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Surgery Exam 2 > Postoperative care - Complications & Management > Flashcards

Postoperative care - Complications & Management Flashcards

1
Q

T/F n if everything before and during the surgery go exactly as planned, no postoperative complications will occur.

A

F

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2
Q

Mechanical complications are
those that arise as a direct
problem of _______

A

the surgical wound and may be a result of
poor technique

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3
Q

Mechanical complications

A

○ Hematoma
○ Hemoperitoneum
○ Seroma
○ Wound Dehiscence
○ Anastomotic Leak
○ Retained Foreign Bodies

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4
Q

Hematoma

A

○ A collection of blood and clot in the wound.
○ Common and usually a result of inadequate
hemostasis in the surgical bed before closure.
○ Risks: Some medications and coagulopathies.

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5
Q

These often require drainage as they increase the risk of wound infection or dehiscence

A

Hematoma

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6
Q

Hemoperitoneum

A

○ Bleeding into the peritoneum after abdominal surgery.
○ Life-threatening and manifests as hypovolemic shock within the first 24 hours post op. Return to OR.

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7
Q

Life-threatening and manifests as hypovolemic shock within the first 24 hours post op.

A

Hemoperitoneum

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8
Q

Seroma

A

○ Collection of serous fluid in the surgical
bed; Usually not “serious”.
○ Increases risk of infection and may slow
wound healing or cause dehiscence.
○ May require drainage, but can recur.
○ Adequate deep tissue closure helps to
prevent the development of seromas

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9
Q

Wound Dehiscence

A

○ Partial or total disruption of any or all layers of the operative wound.
○ Please see the “Wound Management and Wound Healing” lecture

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10
Q

Adequate deep tissue closure helps to
prevent the development of ______

A

seromas

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11
Q

Anastomotic Leak

A

○ A very serious complication of
intestinal anastomoses.
○ Occurs in up to a quarter of cases
to some degree.
○ Same risk factors that can apply
to wound dehiscence apply here.
○ Results in significant peritonitis,
fever, and can cause septic shock.
○ Often requires emergent surgery.
○ High risk of mortality.

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12
Q

A very serious complication of
intestinal anastomoses.

A

Anastomotic Leak

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13
Q

Retained Foreign Bodies

A

○ Rarely objects are accidentally left in the surgical
wound (sponges, instruments, etc).
○ While mortality is low, morbidity is
high because it essentially always
requires return to the OR
○ The most common body cavity
involved is the abdomen, followed by
the thoracic cavity.
○ “Final counts,” possible x-ray, and
scanning counters decrease the rate

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14
Q

Postoperative- Stroke risks

A

● Underlying medical conditions
● Elderly
● Types of surgery
○ Valve replacement
○ Endarterectomy
○ Needed anticoagulants
● Patients can have a stroke just
from general anesthesia alone,
regardless of surgery location

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15
Q

Postoperative Cerebrovascular Attack (Stroke)

A

○ Almost always due to intraoperative or
immediate postoperative hypoperfusion
resulting in ischemic injury.
○ Elderly patients with atherosclerotic disease
that experience perioperative hypotension are
the most common victims.
○ Embolic-type strokes can occur with some
surgeries, such as Carotid Endarterectomies &
heart surgery with extracorporeal circulation

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16
Q

Seizures

A

○ Metabolic derangements, some
medications, and a history of epilepsy all
can lead to a seizure in the postoperative
period. Risk is hard to calculate for most.
○ Treat rapidly with anticonvulsants.

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17
Q

Extensive stays in the ICU can also
result in something called _____

A

ICU Psychosis (the ICU syndrome).

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18
Q

a state of confusion most often caused by an acute metabolic
derangement and is more common in elderly patients

A

Delirium

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19
Q

s may accompany delirium or may occur suddenly without any
apparent confusion

A

Psychosis
■ Manifests as “losing touch with reality” and/or hallucinations
■ Also often caused by medications or metabolic derangement

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20
Q

Most commonly manifest after POD #3

A

Psychiatric Complications

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21
Q

Delirium Tremens (DTs), six and treatment

A

○ Occurs in alcoholic patients who stop drinking
suddenly
○ Re-adaptation to ethanol-free metabolism
requires about 2 weeks.
○ Symptoms include personality changes,
anxiety, tremor, hallucinations, confusion,
agitation, and occasionally seizures.
○ Benzodiazepine and Thiamine (B1) are the
treatments of choice

