa
- PaCO2 >6.5kPa
- PaCO2 < 3.5kPa
- PaO2 < 8.0kPa
- PaO2 < 8.0kPa, PaCO2 >6.0kPa
What are the examples of respiratory complications?
- Chest infection
- COPD exacerbation
What are the initial assessment and mx for pt c suspected respiratory complications
- Position: sit pt up
- Airways
- give high flow O2 using tight fitting mask
- Breathing
- check chest expansion
- auscultate lungs bilaterally
- If bronchospasm - nebulise 5mg salbutamol
- Order CXR
- Circulation
- assess circulation
What features lead to the diagnosis of chest infection?
- Bedside
- cough c purulent sputum
- pyrexia
- bronchial breathing
- reduced air entry
- Lab
- raised CRP, neutrophils
- Sputum culture + for organism
- Imaging
- CXR consolidation
How to prevent chest infection post op?
- Active chest infection
- Prevent surgery
- Cough, temp, clinicl signs of chest infection undergoing elective
- deferred fortnight and reassess
What are the RF for chest infections?
- Active smoker
- Stopped smoking within last 6 weeks
- COPD
- Obesity
- Prolonged ventilation
- Aspirating pt
What are the supporting tx for chest infections?
- Physiotherapy
- assist coughing
- prevent mucus plugging
- Analgesia
- allow pt to cough
What are the definitive tx for chest infection?
- Braod spec antibiotic until organism sensitivities known
- Tx suspected aspiration pneumonia
- Humidify oxygen - prevent mucus plugging
- CPAP - improve basal collapse
- Hypoxic, tachypnic, tiring pt should be reviewd urgently
What is the epidemiology of COPD?
- Moderate COPD
- not associated c inc. post op cx
- Severe COPD + steroid use
- associated c increase morbidity, mortaity after surgery
What to ensure for Pt on preoperative B-agonist inhalers?
- Regular post-operative nebulizers
What are the causes of post-op chest pain?
List them according to these headings
Dull,central ache
Central pain radiating to back
Pain on movement
Pleuritic pain
- Dull,central ache
- MI
- Gastric distention
- Central pain radiating to back
- Thoracic aneurysm/dissection
- PUD, oesophagitis, panreatitis
- Pain on movement
- MSK pain
- Chest drains
- Pleuritic
- Chest infection
- Pneumothorax
- Haemothorax, pleural effusion, empyema
- Chest drain in situ
- PE
What is oliguria an anuria?
- oliguria
- UO <0.5ml/kg/h
- anuria
- no UO
What does UO indicate?
What does UO indirectly measure?
- GFR
- influenced by renal plasma flow and renal perfusion
- Renal and blood flow function
What are the initial mx for oliguria?
- Check Foley catheter
- catheter may be obstructed, bypassing or malpositioned
- Flush 60ml saline. If unable to draw back this amount - change to new catheter
How would you mx oliguric pt with loop diuretics?
- If pt is adequately filled, MAP normal
- 20mg furosemide IV
- if no response, give further 40mg IV
- If urine produced after furosemide concentrated
- pt inadequately filled
What are the Cx of oliguria?
- Pulmonary & cerebral oedema
- CCF
- Hyperkalaemia
- Acidosis
What type of pt will commonly get acute urinary retention post operatively?
- elderly males after abdominal, pelvic or groin surgery and after anticholinergics
What are the clinical features of acute urinary retention?
- Suprapubic discomfort
- inability to initiate micturition
- Hx of prostatic disease
- Percussable bladder
How would you Mx acute urinary retention?
- Conservative
- Analgesia
- tx constipation
- mobilise
- warm baths
- restart tamsulosin
- Definitive
- insert urinrary catheter
What are the types of gastrointestinal complications post op?
- Paralytic ileus
- Post op mechanical small bowel obstruction
- N&V
- D&C
- Anastomotic leakage
What are the causes of constipation?
- Lack of privacy
- immobility
- pain from wounds
- anal fissure
- dehydration
- poor nutrition
- low fibre
- opiates
- spinal anaesthesia
What are the tx for post op constipation?
- Bulking agents
- Stool softeners
- sodium docusate 30-60mg od PO
- Osmotic agents
- lactulose 5-10ml bd
- Stimulants
- senna one table bd PO
What are the common causes of post op diarrhoea
- resolving ileus/obstruction
- Antibiotic related diarrhoea
- C.diff
- pseudomembranous colitis
What are the cx of post op N&V?
- increase bleeding
- incisional hernias
- aspiration pneumonia
- dec. absorption of oral medication
- poor nutrition
- hypokalaemia
What causes post op N&V?
- Anaesthetic agents
- opiods
- spinal anaesthesia
- gastric dilation from CPAP
- bowel obstruction
- gastric refulx
- peptic ulceration
- constipation
- sepsis
- hyponatraemia
- antibiotics
- NSAIDs
What are the common causes of confusion post op?
- Medication
- benzos, opiates, anticonvulsant
- Stroke
- Hypoxia, hypercapnia
- shock
- sepsis
- alcohol withdrawal
- metabolic distrubances
- low - glucose, Na, pH
- high- Ca, creatinine, urea
What are the clincial features of post op confusion?
- Obvious signs
- disoriented
- uncooperative
- hallucinating
- Subtle signs
- inactivity
- quietness
- slow thinking
- labile mood
How would you mx post op confusion?
- If pt pose danger to themselves or others
- First line: sedate c Haloperidol 2.5mg PO, IM or IV
- 2.5-5mg midazolam if still disturbed
- Be aware of sedating hypoxic or hypotensive - can trigger cardiorespiratory arrest
- Assess & tx hypoxia and hypotension
- Reassess drug chart
- stop opiates and benzos
- Assess metabolic status
- correct low glucose/Na
- Perform neurological examination - exclude stroke
