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General Surgery > Post Op Cx > Flashcards

Post Op Cx Flashcards

1
Q

What commonly causes respiratory complications?

A
  • general anaesthesia
  • post-op pain
  • immobility
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2
Q

Define the following terms

Hypoxia

Hypercapnia

Hypocapnia

T1RF

T2RF

A
  • PaO2 <10.5kPa
  • PaCO2 >6.5kPa
  • PaCO2 < 3.5kPa
  • PaO2 < 8.0kPa
  • PaO2 < 8.0kPa, PaCO2 >6.0kPa
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3
Q

What are the examples of respiratory complications?

A
  • Chest infection
  • COPD exacerbation
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4
Q

What are the initial assessment and mx for pt c suspected respiratory complications

A
  • 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
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5
Q

What features lead to the diagnosis of chest infection?

A
  • Bedside
    • cough c purulent sputum
    • pyrexia
    • bronchial breathing
    • reduced air entry
  • Lab
    • raised CRP, neutrophils
    • Sputum culture + for organism
  • Imaging
    • CXR consolidation
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6
Q

How to prevent chest infection post op?

A
  • Active chest infection
    • Prevent surgery
  • Cough, temp, clinicl signs of chest infection undergoing elective
    • deferred fortnight and reassess
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7
Q

What are the RF for chest infections?

A
  • Active smoker
  • Stopped smoking within last 6 weeks
  • COPD
  • Obesity
  • Prolonged ventilation
  • Aspirating pt
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8
Q

What are the supporting tx for chest infections?

A
  • Physiotherapy
    • assist coughing
    • prevent mucus plugging
  • Analgesia
    • allow pt to cough
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9
Q

What are the definitive tx for chest infection?

A
  • 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
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10
Q

What is the epidemiology of COPD?

A
  • Moderate COPD
    • not associated c inc. post op cx
  • Severe COPD + steroid use
    • associated c increase morbidity, mortaity after surgery
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11
Q

What to ensure for Pt on preoperative B-agonist inhalers?

A
  • Regular post-operative nebulizers
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12
Q

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

A
  • 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
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13
Q

What is oliguria an anuria?

A
  • oliguria
    • UO <0.5ml/kg/h
  • anuria
    • no UO
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14
Q

What does UO indicate?

What does UO indirectly measure?

A
  • GFR
    • influenced by renal plasma flow and renal perfusion
  • Renal and blood flow function
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15
Q

What are the initial mx for oliguria?

A
  • Check Foley catheter
    • catheter may be obstructed, bypassing or malpositioned
    • Flush 60ml saline. If unable to draw back this amount - change to new catheter
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16
Q

How would you mx oliguric pt with loop diuretics?

A
  • 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
17
Q

What are the Cx of oliguria?

A
  • Pulmonary & cerebral oedema
  • CCF
  • Hyperkalaemia
  • Acidosis
18
Q

What type of pt will commonly get acute urinary retention post operatively?

A
  • elderly males after abdominal, pelvic or groin surgery and after anticholinergics
19
Q

What are the clinical features of acute urinary retention?

A
  • Suprapubic discomfort
  • inability to initiate micturition
  • Hx of prostatic disease
  • Percussable bladder
20
Q

How would you Mx acute urinary retention?

A
  • Conservative
    • Analgesia
    • tx constipation
    • mobilise
    • warm baths
    • restart tamsulosin
  • Definitive
    • insert urinrary catheter
21
Q

What are the types of gastrointestinal complications post op?

A
  • Paralytic ileus
  • Post op mechanical small bowel obstruction
  • N&V
  • D&C
  • Anastomotic leakage
22
Q

What are the causes of constipation?

A
  • Lack of privacy
  • immobility
  • pain from wounds
  • anal fissure
  • dehydration
  • poor nutrition
  • low fibre
  • opiates
  • spinal anaesthesia
23
Q
A
24
Q

What are the tx for post op constipation?

A
  • Bulking agents
  • Stool softeners
    • sodium docusate 30-60mg od PO
  • Osmotic agents
    • lactulose 5-10ml bd
  • Stimulants
    • senna one table bd PO
25
Q

What are the common causes of post op diarrhoea

A
  • resolving ileus/obstruction
  • Antibiotic related diarrhoea
  • C.diff
  • pseudomembranous colitis
26
Q

What are the cx of post op N&V?

A
  • increase bleeding
  • incisional hernias
  • aspiration pneumonia
  • dec. absorption of oral medication
  • poor nutrition
  • hypokalaemia
27
Q

What causes post op N&V?

A
  • Anaesthetic agents
  • opiods
  • spinal anaesthesia
  • gastric dilation from CPAP
  • bowel obstruction
  • gastric refulx
  • peptic ulceration
  • constipation
  • sepsis
  • hyponatraemia
  • antibiotics
  • NSAIDs
28
Q

What are the common causes of confusion post op?

A
  • Medication
    • benzos, opiates, anticonvulsant
  • Stroke
  • Hypoxia, hypercapnia
  • shock
  • sepsis
  • alcohol withdrawal
  • metabolic distrubances
    • low - glucose, Na, pH
    • high- Ca, creatinine, urea
29
Q

What are the clincial features of post op confusion?

A
  • Obvious signs
    • disoriented
    • uncooperative
    • hallucinating
  • Subtle signs
    • inactivity
    • quietness
    • slow thinking
    • labile mood
30
Q

How would you mx post op confusion?

A
  • 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

General Surgery (20 decks)

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