Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gen Med: Surgery > Post-operative care > Flashcards

Post-operative care Flashcards

1
Q

What are the potential post-op complications?

A
  1. Fever
  2. Abscess
  3. Anastomotic Leak
  4. Chest pain
  5. Respiratory Distress
  6. Bleeding
  7. Pain
  8. N/V
  9. Oliguria
  10. Electrolyte abnormalities
  11. Paralytic Ileus
  12. Hypotension
  13. Sepsis
  14. Arrhythmias
  15. DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is included in the post-op checklist?

A
  1. Talk to patient to see they are alert, breathing well & having any concerns
  2. Are they are ambulating?
  3. Check for fever
  4. Heart exam
  5. Lung exam
  6. Abd exam
  7. Check legs for DVT
  8. Check wound
  9. Check lab work
  10. Be sure to advance diet, address exercise & adjust pain med
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What should the WBC count be on post-op day 1?

A
  1. 10,000
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is reactive leukocytosis?

A
  1. Non neoplastic increase in WBC >10,000
    A. If accompanied by symptoms & fever, then there is an Infection
    B. Find the source
  2. Common inflammatory response 2°major surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the five W’s for Post-po fever?

A
  1. Wound- check surgical site
  2. Wind- Pneumonia or atelectasis
    A. Check a CXR- Encourage IS/ ambulation
  3. Water- UTI- post-op Foley?
    A. DC Foley, UA & culture
  4. Walk- DVT
    A. Exam & doppler US if high suspicion
  5. Weird/Wonderdrug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common cause of fever post-op day 1-2?

A

Atelectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common cause of fever post-op day 3-5?

A

Pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most common cause of fever post-op day 5-7?

A

Urinary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most common cause of fever post-op day 7-10?

A

Wound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the stages of wound healing?

A
  1. Hemostasis
  2. Inflammation
  3. Proliferation
  4. Remodeling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are complications of wound healing?

A
  1. Infection
  2. Dehiscence
  3. Evisceration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is dehiscence?

A
  1. Breakdown & opening of wound

A. If wound is breaking down, open it, clean it, allow it to drain, culture it, pack it (Wet to Dry)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is evisceration?

A
  1. Opening of wound & protrusion of organs

2. Cover w/ moist (saline) gauze & call the Attending -> OR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the risk factors for wound dehiscence?

A

Overweight

  1. Increasing age
  2. Poor nutrition
  3. Presence of prior scar or radiation at incision site
  4. Non-compliance w/ post-operative instructions
  5. ↑ pressure w/in the abdomen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does a negative pressure dressing work?

A
  1. Removes fluid & infectious material from abdomen & helps reduce edema
  2. Provides medial tension, minimizing fascial retraction
  3. Protects viscera & abdominal contents from external environment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are examples of negative pressure dressings?

A

Wound Vac, Vera-flo, AB Thera

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Where are common abscess locations?

A
  1. Fluid collects & walls off in L/R gutter, L/R infradiaphragm, pelvis, hepatorenal, interloop spaces
  2. Check where surgery took place
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the sxs of an abscess?

A
  1. Presents w/ persistent pain, nausea, ileus, fever, bacteremia
  2. Often delayed dx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is an abscess dxed?

A

CT abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How are abscesses treated?

A

Tx w/ Percutaneous Drainage (IR) & IV Abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the first choice empiric abx post surgery?

A

Monotherapy w/ beta-lactam/beta-lactamase inhibitor:

  1. Ampicillin-sulbactam (Unasyn) 3 g IV every six hours
  2. Piperacillin-tazobactam (Zosyn) 3.375 or 4.5 g IV every six hours
  3. Ticarcillin-clavulanate (Timentin) 3.1 g IV every four hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the second choice empiric abx post surgery?

A

a. 3rd gen. cephalosporin + metronidazole:
i. Ceftriaxone (Rocephin) 1 g IV every 24 hours or 2 g IV every 12 hours
ii. Metronidazole (Flagyl) 500 mg IV every eight hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the alternative choice empiric abx post surgery?

A

a. Combo fluoroquinolone + metronidazole (Flagyl):
i. Ciprofloxacin (Cipro) 400 mg IV every 12 hours or
ii. Levofloxacin (Levaquin) 500 or 750 mg IV once daily
iii. Metronidazole (Flagyl) 500 mg IV every eight hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Define fistula

A

Abn. communication between 2 hollow organs or hollow organ to skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the predisposing factors for fistulas?

A

“FRIENDS”

  1. FB
  2. Radiation
  3. Infection
  4. Epithelialization
  5. Neoplasm
  6. Distal Obstruction
  7. Steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the conservative treatment for fistulas?

