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Questions and Answers
What is a mild fever temperature range in the postoperative period?
Atelectasis is caused by bronchial secretions obstructing the airways.
True
What is the most common cause of wound infection in the postoperative period?
Superficial wound infection
Which type of hemorrhage occurs several days after surgery?
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Infection complications are the main causes of postoperative morbidity in ______ surgery.
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Which of the following is a treatment step for wound infection?
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What should be covered with a sterile dressing when evisceration occurs?
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Cellulitis, occurring after bowel-related surgery, is often treated with antibiotics.
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What may be a potential cause of disordered wound healing?
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What is a common cause of mild postoperative fever in the first two days?
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What are the two types of hemorrhage that can occur?
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Infection is a rare cause of postoperative morbidity.
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Cellulitis is treated with _____ .
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What is a sign of wound sepsis?
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What management step should be taken if a wound evisceration occurs?
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Which complication can occur due to bronchial secretions after surgery?
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Blood transfusions are always necessary for managing hemorrhage.
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Infectious complications are primarily caused by _____ organisms.
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Study Notes
### Postoperative Fever
- Fever after surgery is common and can be caused by a variety of factors.
- A mild fever (38°C) within two days post-surgery may be caused by atelectasis (collapsed lung), infection, blood transfusion complications, or drug reactions.
- Fever after two days post-surgery may indicate more serious complications, such as bronchopneumonia, sepsis, wound infection, deep vein thrombosis (DVT), or abscesses.
Five Ws of Post-op Fever
- What: The source of the infection
- Where: The location of the infection
- When: The time of onset
- Why: The underlying reason for the fever
- Who: The patient's individual risk factors and medical history
Hemorrhage
- Hemorrhage can occur during surgery (primary hemorrhage) or after surgery (reactionary hemorrhage) due to an increase in blood pressure.
- Hemorrhage can also occur days after surgery (late postoperative hemorrhage) and is often caused by infection.
- Hemorrhage requires prompt assessment and intervention to stop the blood loss.
### Management of Hemorrhage
- Assess clotting and platelet levels.
- Ensure good IV access.
- Place the patient in a shock position.
- Inspect the wound for bleeding.
- Apply direct pressure using sterile dressings.
- Elevate the bleeding part whenever possible.
- Initiate blood transfusions if necessary.
- Monitor vitals frequently (every 15 minutes).
- Consider sedation or narcosis.
- Administer protamine if heparin has been used.
Infection
- Postoperative infections are a significant cause of morbidity after abdominal surgery.
- Prophylactic antibiotics have helped reduce the incidence of infections, but multi-resistant organisms pose a growing challenge.
Wound Infection
- The most common type of wound infection is superficial, occurring within the first week.
- Symptoms include pain, redness, and slight discharge.
- Staphylococcus is the most common cause of superficial wound infections.
Cellulitis and Abscesses
- Cellulitis and abscesses typically occur after bowel-related surgery and present with fever, spreading redness, or localized pus collection.
- Cellulitis is treated with antibiotics.
- Abscesses often require surgical drainage and may necessitate re-exploration.
Gas Gangrene
- Gas gangrene is a rare but life-threatening infection.
Wound Sinus
- A wound sinus is a late complication that can develop after apparently normal wound healing.
- A sinus typically indicates a deep chronic abscess, often caused by non-absorbable suture material or mesh.
Factors Affecting Wound Healing
- Poor blood supply
- Excess suture tension
- Long-term steroid use
- Immunosuppressive therapy
- Radiotherapy
- Severe rheumatoid disease
- Malnutrition and vitamin deficiency
Wound Complications
- Wound Infection (Sepsis) is characterized by redness, swelling, pain, heat, and purulent drainage.
- Wound Dehiscence is partial or complete separation of wound edges.
- Wound Evisceration is protrusion of abdominal organs through the incision, requiring immediate surgical intervention.
Respiratory Complications
- Respiratory complications are common after major surgery, especially after general anesthesia.
Atelectasis
- Atelectasis (collapsed lung) is caused by airway obstruction, often due to mucus buildup.
- Symptoms include slower recovery, poor color, rapid breathing, and rapid heart rate.
