Post Op Care & Complications

Question 1

Risk factors for getting C. Diff infection.

Answer 1

1. Recent Abx use: Clindamycin, Fluoroquinolones, Broad Spectrum
2. Age

Question 2

How do you test for C. Diff?

Answer 2

C. Diff Ag PCR

Question 3

How do you treat C. Diff?

Answer 3

1. Stop other abx if possible
2. IV/PO Flagyl
3. PO/PR Vancomycin

Question 4

Cause of Post Op Fever POD 3 (Think 5 W’s)

Answer 4

Water – UTI

Question 5

Cause of Post Op Fever POD 7 (Think 5 W’s)

Answer 5

Wound – Surgical Site Incision

Question 6

Cause of Post Op Fever POD 1 (Think 5 W’s)

Answer 6

Wind – Atelectasis

Question 7

Cause of Post Op Fever POD 7+ (Think 5 W’s)

Answer 7

Weird Drugs – Beta-lactam Abx, Procainamide, INH, Alpha-methyldopa

Question 8

Cause of Post Op Fever POD 5 (Think 5 W’s)

Answer 8

Walking – DVT

Question 9

Workup & Treatment of Post Op Fever POD 3 (Think 5 W’s)

Answer 9

Water – UTI
Order UA & Culture
Tx: Cipro/Nitrofurntoin

Question 10

Workup & Treatment of Post Op Fever POD 7 (Think 5 W’s)

Answer 10

Wound – Surgical Site Incision
Work up: Open wound
Tx: Wet to Dry Dressings

Question 11

Workup & Treatment of Post Op Fever POD 1 (Think 5 W’s)

Answer 11

Wind – Atelectasis

Work up: Incentive Spirometry, Nebulizer

Question 12

Workup & Treatment of Post Op Fever POD 7+ (Think 5 W’s)

Answer 12

Weird Drugs – Beta-lactam Abx, Procainamide, INH, Alpha-methyldopa
Tx: Discontinue Drugs

Question 13

Workup & Treatment of Post Op Fever POD 5 (Think 5 W’s)

Answer 13

Walking – DVT
Work up: Extremity Duple US
Tx: Anticoag

Question 14

Risk factors for Pulmonary Embolus (Same as DVT)

Answer 14

1. Hypercoaguable State – Virchow
2. Intimal Injury – Virchow
3. Stasis – Virchow
4. Prior Embolus
5. Long operation
6. Oral Contraceptives
7. Trauma
8. Malignancy
9. Paralysis
10. Immobilization
11. Obesity
12. Age
13. Chronic Heart Dz

Question 15

Treatment for a Pulmonary Embolism

Answer 15

1. Anticoagulate with heparin 10,000 units IV bolus and heparin gtt at 1000 units per hour if low risk of bleeding
2. IVC Filter is option for high bleeding risk patient.

Question 16

How can you Prevent a DVT or PE?

Answer 16

• All post-op patients should be on Lovenox/Heparin
• Question your upper level is patient was no written for these. There should be a reason
• Bilateral SCD (Sequential Compression Device)
• IVC Filter in Trauma Patient

Question 17

T/F: You need a CXR to confirm a Pneumothorax

Answer 17

False, if you don’t hear breath sounds, that’s all you need to dx it.

Question 18

How do you treat a pneumothorax?

Answer 18

1. Needle Aspiration - 2nd intercostal space in the mid clavicular line
2. Chest Tube - 4th or 5th intercostal space in the mid-axillary line

Question 19

If there is yellow fluid discharge after performing a cholecystectomy, what do you think and what do you need to do?

Answer 19

Bile!!! You need to go back into surgery. Order labs STAT! Be sure to inform the patient and keep them warm for follow up surgery. Make sure there is IV access and give 1L NS bolus

Question 20

When a wound is continuously draining fluid post-op, what should you do?

Answer 20

Open the sutures and let the wound drain.

Question 21

If intestines are eviscerated, what do you do?

Answer 21

Sterilize/bag them because you need to reduce risk of infection.

Question 22

This is the term used for the separation of facial layers in the early post-op course.

Answer 22

Abdominal Dehiscense

Question 23

What is the most common cause of abdominal dehiscence?

Answer 23

Technical Error, such as:

1. Sutures too close to the edge
2. Sutures too far apart
3. Two much tension

Question 24

What is the biggest worry with abdominal dehiscenes?

Answer 24

Evisceration

Question 25

What can increase the risk of dehiscense?

Answer 25

1. Intra-abdominal infection
2. Malnutrition
3. Advanced Age
4. Chronic Corticosteroid Use
5. Wound Infection, Hematoma
6. Increased Abdominal Pressure (ascites, distended bowel, coughing, straining, vomiting)