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Flashcards in periop/postop Deck (23):
1

second mc complication in surgery

nerve damage due to positioning

2

5 P's of writing orders

pain (mild to severe controlled w meds or position)

pee (urination)- urinary cath q6prn; indwelling cats can lead to infx and may lead to oliguria after removal bc pt has been relying on cath

poop (BM)- constipation can cause urinary problems

puking (nausea)

pyrexia (fever)

3

what should there be evidence of prior to feeding following abd operations

evidence of peristalsis- bowel sounds, passing gas

4

what is POD1

first day after an operation

5

tmax

max temp w/in last 24hr

6

tachycardia, metabolic acidosis, hyperthermia, hypercapnia

malignant hyperthermia (postop anesthesia problem)

102.5

7

tx of malignant hyperthermia

IV dantrolene

8

goal of surgical drains

dec infx rate and dec healing time

9

indications for surgical drains

eliminate dead space; evacuate accum of gas, bile, pus, blood, or fluid; prevent accumulation of gas, bile, pus, blood, or fluid

10

penrose (passive drain)

latex and dependent on capillary action; drainage is related to surface area

11

adv of penrose drain

allow drainage, help obliterate dead space, soft/malleable (less painful)

12

disadv of penrose drain

very irritating, allow bacterial ingress, can't be connected to suction, gravity dependent

13

jackson pratt (active drain)

soft w multiple perforations; bulb that can recreate low neg pressure vacuum; designed so tissues are not sucked into tube

14

hemovac (active drain)

needle for placement (needs to be cut out in order for suction to work); accordion like reservoir (evacuator); more volume capacity than JP; placed away from incision so wound can heal

15

adv of active drain

keep wound dry (efficient fluid removal), can be placed anywhere, prevent bacterial ascension, help appose skin to wound bed (quicker wound healing)

16

disadv of active drain

high negative pressure may injure tissue; drain clogged by tissue

17

why are there complications and failures of drains

poor drain selection, poor drain placement, poor post op management

breakdown of anastomotic site; erosion into hollow organs; incisional dehiscence/hernia (poor placement); premature removal (accum of fluid); dec mobility (DVT/PE, inc hospital stay)

18

which drain is more likely to be assoc w an infx

pinrose- ascending bacterial invasion; foreign body reaction; dec local tissue resistance; bacterial hiding places; poor placement (fluid accum, drain kinked), poor postop manag

19

causes of inefficient drainage

exiting in non dependent locale (passive drains); kinked tube; obstructed; poor drain selection (diameter too small to remove viscous fluid)

20

when should drain be removed

when drainage ceases

21

obligatory urine output for adult

generally 50ml/hr

22

the 5 W's for postop fever

wind (24-48hr, atelectasis); water (3d, UTI); wound (5-7d, infx); walking (7-10d, DVT); wonder drugs

23

w/u for postop fever (>101.5)

PE (lungs,heart, site, calf tenderness, Homans); cxr; UA; blood cx (2 sep sites); cbc