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Flashcards in periop/postop Deck (23)
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1
Q

second mc complication in surgery

A

nerve damage due to positioning

2
Q

5 P’s of writing orders

A

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
Q

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

A

evidence of peristalsis- bowel sounds, passing gas

4
Q

what is POD1

A

first day after an operation

5
Q

tmax

A

max temp w/in last 24hr

6
Q

tachycardia, metabolic acidosis, hyperthermia, hypercapnia

A

malignant hyperthermia (postop anesthesia problem)

102.5

7
Q

tx of malignant hyperthermia

A

IV dantrolene

8
Q

goal of surgical drains

A

dec infx rate and dec healing time

9
Q

indications for surgical drains

A

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

10
Q

penrose (passive drain)

A

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

11
Q

adv of penrose drain

A

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

12
Q

disadv of penrose drain

A

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

13
Q

jackson pratt (active drain)

A

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

14
Q

hemovac (active drain)

A

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
Q

adv of active drain

A

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

16
Q

disadv of active drain

A

high negative pressure may injure tissue; drain clogged by tissue

17
Q

why are there complications and failures of drains

A

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
Q

which drain is more likely to be assoc w an infx

A

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

19
Q

causes of inefficient drainage

A

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

20
Q

when should drain be removed

A

when drainage ceases

21
Q

obligatory urine output for adult

A

generally 50ml/hr

22
Q

the 5 W’s for postop fever

A

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

23
Q

w/u for postop fever (>101.5)

A

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