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Surgical complcation
- 3. preoperative screening nutritional status health of the heart and lung
- 4. Seroma A seroma is a collection of liquefied fat, serum, and lymphatic fluid under the incision. The fluid is usually clear, yellow, and viscous and is found in the subcutaneous layer of the skin
- 6. swelling pressure discomfort occasional drainage suction drains
- 7. at least two aspirations secondary intention open drainage
- 8. infected seroma open drainage severe sepsis spreading cellulitis
- 9. Hematoma abnormal collection of blood
- 11. coagulopathy
- 12. antiplatelet drugs anticoagulants vitamin K antagonist
- 14. correcting any clotting abnormalities discontinuing medications that alter coagulation.
- 15. high risk 4 to 5 days before surgery (INR) to be less than 1.5 bridging anticoagulation UFH LMWH 4 hours 16 to 24 hours
- 16. 12 to 24 hours after surgery delayed for 48 to 72 hours
- 18. acetylsalicylic acid clopidogrel 6 to 7 days before surgery 24 hours after surgery continued in the perioperative period
- 19. fresh-frozen plasma prothrombin concentrate low-dose IV or oral vitamin K • Closed suction drainage
- 20. assessment of preexisting risk factors coagulation parameters
- 24. • Gram-positive cocci gram-negative bacilli
- 26. patient-related operative procedure–related factors specific surgical procedure surgical wounds
- 31. heavy smokers at least 30 days before surgery glucose levels malnourished 7 to 14 days before surgery Obese high doses of corticosteroids
- 36. a preoperative dose 4 hours apart two postoperative doses 30 minutes
- 39. drains closed suction drains very deep large wounds large wound flaps
- 40. widespread cellulitis significant signs of infection fever tachycardia IV antibiotics • Empirical therapy vancomycin linezolid clindamycin Cultures
- 41. • Wound cultures small superficial not associated with cellulitis tissue necrosis fascial dehiscence more complex infection
- 42. infection systemic inflammatory response syndrome two thirds of patients infection one third of cases.
- 44. UTI
- 48. 5 to 8 days after surgery first 48 to 72 atelectasis clostridial streptococcal SSIs
- 49. 5 to 8 days postoperatively
- 51. • Complete blood count urinalysis culture radiograph of the chest blood culture
- 52. (CT) of the abdomen
- 56. • Vital capacity reduced 50% first 2 days
- 57. mild to moderate aggressive pulmonary toilet severe intubation
- 58. Type I hypoxic abnormal gas exchange alveolar level low partial arterial oxygen pressure (PaO2) normal partial arterial carbon dioxide pressure (PaCO2) ventilation-perfusion ( V/Q) mismatching shunting type I failure pulmonary edema sepsis
- 59. Type II respiratory failure hypercapnia low PaO2 high PaCO2 excessive narcotic use increased carbon dioxide production altered respiratory dynamics adult respiratory distress syndrome (ARDS).
- 60. 25% 25% 25%
- 62. history of heavy smoking maintenance on home oxygen inability to walk one flight of stairs without severe respiratory compromise major lung resection older patients who are malnourished pulmonary function tests long-term bronchodilator therapy
- 63. posteroanterior and lateral chest radiographs arterial blood gas PaO2 less than 60 mm Hg PaCO2 is more than 45 to 50 mm Hg
- 64. Spirometry (FEV1) FEV1 greater than 2 liters FEV1 less than 50%
- 65. atelectasis anesthetic abdominal incision postoperative narcotics pneumonia
- 66. more than 48 hours after admission without antecedent signs of infection hospital- acquired pneumonia. • Extended intubation results in ventilator-associated pneumonia.
- 67. Health care–associated pneumonia were hospitalized in the last 90 days nursing facilities frequenting a hemodialysis unit recent antibiotics chemotherapy wound care.
- 68. early (<5 days) late (>5 days)
- 70. early no
- 72. atelectasis low-grade fever malaise diminished breath sounds in the lower lung fields incentive spirometry deep breathing coughing
- 73. high fever occasional mental confusion thick secretion with coughing leukocytosis infiltrates
- 74. prevent stop smoking for at least 1 week before surgery treatment • Adequate pain control proper pulmonary hygiene incentive spirometer cough