Post Op Care and Surgical Complications PT2

AKI

due to shock, sepsis, hypovolemia, bleeding, toxins, CV failure, or urinary retention

common form of post op kidney dysfunction

ATN

MCC of ATN leading to post-op kidney dysfunction

poor perfusion

AKI diagnostics

BUN/Cr

AKI treatment

-if poor perfusion or hypovolemic: fluids
-if retention: remove obstruction

Seroma

collection of serous fluid that delays healing and increases infection

Seroma treatment

compression dressing or needle aspiration

Hematoma

collection of blood and clot due to inadequate hemostasis

Hematoma RFs

-history of coagulopathy
-anticoagulation therapy

hematoma treatment

-if small: leave alone
-if large: evacuate, ligation, reclose

_______ hematomas can cause airway compromise

neck

Patient Surg Site Infection RFs

-age
-nutritional status
-DM
-smoking
-obesity
-coexistent infection
-altered immune system

Operative Surg Site Infection RFs

-antiseptic prep
-antimicrobial prophylaxis
-duration of surgery
-venting of OR
-use of foreign material
-surgical site
-surgical technique

Surg Site Infection Treatment

-if mild: abxs
-if moderate: open wound irrigation or debridement
-if severe: go back to OR for exploration, washout, and drainage
-remove involved implanted material

Dehiscence

-partial or total disruption of any layer of the wound

-MC on POD 5-8

Evisceration

total dehiscence and extrusion of the viscera

Dehiscence Increased RFs

->60 yo
-DM
-uremia
-sepsis
-steroid use
-immunosuppression
-poor nutritional status
-obesity
-smoking

Dehiscence Local RFs

-inadequate wound closure
-increased intra-abdominal pressure
-deficient wound healing

earliest sign of dehiscence

serosanguineous drainage

VTE/DVT/PE RFs

-Virchows triad
-prolonged immobilization
-cancer
-surgery
-dissections of pelvis

VTE/DVT/PE Prevention

-anticoagulation
-compression stockings
-pneumatic compression devices
-early ambulation

VTE/DVT/PE Diagnostics

-CBC, CMP, ABG, coag studies
-venous doppler
-CTA for PE
-EKG

VTE/DVT/PE treatment

anticoagulation (heparin/LMWH, NOACs, warfarin)

**prophylaxis can be used for mod-high risk VTE 2 hrs prior then post op

those who develop VTE from surgery alone should be on anticoagulation therapy for ________ following the incident

3 months

Ileus/Pseudo-Obstruction

-MC after major GI surgeries due to anesthesia and manipulation
-meds, electrolyte abnormalities, inflammatory conditions, pain, and type of surgery influence risk

peristalsis after non-abdominal surgery returns within _______

24 hours

peristalsis after laparotomy returns within __________

48 hours

illeus/pseudo-obstruction diagnostics

CBC, CMP, KUB

Ileus/ Pseudo-Obstruction Treatment

-NPO
-electrolyte correction
-NG tube decompression if obstruction

Constipation post op most commonly occurs due to ____ ___

opioid use

CVA

most commonly thromboembolic occuring within 72 hours post-op

CVA RFs

-type of surgery
-hx of: CVA, afib, valve disease, HTN, CAD, COPD, etc
-advanced age
-cancer
-smoking
-intraoperative HoTN
-discontinuation of anticoag therapy

CVA S/S

-facial droop
-mental status changes
-extremity weakness
-slurred speech

CVA Diagnostics

-non contrast head CT

-CBC, BMP

-EKG, Echo

Paraplegia

-caused by spinal cord ischemia
-surgery/ manipulation of descending thoracic aorta poses most risk

surgeries involving the deep pelvis (ex. proctectomy, hysterectomy) resulting in hypoperfusion or injury of certain nerves pose the most risk for ______

sexual dysfunction

MI RFs

-history of CHF
-preop cardiac ischemia
-advanced age
-surgeries for atherosclerotic disease
-HoTN
-hypoxemia

MI diagnostics

-cardiac enzymes
-EKG

MI Treatment

-PCI
-fibrinolysis
-CABG

most common post-op heart failure

left ventricular

Heart Failure Etiology

-fluid overload
-post-op MI
-dysarhythmias

Heart Failure Diagnostics

-BNP, ABG

-EKG, Echo, CXR

-pulmonary wedge pressure

Heart Failure Treatment

-diuretics
-nitroprusside
-ACE
-beta blocker

Dysrhythmias

-appear during surgery or within the first 3 post-op days

-MC: A fib and flutter

MC cause of dysrhythmias intra-op

general anesthesia

MC causes of dysrhythmias post-op

-electrolyte abnormalities
-hypoxemia
-stress
-MI

Dysrhythmia Diagnostics

-CBC, BMP
-EKG

Dysrhythmia Treatment

-meds
-cardioversion
-defibrillation

Central Venous Line Complications

-pneumothorax
-line infection
-air embolus

prevention of central venous line complications

US guidance and sterile technique

Pulmonary Artery Catheters

-most common type is Swan-Ganz catheter
-indications: cardiogenic shock, ventricular failure, HF, etc
-CIs: routine pulm cath in high risk pt or non-cardiac pt

Pulmonary Artery Catheter Complications

-cardiac perforation
-intracardiac knotting of the catheter
-dysrhythmias
-pulmonary hemorrhage
-air embolus

Pulmonary Artery Catheter Complication Prevention

-careful placement
-advancing under continuous pressure monitoring
-checking position of tip before inflation

_____ prevent accumulation of fluid

drains

Drain Complications

-infection
-perforation of viscera or vessels
-fistula formation
-bleeding

Retained Foreign Bodies

-almost always requires re-operation
-exs: sponges and instruments

Retained FB Prevention

formal sponge and instrument counts before surgery and before closing

superficial parotidectomy poses threat of direct injury to ________

facial nerve

carotid endarterectomy poses threat of direct injury to __________

hypoglossal nerve

thyroidectomy poses threat of direct injury to ___________

recurrent laryngeal nerve

prostatectomy poses threat of direct injury to ___________

pelvic splanchnic nerves

inguinal herniorrhaphy poses threat of direct injury to __________

ilioinguinal nerve

mastectomy poses threat of direct injury to ________ and __________

long thoracic and thoracodorsal nerves