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22
Q

Most cardiac dysrhythmias appear during
_____

A

the operation or within the first 3
postoperative days (POD #0-3)

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22
Q

Intraoperative dysrhythmias

A

Overall incidence is 20%
■ Higher incidence in those with known heart conditions (35%).
■ Usually related to the anesthesia meds

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23
Q

Postoperative dysrhythmias

A

Overall incidence varies with type of surgery
■ Generally related to reversible factors such as hypokalemia, hypoxemia, alkalosis,
digitalis toxicity, and cardiac stress during anesthesia weaning.
■ Treatment- focused on any metabolic derangements and follows ACLS protocols

24
Q

Postoperative MI may be precipitated by
factors such as _____

A

hypotension and hypoxemia

25
Q

Postoperative Heart Failure

A

Left ventricular failure and pulmonary edema appear in 4% of patients over the age of 40 years undergoing a surgery with general anesthesia
○ Fluid overload during and after surgery is
the most common cause
○ Fluid restriction is needed; diuretics may be
given, occasionally ventilation

26
Q

_____ are the most common single cause of
morbidity after major surgical procedures and the second most common cause of postoperative deaths in patients over 60 years

A

Respiratory complications

27
Q

Atelectasis

A

○ The most common pulmonary complication affecting 25% of patients
undergoing abdominal surgeries because of shallow breathing.
○ Appears most commonly in the first 48 hours after surgery.
○ Responsible for over 90% of fevers on POD #1 or 2.

28
Q

The most common pulmonary complication

A

Atelectasis

29
Q

Prevention of Atelectasis

A

Can usually be prevented with early mobilization, use of incentive spirometers, and encouragement to cough
○ Bronchodilators and mucolytics may be used.
○ Severe cases may need intrabronchial suction.

30
Q

_____ are particularly likely to aspirate regurgitated gastric contents when
consciousness is depressed.

A

Trauma victims

31
Q

About 50% of aspirations result in _____

A

Pneumonia.

32
Q

Preventing Aspiration

A

○ Can be prevented by preoperative fasting, proper patient positioning,
and careful intubation.
○ Bronchoscopy sometimes required for Tx, along with resp therapy.

33
Q

Postoperative Pneumonia

A

○ Pneumonia is the most common pulmonary complication among patients who die in the postoperative period.
○ Patients with peritoneal infection and those requiring prolonged ventilation after surgery are at the greatest risk
○ Often times the infecting pathogen is a
hospital-borne, drug-resistant bacteria.
○ Tx consists of clearing secretions and IV Abx.

34
Q

Treatment for postopoerative pneumonia

A

Tx consists of clearing secretions and IV Abx

35
Q

Pneumothoraces may occur following the insertion of a ______

A

subclavian central catheter or after
positive-pressure ventilation

36
Q

Gastrointestinal Complications:

A

○ Paralytic Ileus
○ Gastric Dilation
○ Bowel Obstruction
○ Fecal Impaction
○ Post Op Pancreatitis or Hepatic Dysfunction

37
Q

Paralytic Ileus

A

○ Anesthesia and surgical manipulation result in a decrease in enteric
nervous system activity- Postoperative Ileus
○ Gastrointestinal peristalsis generally recovers to near normal within
24-48 hours after surgery

38
Q

Gastric Dilation

A

○ Rare, but life-threatening complication of massive distention of the stomach by gas and fluid, sometimes after failed intubation.
○ Intragastric pressure can cause ischemic necrosis and perforation, as well as pressure on intrathoracic or intra abdominal structure/organs

39
Q

Bowel Obstruction

A

○ Acute bowel obstruction is usually from
constipation or paralytic ileus.
○ Delayed development of bowel obstructions
can occur as the postoperative formation of
adhesions or intussusception

40
Q

Delayed development of bowel obstructions
can occur as the postoperative formation of
______

A

adhesions or intussusception

41
Q

Fecal Impaction

A

○ Fecal impaction can develop as a result of colonic ileus after surgery.
○ Most commonly a problem in elderly patients, although not always

42
Q

The use of postoperative opioid or anticholinergic medications is a common cause of _____

A

Fecal impaction

43
Q

Postoperative Pancreatitis

A

○ Postoperative pancreatitis accounts for 10% of all acute pancreatitis cases.
○ Occurs in 1-3% of patients having surgery near to the pancreas.
○ Can complicate surgeries of bilary system, ERCP
○ Post Op pancreatitis is a severe (necrotizing) type, mortality rate is 30-40%

44
Q

Postoperative Hepatic Dysfunction

A

○ Hepatic dysfunction ranging from mild jaundice to life-threatening hepatic
failure develops after 1% of general anesthesia operations.
○ The cause may be medications, transfusions, sickle cell crisis, resorption of
hematomas (bilirubin overload with hemolysis), ischemia, sepsis, biliary
obstruction etc. Can be pre-, intra-, posthepatic source.