A
  1. NPO
  2. Bowel rest
  3. IVF
  4. TPN
  5. Correct “FRIENDS”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the aggressive treatment for fistulas?

A

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Where can fistulas develop?

A
  1. Enterocutaneous
  2. Colovaginal
  3. Colovesical
  4. Tracheoesophageal
  5. Gastrocolic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the pontenital complications from fistulas?

A
  1. Malnutrition
  2. Skin breakdown
  3. Pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does an anastomotic leak present?

A
  1. Presents w/ pain, tachycardia, fevers, sepsis

2. Aggressive presentation early, often more vague if delayed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What can an anastomotic leak cause?

A
  1. Breakdown of anastomosis
  2. Can cause peritonitis, abscess, or fistula formation
  3. Mortality rate 10-15%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How is an anastomotic leak treated?

A

Back to OR, often w/ diversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What 6 potentially fatal things must you be aware of regarding post op chest pain?

A
  1. MI
  2. PE
  3. Tension
    Pneumothorax
  4. Aortic Dissection
  5. Cardiac Tamponade
  6. Esophageal rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What pts should you be suspicious of a post op MI in? What should you do?

A
  1. careful w/ anemic pts

A. EKG, troponin (serial), aspirin, fluid, call Cardiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What pts should you be suspicious of a post op PE in? What should you do?

A
  1. careful w/ hypercoagulable pts
  2. Acute onset SOB, CP, palpitations, anxiety, restless, hemoptysis, tachycardia, diaphoresis
  3. VQ scan, CTA chest, heparinize
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What pts should you be suspicious of a post op esophageal rupture in?

A

careful w/ pts who were just scoped

37
Q

What else may cause post-op chest pain?

A

Often musculoskeletal, positional, gas pain, or GERD

38
Q

What are the initial actions for a pot-op pt in respiratory distress?

A

1, CXR, increase O2 prn, review Hx (COPD/asthma), bronchodilators, call respiratory

  1. ABC’s
  2. ABG’s if indicated
  3. Intubate if necessary
39
Q

What life threatening issues may present as respiratory distress?

A

PE, pneumothorax, MI, anaphylaxis, mucus plug, flash pulm. edema

40
Q

What non-life threatening issues may present as respiratory distress?

A

COPD, asthma, pneumonia, atelectasis, anxiety, CHF, pain issues

41
Q

What needs to be noted if pt has post-op bleeding?

A

Note if pt is on anticoagulants

42
Q

What may cause gastric bleeding?

A
  1. From any source (get detailed Hx)
  2. Gastric “stress” ulcers
    A. Prophylaxis w/ H2 Blockers or PPI
43
Q

What sxs may a pt with post-op bleeding present with?

A

Pt may have symptoms of anemia, check Hct (serial), oliguria

44
Q

How is incisional site post-op bleeding managed?

A 
1. Inspect the site
A. Look for hematoma & evacuate clot
2. Apply pressure 
A. Pressure dressing, sand bag it
3. Suture may need to be placed
45
Q

How is post-op intra-abdominal bleeding managed?

A
  1. Firm, tender abdomen- call attending

2. Back to OR

46
Q

What is considered low urine output?

A

UO

47
Q

What are the prerenal causes of low urine ouput?

A
  1. Anything that causes effective renal perfusion: A. Hypovolemia, CHF, Renal Artery Stenosis, Sepsis, etc.
48
Q

How is fluid overload treated?

A

If S & S of CHF- give Lasix

49
Q

How is a ‘dry’ cause of low urine output treated?

A

Give a fluid bolus or increase IVF rate

50
Q

What are renal causes of low urine output?

A
  1. ATN

2. Nephrotoxic drugs

51
Q

How are post-renal causes of low urine output treated?

A
  1. Urinary retention- place Foley

2. Obstruction- BPH- place Foley or Coude cath

52
Q

How is prerenal vs. renal vs. postrenal causes of low urine output determined?

A
  1. Calculate a FENA

A. If 1: Renal or Postrenal

53
Q

How is FENA (fractional excretion of sodium) calculated?

A

= [(urine Na x serum Cr) / (serum Na x urine Cr)] X 100

54
Q

What is third spacing of fluid?

A

Accumulation of fluid in the interstitium of tissue

55
Q

When do fluids generally third space?

A
  1. After surgery fluid shifts between compartments

2. Generally, fluids will “mobilize” POD#2-3

56
Q

What is the rule of thirds?

A
  1. 60% is free H2O, 40% is IC fluid, 20% is EC fluid

2. Intravascular is ~7%

57
Q

What lytes are managed on a daily basis?

