Ch. 11 The post-op patient

Question 1

What is the recovery period?

Answer 1

From cessation of anesthesia to P return of normal vital signs and consciousness

Question 2

What is stage 1 if heat loss

Answer 2

transferred from core to the skin

Question 3

What is stage 2 of heat loss

Answer 3

lost to the environment by conduction, convection, radiation, evaporation

Question 4

When should you consider rewarming a patient?

Answer 4

97.6F

Question 5

Rewarming techniques

Answer 5

-Passive external (blankets)
-active external (warming devices)
-active core (warmed fluids)

Question 6

What should you beware of when monitoring rewarming

Answer 6

after-drop

Question 7

What heating method should not be used

Answer 7

electric heating pads

Question 8

Emergence delirium is when the P has returned to stage _

Answer 8

2

Question 9

Risks of emergence delirium

Answer 9

-severe trauma
-dehiscence
-hyperthermia
-disruption in clinic

Question 10

Tx of emergence delirium

Answer 10

-careful approach
-tranquilizers

Question 11

Anesthesia related causes of prolonged recovery

Answer 11

-excessive anesthesia depth
-breed predisposition

Question 12

Patient related causes of prolonged recovery

Answer 12

-hypotension, poor perfusion, shock
-liver or kidney diseases
-intracranial disease
-hypoglycemia
-hypothermia

Question 13

Therapeutic measures of prolonged recovery

Answer 13

-physical stimulation
-ventilation
-fluid therapy
-reversal agents
-warming devices
-dextrose

Question 14

What should be done if direct pressure for 5-10 minutes doesn’t stop hemorrhage

Answer 14

bandage, notify surgeon

Question 15

The following are signs of _ _:
-Pale MM
-Slowed CRT
-Rapid RR
-Abdominal bloating
-Swelling at/around sx site
-Hypotension

Answer 15

internal bleeding

Question 16

Diagnosis of hemorrhage

Answer 16

abdominocentesis, thoracocentesis

Question 17

Causes of hemorrhage

Answer 17

-Coagulation disorder (breeds, chronic liver dz)
-Dislodged ligature
-Post-sx perfusion

Question 18

Tx of hemorrhage

Answer 18

reoperate
transfusion or autotransfusion

Question 19

Tx of hematoma at incision site

Answer 19

-warm, moist compresses
-suction & pressure bandage
-drain

Question 20

What is a seroma

Answer 20

-serum collects b/w skin and muscle
-typically due to excessive movement
-potential abscess formation

Question 21

Dx of a seroma

Answer 21

-aspiration
-differential via Diff-Quik type stain

Question 22

Tx of seromas

Answer 22

-warm, most compresses
-suction and pressure bandage
-possibly sx drain

Question 23

What is loss of sutures allowing sx site to open

Answer 23

postoperative dehiscence

Question 24

Risks of postop dehiscence

Answer 24

contamination, serious potentially fatal

Question 25

Causes of postop dehiscence

Answer 25

-excessive licking and chewing at site (self trauma -infection -blunt trauma

Question 26

What does sx site infection look like

Answer 26

swollen, red, draining

Question 27

What does infection at sx site cause

Answer 27

delayed healing

Question 28

Tx of sx site infection

Answer 28

-possible sx debridement and restoring -systemic antibiotics -warm, moist compresses -dilute antiseptic solution at site

Question 29

What may mimic infection of sx site

Answer 29

allergic reaction to suture material

Question 30

What are the phases of wound healing

Answer 30

-Inflammatory -Debridement -Repair (fibroblastic) -Maturation

Question 31

Factors affecting healing

Answer 31

-host factors -wound characteristics -external factors

Question 32

Duration and degree of contamination are classes _ through _

Answer 32

1-3

Question 33

Degrees of contamination

Answer 33

-clean -clean contaminated -contaminated -infected or dirty

Question 34

Types of wound cleansing

Answer 34

lavage and debridement

Question 35

Types of debridement

Answer 35

-Surgical -Dry to dry bandage -Wet to dry bandage -Enzymatic solutions

Question 36

Types of wound dressing

Answer 36

-Semi occlusive -Occlusive -Antimicrobial agents

Question 37

What type of drain is described? Gravity and overflow gradients

Answer 37

passive drains

Question 38

What type of drain is described? -Negative-pressure gradients -Fenestrated

Answer 38

Active drain

Question 39

Types of wound closure

Answer 39

-Primary -Delayed primary -Secondary -Secondary intention (contraction, epithelialization)

Question 40

What does bandages, splints, casts, and slings do

Answer 40

-protect wounds -speed healing -immobilize extremities

Question 41

What are the 3 layers of bandages

Answer 41

-primary (contact) -secondary (padded) -tertiary (outer)

Question 42

What should be monitored with bandages, splints, casts, and slings

Answer 42

extremities for blood flow

Question 43

When are urinary catheters placed post op

Answer 43

back sx, some orthopedic procedures,

Question 44

What should be monitored with urinary catheters

Answer 44

patency and leaking

Question 45

When should urinary catheter collection system be replaced

Answer 45

every 24 hrs

Question 46

When should a urinary catheter be replaced

Answer 46

every 3-5 days

Question 47

Methods of physical rehabilitation

Answer 47

-massage -cryotherapy or thermotherapy -bandaging -range of motion excursuses (passive, active) -exercise

Question 48

Post op pain indicators

Answer 48

-increased HR and RR -elevated blood pressure -longer CRT

Question 49

Drugs best for managing wind-up pain

Answer 49

morphine, ketamine, lidocaine