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Post op....infection , oliguria, dvt..
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Transcript of Post op....infection , oliguria, dvt..
Post-Operative problems in Patients…
Submitted By… M.Abdullah 3rd Year O.T.T
Learning Objectives…Wound complicationsSeromaHaematomaWound DehiscenceSSIOliguriaAltered sensorium DVTPulmonary embolism
First Post-operative Assessment…
The first postoperative assessment should take place immediately after surgery on return to the ward.
It provides A baseline against the patient’s condition. Identifies problems occurred on transfer from the
operating department. Respiratory status Mental status
Post-operative Complications … Days……..(0-2) Fever Days……( 3-5 )Bronchopneumonia.SepsisDrip site infection Abscess formation
After 5 days:Specific complications related to surgery eg. fistula formation.
After the first week:HaemorrhageWound infection. UTI. DVT.
Wound Complications….
Seroma
Haematoma
Wound Dehiscence
SSI (Surgical Site Infections)
Seroma…Collection of liquid , serum and lymphatic fluid under
the incision. Mostly yellow fluid.Localised and swelling.Place drain during surgery/ aspiration.
Hematoma…Abnormal collection of blood, usually in a potential
space in abdominal cavity.
Wound Dehiscence… Separation of ant. abd. wound involving the
anterior fascia and deeper layers. Causes….
Pat. with poor nutrition , obesity. Increased intra-abd. pressure. Hemorrhage Infection Poor suture technique Drain and stoma placed along incision.
Treatment….. Occlusive dressing
Wound Infection…. Major factors:
1) Breaks in surgical technique2) Host parasite relationship
Potential sources of contamination:1) Patients themselves2) Operating room and personnel.
Organisms:1) S. aureus2) E. coli, Bacteroides , Proteus, Klebsiella ,
Pseudomonas.
Pulmonary infections:1. Atelectasis2. Aspiration pneumonia
Urinary tract infection: Indwelling urinary catheter
E. coli, Pseudomonas, klebsiella
Intra-abdominal infection:
Abdominal abscess Sites:
1. Sub-phrenic ---> most common2. Pelvis3. Liver
Treatment: drain ---> explor lap / needle aspiration
Wound Infections… Most common form is superficial wound infection
occurring within the first week.
Presenting as Localised painRedness and slight discharge usually caused by skin
staphylococci.
Cellulitis and Abscesses…
Most present within the first week But can be seen as late as the third postoperative week, even
after leaving hospital.
Present with fever and spreading cellulitis or abscess.Cellulitis is treated with antibiotics.
Abscess requires suture removal and probing of the wound but deeper abscess may require surgical re-exploration. The wound is left open in both cases to heal by secondary intention.
Gas Gangrene ….. Is uncommon and life-threatening.
Wound Sinus… A late infectious complication from a deep chronic
abscess that can occur after apparently normal healing.
It usually needs re-exploration to remove non-absorbable suture or mesh, which is often the underlying cause.
Disordered wound healing…Most wounds heal without complications.
Factors which may affect healing rate are:Poor blood supply.Excess suture tension.Long-term steroids.Immunosuppressive therapy.Radiotherapy.Severe rheumatoid disease.Malnutrition and vitamin defi.
Oliguria…. Urine volume less than 1ml/kg/hr or <400ml /day. This may be the result of fluid and blood loss. Considered acute renal failure.
There is an increased release of aldosterone and ADH in the first 24 hours after surgery. This results in both salt and water retention.
Causes…..1. Catheter obstruction2. Pre-renal failure3. Electrolyte Imbalance (hyperkalemia)4. Hemodialysis
Management of Oliguria….
Minimal acceptable output is 1 ml/kg/hrTake records of fluid intake and output.
If oliguria is associated with other symptoms of fluid depletion, it should be treated initially with a fluid challenge.
Exclude obstruction of the urinary tract like urinary catheter.
Diuretics (NSAIDS), Dopamine should not be used .
Altered Sensorium….
• Sensorium… Ability of the brain to receive and interpret sensory stimuli.
• Good Sensorium = Alertness +Awareness • Altered Sensorium…. • Not a disease but a symptom.• Altered sensorium can be determined by evaluating
level of consciousness.
Some Common Terms in Altered Sensorium….
Confusion..Impaired attention and concentration, Manifest disorientation in time, place and person,
impersistant thinking, speech etc. Delirium… Disturbed state of mind characterized by restlessness ,
illusion , confusing speech and thinking.
Amnesia…Loss of past memories and to an ability to form new ones,
Dementia… Memory loss.
Phychosis….Refers to a mental state often
described as involving a "loss of contact with reality".
Initial Actions….Assessment of the ABC's.
Cardiac monitoring and pulse oximetry .
Supplemental oxygen
Bedside glucose testing
Intravenous access (Dextrose)
Consider naloxone administration if narcotic overdose is suspected.
Neurologic Status….Checked by GCS scale.
Treatment…. ‘’TONG’’ T=Thiamine , O=oxygenN = Naloxone , G= Glucose
DVT ……. Post operative Immobilisation
Prolonged bed rest
Usually occurs within 6 days post op.Signs and symptoms of DVT….Edema , Redness, Warmth ,Prolonged dull pain,Low grade fever,
Investigations… DopplerDVT Prophylaxis….• Graduated compression stockings• • Intermittent pneumatic compression• • Aspirin• • Heparin• • Vitamin K antagonists (warfarin, acenocoumarol, phenindione,
and dicoumarol)• • Fondaparinux
Pulmonary Embolism…No specific signs and symptoms.
Dyspnoea, chest pain, hemoptysis , CVS collapse tachycardia, or dysarrhythmia. Investigations…. Oxygen saturation, CXR, ECG, CT ChestPulmonary Angiography
Pulmonary Embolism…
Management… Supplemental O2Maintain vitalsAnticoagulantsEmbolectomy (surgical removal of embolus)
Thank you....