45
Q

Postoperative Urinary Retention

A

○ The inability to void after surgery is common,
especially after pelvic/perineal operations, or
operations conducted under spinal anesthesia.
○ The narcotics used during anesthesia in general
can also induce inability to void urine.
○ Foley should be removed as soon as possible.
○ Within a few hours, they will hopefully start
voiding, but if not, a Foley should be placed
again, for 4-5 days to allow recovery

46
Q

Postoperative Urinary Tract Infection

A

○ UTI is the most frequently acquired nosocomial infection.
○ The strongest risk factor for postoperative urinary tract infection is the
placement of a Foley catheter
○ Prevention involves prompt
treatment of urinary retention
and avoidance of unnecessary
prolonged urinary catheter use.
○ Treatment with antibiotics

47
Q

___ is the most frequently acquired nosocomial infection

A

UTI

48
Q

______ are perhaps the most common
postoperative complication.

A

Infectious complications

49
Q

Meticulous surgical technique and giving an
appropriate perioperative antibiotics are the best ways to prevent _____

A

SSIs.

50
Q

Treatment for surgical site infections

A

Antibiotics, debridement, irrigation, and healing by secondary intention are the usual treatments.

51
Q

Clostridium Difficile Colitis

A

○ Excessive (or even normal) perioperative antibiotic use can result in the
postoperative diarrhea of Clostridium difficile (C Diff Colitis).
○ Spectrum of severity ranges from mild to severe toxic colitis (rare).
○ Tx-DC the antibiotic, and treat with PO Vancomycin or IV metronidazole

52
Q

Drug-Resistant Infections

A

○ Drug-resistant organisms, such as MRSA and VRE, are present as
asymptomatic colonization in about 30% of the community.
○ Nosocomial spread of these bacteria to postoperative patients can result
drug-resistant pneumonia, UTIs, surgical site infections, sepsis, etc.
○ Prevention involves contact precautions and limited Abx use

53
Q

Venous Thromboembolism

A

○ Because of the vessel damage that occurs in
surgery, and the increased incidence of “laying
around” during recovery, surgical patients are at
increased risk of developing DVTs and PEs
○ Prevention strategies are required postoperatively and may involve Sequential Compression Devices, SC Heparin/LMWH, early ambulation, DOAC
○ If VTE is suspected, Duplex Ultrasound and/or CT Pulmonary Angiography are the Dx tests of choice.
○ Systemic anticoagulation (IV then PO) is required, and other Txs may be needed (such as IVC filter

54
Q

Prevention strategies for Venous Thromboembolism

A

may involve Sequential Compression Devices,
SC Heparin/LMWH, early ambulation, DOAC

55
Q

What to do If VTE is suspected post-surgery

A

Duplex Ultrasound and/or CT
Pulmonary Angiography are the Dx tests of choice

56
Q

What should be on your differential diagnosis if your postoperative patient
develops a fever

A

Remember the 6Ws!○ Wind- Lungs. Does the patient have Atelectasis or Pneumonia?
○ Water- Urine. Does the patient have a Urinary Tract Infection?
○ Wound- Incision or anastomosis. Does the patient have a SSI?
○ Wonder drugs - certain anesthetics
○ Walking- DVT
○ Wires- Access Lines. Infection of the IV or Arterial lines?

57
Q

What are the 6Ws for?

A

The Postoperative Fever
○ Wind- Lungs. Does the patient have Atelectasis or Pneumonia?
○ Water- Urine. Does the patient have a Urinary Tract Infection?
○ Wound- Incision or anastomosis. Does the patient have a SSI?
○ Wonder drugs - certain anesthetics
○ Walking- DVT
○ Wires- Access Lines. Infection of the IV or Arterial lines?

58
Q
A

Surgery Exam 2 (3 decks)

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