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post op Flashcards

1
Q

cellulitis presentation

A

can occur form any breach of the skin

will appear read slightly swollen warm to touch
might blanch

staph and strep (gram negative) most common

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2
Q

tx of cellulitis

A

MSSA –>keflex (cephalexin) 7-10 days (no purulent)

if it is purulent, MRSA is suspected

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3
Q

subcutaneous abscess workup

A

want packing to help heal from inside out

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4
Q

lymphatic fluid with liquified fat under incision presenting post surgery complication

A

seroma

no erythema or acute pain and seen after breast surgery or sentinal node biopsy

can get this from overactivity

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5
Q

complications of seroma

A

can become so large that it is painful

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6
Q

preventions of seroma

A

can send to patients home with JP drains especially after a surgery in the axilla

20cc for 2 days in a row can take out the JP

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7
Q

sutures or staples are removed POD

A

5

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8
Q

sutures over creases and extremities are left on for

A

2 weeks

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9
Q

hwo does the timing of the fever influence the etiology of cause

A

fever that starts POD#5 is surgical infection

fever that lasts 5 days post op is surgical in

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10
Q

immediate fever causes

A

bactermia

catheter with bladder infection

or reaction to the antibiotics

or gangrene

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11
Q

tx of gangrene

A

surgical debridement and antibitocs

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12
Q

acute fever

A

post op day 1 -POD7

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13
Q

unresolved atelectasis can progress

A

to pneumonia

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14
Q

POD 6 the source of elevated temperature is a

A

PE

SOB
Pleuritic CP
CTA dx

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15
Q

wound infection fever usually occurs

A

POD 7-10

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16
Q

sxs of pulmonary aspirations

A

basilar rales
hypoxia
tachypnea

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17
Q

prevention of pulmonary aspiration

A

pre-op fasting

patient positioning

careful intubation and extubation

H2 blocker or PPI before intubation-

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18
Q

causes of postop pneumonia

what type of organism is most commonly the culprit

A

aspiration

stelectasis

copious secretions

usually gram negative

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19
Q

sxs of pneumonia post op

A

fever
tachypnea
increased screations
CXR confirms consolidations

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20
Q

tx of post op PNA

A

culture sputume and treatment if anbx

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21
Q

respiratory management to prevent atelectasis, aspiration, and PNA

everyone get’s this that is admitted

A

Encourage coughing

Frequent change in position

Get out of bed!

I/S incentive spirometer (5x a day)

Deep breathing

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22
Q

RF for post op PE

A

Obesity

Age

Lengthy operative procedure (>5 hrs)

Birth control pills

Malignancy

Trauma

Immobilization

Paralysis
IBS, Crohn’s
Chronic heart dz
Coagulation disorders

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23
Q

longer surgery is usually

A

mroe than 5 or 6 hours on the table

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24
Q

infectous causes of post op fever

A

— SSI, pneumonia (especially VAP), UTI, and intravascular catheter-associated infection are the most common infectious causes of postoperative fever.

