Postoperative Patient Management Flashcards

A patient's postoperative chest X-ray shows a wedge-shaped density in the right lower lobe. Combined with tachycardia, dyspnea, and elevated D-dimer, this presentation is MOST consistent with:

Answer: Pulmonary embolism with Hampton's hump sign

A Hampton's hump (wedge-shaped pleural-based density) in the setting of tachycardia and elevated D-dimer is a classic radiographic sign of pulmonary infarction from embolism.

When educating a patient about incentive spirometry after open abdominal surgery, the surgical first assistant should instruct the patient to:

Answer: Use it 10 times every 1-2 hours while awake, holding the breath at peak inhalation

Incentive spirometry should be performed frequently while awake (every 1-2 hours) with sustained maximal inspiration to prevent atelectasis.

A postoperative patient with a T6 spinal cord injury develops a sudden severe headache, hypertension (BP 210/110), bradycardia, and profuse diaphoresis above the injury level. The PRIORITY action is:

Answer: Identify and remove the noxious stimulus (check catheter, bowel distension)

Autonomic dysreflexia is a medical emergency triggered by noxious stimuli below the injury; removing the trigger (commonly bladder distension or pressure) is the first priority.

Which postoperative electrolyte imbalance is MOST commonly associated with cardiac arrhythmias and is a known risk following prolonged nasogastric suctioning?

Answer: Hypokalemia

Prolonged NG suctioning removes gastric fluid rich in potassium and hydrogen ions, leading to hypokalemia and metabolic alkalosis that predispose to arrhythmias.

A patient who had a Whipple procedure (pancreaticoduodenectomy) 3 days ago develops fever, leukocytosis, and a new onset of abdominal pain. Drain amylase levels are elevated 3x the upper limit of normal. This is MOST consistent with:

Answer: Pancreatic fistula/leak

Elevated drain amylase greater than 3x the upper limit of normal on postoperative day 3 or later is the diagnostic criterion for a postoperative pancreatic fistula.

The Aldrete score used for PACU discharge decisions evaluates which five parameters?

Answer: Activity, respiration, circulation, consciousness, and oxygen saturation

The modified Aldrete score assesses activity level, respiratory effort, circulation (BP), consciousness, and oxygen saturation to determine PACU discharge readiness.

A patient in the PACU who received spinal anesthesia for an inguinal hernia repair is unable to move their legs 3 hours postoperatively. The MOST appropriate action is:

Answer: Monitor and document, as motor block resolution after spinal anesthesia can take 2-4 hours

Spinal anesthesia can produce motor blockade lasting 2-4 hours depending on the agent used; this is expected and requires monitoring, not emergency intervention in the absence of other neurologic signs.