- Prevention of atelectasis includes deep breathing exercises, early ambulation, and coughing.
Postoperative Fever
- Mild fever (temperature 38°C) in the first two days post-surgery could be due to various reasons like atelectasis, specific infections related to the surgery, blood transfusion reactions, or drug reactions.
- Atelectasis is a condition where the lung collapses and may become secondarily infected.
- Fever in the first two days could also indicate bronchopneumonia, sepsis, wound infection, DVT, or abscess formations like pelvic or subphrenic.
Hemorrhage
- Primary hemorrhage occurs during surgery while reactionary hemorrhage happens post-surgery due to increased blood pressure. Both situations require immediate replacement of blood loss and may necessitate a return to the operating room to re-explore the wound.
- Late postoperative hemorrhage occurs several days after surgery and is typically caused by an infection damaging vessels at the surgical site. This requires treating the infection and may involve exploratory surgery.
Management of Hemorrhage
- Conduct clotting screen and platelet count, establish good intravenous access, and place the patient in a shock position.
- Inspect the wound for bleeding, apply direct pressure with sterile dressing pads or bandages, elevate the bleeding area if possible, and initiate blood transfusion if needed.
- Monitor vital signs every 15 minutes, administer sedation or narcosis if prescribed, and provide protamine if heparin was used.
Infection
- Infectious complications are a primary cause of morbidity in abdominal surgery, even though prophylactic antibiotics have reduced their incidence.
- Multi-resistant organisms pose an increasing challenge.
Wound Infection
- The most common type is a superficial wound infection occurring within the first week, presenting as localized pain, redness, and mild discharge. It is usually caused by skin staphylococci.
Cellulitis and Abscesses
- Often occur after bowel-related surgery and can appear as late as the third postoperative week.
- Present with pyrexia, spreading cellulitis, or abscesses.
- Cellulitis is treated with antibiotics while abscesses require suture removal, probing of the wound, and possible surgical re-exploration.
- The wound is left open to heal by secondary intention in both cases.
Gas Gangrene
- Uncommon but life-threatening.
Wound Sinus
- Late infectious complication from a deep chronic abscess, occurring after apparently normal healing.
- Typically needs re-exploration to remove non-absorbable sutures or mesh, which are often the underlying cause.
Disordered Wound Healing
- Most wounds heal without complications and healing is not impaired in the elderly unless there are specific adverse factors or complications.
- Factors affecting healing rate include poor blood supply, excess suture tension, long-term steroid use, immunosuppressive therapy, radiotherapy, severe rheumatoid disease, malnutrition, and vitamin deficiency.
Wound Complications
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Wound Infection (Sepsis): Occurs around 3-6 days after surgery, with symptoms including redness, swelling, tenderness, heat around the wound, purulent drainage, increased pulse rate and temperature, and positive laboratory examination of wound drainage.
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Treatment: Removal of sutures, wound irrigation and cleaning with sterile saline, and appropriate antibiotic therapy based on culture findings.
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Wound Dehiscence or Wound Disruption: Partial-to-complete separation of wound edges.
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Wound Evisceration: Protrusion of abdominal viscera through the incision onto the abdominal wall.
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Management of wound dehiscence and evisceration:
- Immediately notify the surgeon.
- Position the client in low Fowler's position.
- Instruct the client to avoid coughing, sneezing, eating, drinking, and remain quiet until the surgeon arrives.
- Cover protruding viscera with a sterile dressing moistened with sterile normal saline.
Respiratory Complications
- Respiratory complications occur after major surgery, particularly after general anesthesia.
- Complications include:
- Atelectasis (alveolar collapse): Caused by airway obstruction, usually by bronchial secretions. Most cases are mild and go unnoticed. Symptoms include slow recovery from surgery, poor color, mild tachypnea, and tachycardia.
- Prevention: Regular chest physiotherapy, deep breathing exercises, and early ambulation.
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Description
Test your knowledge on postoperative fever and hemorrhage with this quiz. Learn about the various causes of fever after surgery, the important factors to consider, and the different types of hemorrhage that can occur during and after surgical procedures. This quiz is essential for nursing and medical students alike.
