Postop Complications ABCs Flashcards
Postoperative Complications (10)
Atelectasis
Aspiration
Pneumonia/Sepsis
VTE (DVT, PE, Stroke)
Hypovolemia (bleeding and dehydration)
Paralytic Ileus
PONV (post-op nausea and vomiting)
Urine Retention
UTI/HAUTI
Surgical site infection
How does anesthesia affect breathing
General anesthesia hampers your normal breathing and stifles your urge to cough
After chest or abdo surgery it could hurt to breathe in deeply or push air out - mucous builds up in the lungs
Anaphylaxis (airways can swell)
Atelectasis/pneumonia = hypoxemia
What can cause acute respiratory distress post op
Tongue falling back because of decreased LOC (snoring)
Retained thick secretions
Laryngospasm
Laryngeal edema
How to respond to acute resp distress
assess if the tongue has fallen back. look for sternal retraction. wake the patient up. oral airway. sit them up. supplemental oxygen. check O2
if anaphylaxis has occurred we are immediately going to give Epi IM q5min
what is hypoxemia
reduction in the oxygen tension in arterial blood which will lead to a reduction in oxygen at the tissue level referred to as hypoxia
want it to be 80-100
hypoxema is a PaO2 of less than 80 mmHg
need blood gas analysis to confirm.
The “gold standard” diagnostic test for hypoxemia is arterial blood gas taken from radial artery.
what causes hypoxemia
Hypoxemia is a result of conditions or diseases that reduce the ability of oxygen to diffuse across the alveoli, reduce perfusion of ventilated alveoli, reduce the ventilation of perfused alveoli, reduce the oxygen tension of inspired air, reduce the volume of inspired air
happens when the air sacs in the lungs become deflated. can cause partial or complete colapse of a lung or lobe of a lung which is going to sound like decreased air entry.
what is the most common cause of hypoxemia in the post-op patient:
Atelectasis
S&S of hypoxemia (HATT)
Hyper/hypotension
Agitation
Tachycardia (compensate)
Tachypnea (unless being suppressed by opioids)
What is atelectasis
hypoventilation and excessive retained secretions
collapse of the alveoli
S&S of Atelectasis (7)
Diminished or absent breath sounds
Dullness on percussion
Reduced chest expansion, tachypnea
Fever
Restlessness/confusion
Hypertension, tachycardia
Interventions for Atelectasis
DB&C q1h while awake, incentive spirometer
Reposition patient, HOB> 30
Apply oxygen
Notify surgeon
Aspiration; what is it?
foreign material that enters the trachea instead of the esophagus and can then enter the lungs.
What causes aspiration?
Abnormality of any of the nerves, muscles, or processes required for swallowing can result in ineffective swallowing or GI reflux, as a result saliva or ingested materials can be aspirated.
happens in 45% of healthy individuals but most can clear the aspirate from the pulmonary tree by intact cough and gag reflex
not having these reflexes: unconscious, pts with stroke or other neuromuscular degenerative conditions.
how does anesthesia affect aspiration risk?
when patients dont have cough or gag reflexes such as intraoperatively, they cant claer secretions. because of this, patients are often intubated to protect the airway from GI reflux.
interventions for aspiration
Prevention is key and involves administration of PPIs prior to surgery such as those who are obese or pregnant, pts with decreased LOC coming out of general anesthetic. pts with stroke
Aspiration can lead to pneumonia
Sit the patient up
Dont feed when asleep
Pneumonia S&S
Sudden onset of chills, shaking, with high fever
Dyspnea, tachypnea, sharp chest pain exacerbated by inspiration
Productive cough
Diminished breath sounds
Cyanosis with hypoxemia
What measures can we implement to prevent Post-op pneumonia
- DB & C q1h while awake along with incentive spirometry
- Early ambulation which includes good pain control
- HOB elevated > 30 degrees at all times or patient is sitting up for all meals
- Oral hygiene at least BID with mouthwash
Interventions for Pneumonia
maintain airway
apply oxygen
labs/diagnostics
- sputum cultures (best to get right in the morning)
- CXR (diagnostic)
- blood cultures (if septic)
- antibiotics
- fluids
Sepsis
The systemic response to overwhelming infection, when a patient’s immune system fails to control pathogens or their toxins, from a site of infection
See it in surgery all the time because we cut into someone
Systemic illness caused by microbial invasion to normally sterile parts of the body
usually in the blood and often bacterial (can be viral, fungal, parasitic, yeast)
Prevalence of Sepsis
First line of defense has been broken
One of the leading causes of death
Common reason for admission to hospital
Is prevalent and on the rise in aging population, chronic diseases, artificial joints, heart valves, central venous catheters, people living with cancer, autoimmune diseases, immune-compromised, organ transplants, indiscriminate use of antibiotics and antimicrobials
SIRS Criteria
H - heart rate > 90
R - RR > 20
T - temp greater than or equal to 38 or less than 36
W - WBC count greater than 12 or less than 4
A - altered mental status (GCS score < 15)
Sepsis = Suspected source + 2 of the SIRS criteria
QSOFA (quick sepsis-related organ failure assessment)
Resp rate > 22
Systolic BP < 100
Altered mental status
Lactate greater than 4
If the patient develops two or three QSOFA criterial call MRP and inform him/her the patient has SEPSIS and possible SEPTIC SHOCK and needs immediate assessment
Most frequent sites of infection
Lungs
Urinary tract
Abdomen
Skin/soft tissue
Symptoms of Infection
Early on, organs can be hypo-perfused
Blood flow/oxygen is shunted away from the kidneys, skin, GI tract, lungs
Altered consciousness, confusion, psychosis, tachypnea, SaO2 < 90%, jaundice, creatinine, decreased platelets, PT, decreased protein C, D-dimer. Severe sepsis is sepsis that doesn’t respond to aggressive fluid rehydration
