Common Post-Operative Presentations

Question 1

What are the causes of dyspnoea/hypoxia post-operatively?

Answer 1

Previous lung disease
Atelectasis
Aspiration
Pneumonia
LVF
PE
Pneumothorax
Pain leading to hypoventilation

Question 2

Give an example of something that can cause pneumothorax post-operatively

Answer 2

CVP line insertion

Question 3

What investigations may be done into post-op dyspnoea/hypoxia?

Answer 3

FBC
ABG
CXR
ECG

Question 4

How is post-op dyspnoea/hypoxia managed?

Answer 4

Sit up
Give oxygen
Manage cause

Question 5

What are the post-renal causes of post-op reduced urine output?

Answer 5

Blocked/malsited catheter

Acute urinary retention

Question 6

What are the pre-renal causes of post-op reduced urine output?

Answer 6

Hypovolaemia

Question 7

What are the renal causes of post-op reduced urine output?

Answer 7

NSAIDs

Gentamicin

Question 8

What is anuria usually due to post-op?

Answer 8

Blocked or malsited catheter

Question 9

What is oliguria usually due to post-op?

Answer 9

Inadequate fluid replacement

Question 10

Where can information be gathered from in post-op reduced urine output?

Answer 10

Operation history
Obs chart - urine output
Nephrotoxin

Question 11

What should be looked for in examination in post-op reduced urine output?

Answer 11

Assess fluid status
Examine for palpable bladder
Inspect drips, drains, stoma, CVP

Question 12

How should post-op urine output be managed?

Answer 12

Fluid 50ml saline and aspirate back

Fluid challenge

Question 13

What are the causes of post-op nausea and vomiting?

Answer 13

Obstruction
Ileus
Emetic drugs, e.g. opioids

Question 14

What should be considered in patients with post-op nausea and vomiting?

Answer 14

NGT
AXR
Ondansetron 4mg IV TDS

Question 15

What is it important to know with low sodium post-operatively?

Answer 15

What was the pre-op level

Question 16

What are the common causes of reduced sodium post-op?

Answer 16

SIADH

Over administration of IV fluids

Question 17

What can cause SIADH post-operatively?

Answer 17

Pain
Nausea
Opioids
Stress

Question 18

How should acute reduced sodium post-op be managed?

Answer 18

Slow correction of 1mM/hour

Question 19

How should chronic reduced sodium post-op be managed?

Answer 19

Slow correction of 15mM/day

Question 20

How is post-op hypotension immediate managed?

Answer 20

Tilt bed head down, give oxygen

Assess fluid status

Question 21

What are the categories of causes of post-op hypotension?

Answer 21

Cardiogenic
Hypovolaemic
Obstructive
Distributive

Question 22

What are the cardiogenic causes of post-op hypotension?

Answer 22

MI

Fluid overload

Question 23

What are the hypovolaemic causes of post-op hypotension?

Answer 23

Inadequate replacement of fluid losses

Haemorrrhage

Question 24

What are the obstructive causes of post-op hypotension?

Answer 24

PE

Question 25

What are the distributive causes of post-op hypotension?

Answer 25

Sepsis | Neurogenic shock

Question 26

How is post-op hypotension caused by hypovolaemia managed?

Answer 26

Fluid challange - 250-500ml colloid over 15-30 mins

Question 27

How is post-op hypotension caused by haemorrhage managed?

Answer 27

Return to theatre

Question 28

How is post-op hypotension caused by sepsis managed?

Answer 28

Fluid challenge | Start Abx

Question 29

How is post-op hypotension caused by fluid overload management?

Answer 29

Furosemide

Question 30

How is post-op hypotension with a neurogenic cause managed?

Answer 30

Noradrenaline infusion

Question 31

Should you continue anti-hypertensives during the peri-operative period?

Answer 31

Continue anti-hypertensives during peri-operative

Question 32

What are the causes of post-operative hypertension?

Answer 32

Pain Urinary retention Previous HTN

Question 33

How is post-operative hypertension managed?

Answer 33

Manage cause | Maya use labetalol 50mg IV every 5 mins (200mg max)

Question 34

What are the features of post-operative acute confusional state?

Answer 34

Agitation Disorientation Attempts to leave hospital

Question 35

What are the common causes of post-op acute confusional state>

Answer 35

``` Drugs Sensory deficits Low oxygen states Infection Urinary retention or constipation Ictal Dehydration or poor nutrition Metabolic problems ```

Question 36

Give 3 examples of low oxygen states that may lead to an acute confusional state

Answer 36

MI Stroke PE

Question 37

Give 4 examples of metabolic problems that can cause post-op acute confusional state

Answer 37

Sodium derangement AKI Glucose derangement Ethanol withdrawal

Question 38

How is post-acute confusional state managed?

Answer 38

May need sedation with midazolam or haldol Nurse in well-lit environment Management of cause