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35 Cards in this Set
- Front
- Back
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Recovery from surgery
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1. Immediate or post anesthesia
2. intermediate (hospitalization) - where we care most 3. convalescent (discharge->full recovery) |
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Greatest cause of post op morbidity
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pneumonia
atelectasis (2nd- age >60) |
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Greatest risk in surgery
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chest
upper abdomen emergency surgery COPD, asthma, pulmonary fibrosis |
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Atelectasis
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25% -> abd surgery
elderly obese smokers resp disease |
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Pneumonia
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Most common 48hrs
elderly decreased cough reflex peritoneal infection prolonged vent support gm negative bacilli pseudomonas klebsiella |
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Aspiration
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(pt's who are improperly prepared for surgery)
oropharyngeal GI contects *n/g, endo tubes drugs interfering with sphincter function |
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chemical pneumonia
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(burns of lower resp tract)
r/t volume of aspirate pH: 2.5 or < frequency, solid matter |
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Hematoma
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Elevation/discoloration of wound edges
discomfort, swelling higher risk of infection |
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Hematoma Tx
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1. Evacuate clot under sterile conditions
2. Ligation of bleeding vessels 3. Reclosure of wound |
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Seroma
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fluid collection (usually lymph)
breast / groin delays healing / promotes infection |
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Seroma Tx
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needle aspiration(except groin)
compression dressing for reoccurance: use tetracycline gm 1/150 NS |
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Dehiscence
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Diabetics
Uremia Sepsis Hypoalbuminemia Cancer Obesity Corticosteroids inadequate closure COPD vigorous coughing post op bowel obstruction cirrhosis with ascites deficient wound healing most common 5-8days post op |
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Dehiscence Tx
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Return to bed
cover with sterile towels Or Wound rinsed with LR/NS/antibiotic solution replace sutures: full thickness, retention wire or nylon use binder |
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Surgical infection
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Warmth, erythema, induration
tenderness, splinting increase temp, pulse decrease BP Leukocytosis->leukopenia acidosis |
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Surgical infection Tx
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I & D (abscess)
Excision(appendix, GB) circulatory enhancement- (IV Fluids) Antibiotics Nutritional support - best -gastrotube feeding |
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Post op parotitis
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staph infection parotid gland
2nd week post op elderly debilitated *poor oral hygiene *prolonged N/G intubation *dehydration *can spread - auditory/canal/neck **Can lead to RESPIRATORY FAILURE (tracheal obstruction) |
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parotitis symptom/Tx
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pain, tenderness @ jaw angle
increase temp, WBC swelling, tenderness, firm Rx: Vancomycin warm moist packs warm oral irrigations N/S |
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UTI
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most frequently acquired nosocomial infection
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Urinary retention
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pelvic
perineal surgeries spinal anesthesia |
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Phlebitis
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**Virchows triad:
Trauma venous stasis hypercoaguability- cause:dehydration |
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Fat particles
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Fractures expose fat from bone marrow to travel to lungs causing severe damage
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Fat emboli syndrome
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neuro dysfunction
respiratory inufficiency petechia- 12-72hrs after surgery fat droplets in sputum,urine decrease in Hct, thrombocytopenia |
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fat emboli syndrome Tx
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Fluids
diuretics PEEP- positive expository end pressure corticosteroids |
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Fluid for general post op
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Enough to keep I/O equal
extra if: fever, hyperventilation increase catabolism losses from drains 3rd space lesions |
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fluid maintenance
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day1: D5NS or LR 2-2.5L/day
No K+ day2: 2.5L D5NS with 20 KCL 30ml's x KG |
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losses from drains
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<500ml replace by increase of infusion by similar amount
>500 replace 1:1 w/ NS |
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>1500mL loss
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Measure/replace K, NA, CL, Co2
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Hydrocodone
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Vicoprofin
Vicodin Lortab |
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Oxycodone
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OxyContin
Percodan Combunox |
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Smaller Analgesics
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Codeine
Propoxyphene -Darvon -Darvocet |
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Narcan(naloxone)
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for overdose
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Morphine
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Most common for PCA
S/E - Lower BP Resp depression Urinary retention Constipation |
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Versed
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moderate sedation
Watch for: Resp depression Arrythmias Hypotension unresponsiveness agitation confusion |
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Hydroxyzine (Vistaril)
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IM (Z-track)/ PO
Relaxed/Sleepy |
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Lorazepam (Ativan)
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PO/IM (z-track)/IV push
calmer/more sedated |