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25
sxs of PE postop
Cough Dyspnea Pleuritic chest pain Apprehension! Tachypnea Tachycardia P02 less than 70
26
MC non infectious cause of postop fever
Medications are the most common noninfectious cause of fever. Antimicrobials and heparin are the medications most commonly associated with postoperative fever, at least in part because they are used so frequently in the postoperative period
27
we would be concerned for urinary retention if
pain and fullness over bladder with distension | unable to void after 6 hours
28
treatment for urinary retention
Bladder scan if residual is greater than 500 cc, patient is catheterized
29
ileus post op usually occurs as a result of
After abdominal surgery, the colon ceases to function for a period of time 3-5 days due to: ``` bowel manipulation intra-abd infection pancreatitis pneumonia peritonitis narcotics ```
30
ileus sxs
Abd distension N/V Obstipation (failure to pass gas and stool) Abd pain
31
tx of a ileus
Full liquid diet until 1st BM | Patience
32
how do you know if ileus has resolved
Flatulence Sharp, colicky pain
33
Cellulitis
Tissue center with blood supply Will resolve with antibiotics
34
Subcutaneous abscess
Necrotic center without blood supply Pus Will not heal unless pus is drained
35
Lymphatic fluid with liquefied fat under incision
Seroma
36
seromas are of concern in these types of sugeries
Concern in breast surgery ventral hernia repairs Axillary and groin dissection Edema
37
fluid from seromas is usually erythema? pain?
Clear or yellow liquid from incision No erythema or acute pain
38
prevention of a seroma should look like
Close subcutaneous layers to avoid dead space lymphatic fluid collecting is the problem here Use drains and don’t remove prematurely 25cc for two days in a row to remove
39
Most common surgical complication due to lack of coagulation of vessels during surgery
Risk when patient is anti-coagulated with heparin or patient is an aspirin user
40
hematomas are of particular concern when pt is taking
Risk when patient is anti-coagulated with heparin or patient is an aspirin user
41
Hematoma increases risk of
Hematoma increases risk of infection Neck hematomas can compromise airways
42
5 signs and sxs of infection
i. Fever ii. N/V/D possibly iii. Erythema iv. Edema v. Exudate (fluid/pus at incision site)
43
how to tx a seroma
can leave it alone or aspirate 20 gauge syringe and suck out a lot might need to culture if it doesn't look clear wear a binder or sports bra DO NOT RADIATE A SEROMA
44
Dressing over closed wounds should be removed on ______ postop day if dry
Dressing over closed wounds should be removed on 3rd postop day if dry
45
treatment for itching associated with wound adhesives
Treatment is remove offending agent and use of hydrocortisone 1% cream and benadryl cream if itchy
46
5 "w"s 5 causes of post op fever
``` wind -atelectasis water- UTI or PNA from atelectasis wound - look at dressings post op (7) walking-PE/dvt wonder -check all the drugs your pt is on ``` refers to acute fever complications
47
definition of a post op fever
greater than 30 degress or 100.4 on two consecutive post op days OR 102.2 on any post op day
48
how to we classify post op fevers
immediate acute subacute delayed
49
immediate fever occurs when
immediately after surgery or within hours post op day 0 (day of surgery) or POD 1
50
what are the three causes of immediate fever
malignant hypothermia bacteremia (w/ 30 of beginning) ``` gas gangrene (greater than 40) due to C. Diff ``` transfusion reaction
51
malignant as the source of an immediate fever is usually caused by....
reaction to anesthesia or muscle relaxants managed by anesthesiaologists
52
immediate fever bacteremia is usually b/c of
urinary tract infection with a catheter three blood cultures and antibiotics managed by anesthesiolgist
53
gas gangrene as the source of an immediate fever is usually caused by.... what is the treatment
fever greater than 40 (104) severe wound pain usually because of C diff debridement and antibiotic
54
transfusion reaction is usually seen
6 hours post op stop transfusi
55
RF for atelectasis
i. Elderly ii. Overweight iii. Smokers iv. Hx of respiratory dz
56
tx atelectasis with fever
incentive spirometery pain control early ambulation chest physiotherapy semi -recumbent position
57
POD 3 fever
unresolved atelectasis PNA or UTI
58
POD 5 fever
thrombophlebitis can be asymptomatic or sxs dx with Doppler
59
subacute
week 1-7 seep infection pelvic or abdominal CT or reexplanation
60
sxs of atelectasis (acute)
i. None or ii. Elevation of diaphragm iii. Scattered rales iv. Decreased breath sounds
61
injury to bowel with bowel leak is seen with what sxs
fever tachycardia hypotensive low u/o (urinary output) abd tenderness out-of-proportion to p rocedure vs abd ttp app to proc
62
RF for Pulmonary aspirations
GERD Eating before surgery Pregnant women Small bowel or colon obstruction
63
why are pregnant women at greater risk for pulmonary aspirations
– high intra-abdominal pressure and decreased gastric motility
64
how do H2 blockers prevent pulmonary aspiration
reducing acidity of stomach contents thus preventing chemical pneumonitis

Surgery (18 decks)

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