A

Na, K, Mg, Phos, Ca

58
Q

What are the sxs of lyte imbalances?

A

Arrhythmias, ileus, fluid balance, altered mental status

59
Q

How are lyte imbalances managed?

A
  1. R/O lab error
  2. Correct & re-check
  3. If on TPN, talk to pharmacy/dietary to adjust sol’t
60
Q

How is potassium corrected?

A
  1. PO- 20- 40 mEq K-Lor/ K-Dur

2. IV- 10 mEq runs

61
Q

How is sodium corrected?

A
  1. Hypertonic solution per ICU or Nephrology

2. Increases free H2O if high

62
Q

How is magnesium corrected?

A
  1. PO- Mg Oxide 400 mg

2. IV- Mg Sulfate

63
Q

How is phosphorous corrected?

A
  1. PO- Neutra Phos packets

2. IV- K-Phos or Na-Phos

64
Q

How is calcium corrected?

A
  1. PO- Tums!

2. IV- Calcium gluconate

65
Q

What is a post-op Ileus?

A

Paralytic ileus is an impairment of bowel peristalsis that results in obstructive symptoms

66
Q

How does a post-op Ileus present?

A

Abdominal pain, nausea, vomiting, distention

67
Q

What can cause a post-op Ileus?

A

Laparotomy, hypokalemia, narcotics, intraperitoneal infection/ abscess, advancement of diet

68
Q

How is a post-op Ileus managed?

A
  1. Back off diet, possibly NPO
  2. NGT if vomiting
  3. Replacement of lytes
69
Q

How is post-op hypotension managed?

A
  1. Common problem
  2. Approach systematically as it can be potentially serious
    A. Check meds
    B. Treat 1st w/ volume unless there is underlying etiology
70
Q

What can post-op hypotension lead to?

A 
1. Can lead to shock
A. Neurogenic 
B. Cardiogenic 
C. Hypovolemic 
D. Septic
71
Q

What is SIRS?

A

Systemic Inflammatory Response Syndrome

72
Q

What are the criteria for SIRS?

A

≥ 2 of the following:

  1. Temperature > 38 C° or 90 bpm
  2. Respiratory rate > 20/min or PaCO2 12K or 10% Bands (“L” shift)
73
Q

What is sepsis?

A

SIRS w/ a confirmed or suspected source of infection

74
Q

What cultures are obtained for sepsis?

A
  1. Pan culture

A. UC, CXR, Blood Cx x2, Wound Cx

75
Q

How is sepsis treated?

A
  1. Supportive care & empiric abx

2. Leading cause of death in ICU patients

76
Q

What is severe sepsis?

A

Sepsis accompanied by signs of failure of at least one organ

77
Q

How may end organ damage present in severe sepsis?

A
  1. Hypotension
  2. Altered mental status/ confusion
  3. Hypoxemia
  4. Oliguria/ elevated creatinine
  5. Coagulopathies/ “shock liver”
78
Q

What may severe sepsis respond to?

A

fluid resuscitation

79
Q

What may severe sepsis lead to?

A
  1. Septic Shock

A. Severe sepsis resulting in multiple end organ dysfunction & hypotension unresponsive to fluids

80
Q

What is the prognosis for septic shock?

A

Mortality ~40%, especially if present late w/ lactic acidosis & failure to start aggressive Tx

81
Q

How is septic shock treated?

A
  1. Require pressors to maintain perfusion

2. Transfer to ICU

82
Q

How are cardiac arrhythmias managed in the post-op setting?

A

Initial work-up, Vitals, EKG, electrolytes

83
Q

What rhythms require a transfer to telemetry and a call to cardiology?

A
  1. SVT
  2. Atrial fibrillation- most common post-op arrhythmia
    A. Rate control/conversion
84
Q

What may cause sinus tachy?

A

Pain, resp distress, PE

85
Q

What are the sxs of a DVT?

A
  1. Edema of extremity
  2. Erythema of extremity
  3. Warm to touch
  4. +/- Tender to palpate
  5. +/- Homan’s sign
  6. Difficult to mobilize
86
Q

What studies are used to dx DVT?

A
  1. Venous Doppler

2. Gold Standard: Venogram

87
Q

How is a DVT treated?

A
  1. Unfractionated Heparin IV (PTT)
  2. LMW Heparin
    A. Fragmin
    B. Lovenox
    C. Eliquis
  3. Coumadin (Warfarin)
88
Q

How is a DVT prevented?

A
  1. Early Ambulation
  2. TEDS/SCD’s
  3. IVC Filter
    A. Prevents PE

Gen Med: Surgery (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions