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⚠️ Pagbabawas ng Panganib · Aralin 2 sa 6 · 8 min

Post-op Day 1 Hanggang 10: Ano ang Nagkakamali at Kailan

Post-op Days 1 Through 10: What Goes Wrong When

📆 Unang araw: baga. Ikatlong araw: sugat at pantog. Ikalimang araw: maaaring bumuka ang incision. May iskedyul ang mga post-op complication, at ang exam ay nagtatanong ayon sa kalendaryo.

📆 Day one: lungs. Day three: wound and bladder. Day five: the incision might open. Post-op complications keep a schedule, and the exam quizzes you on the calendar.

💡 Pangunahing ideya

Una ang baga, saka ang sugat, pantog, bituka at clots, saka ang dehiscence sa day 5 hanggang 10. Evisceration: basang sterile gauze, low Fowler's na nakataas ang tuhod, NPO, tawagan ang surgeon.

Lungs first, then wounds, bladder, bowel and clots, then dehiscence at days 5 to 10. Evisceration: moist sterile gauze, low Fowler's with knees up, NPO, call the surgeon.

🧠 Bakit mahalaga

UNANG 48 ORAS: ATELECTASIS at hypoventilation, na makikita sa mababang lagnat, crackles at bumababang saturation; maiwasan ito sa incentive spirometer 10 beses kada oras habang gising, pag-ubo habang naka-splint ang incision, at maagang paglalakad. HEMORRHAGE at HYPOVOLEMIA: tachycardia, hypotension, malamig at maputlang balat, pagkabalisa at kaunting ihi; suriin ang dressing at sa ilalim ng pasyente. URINARY RETENTION: inaasahang makakaihi sa loob ng 6 hanggang 8 oras; mag-bladder scan kung hindi. DAY 3 HANGGANG 5: WOUND INFECTION na may lagnat, pamumula, init at purulent na drainage; PARALYTIC ILEUS na may distention, walang flatus at walang bowel sounds, na ginagamot sa NPO status, nasogastric tube at paglalakad; DEEP VEIN THROMBOSIS na may pamamaga at init ng isang binti sa bahagi ng calf, na naiiwasan sa compression devices, maagang paglalakad at prophylactic anticoagulants. DAY 5 HANGGANG 10: DEHISCENCE (bumubuka ang incision) at EVISCERATION (lumalabas ang mga organ), kadalasan pagkatapos ng 'pop' na may biglang paglabas ng serosanguineous na likido sa mga obese, diabetic o umuubong pasyente. Para sa evisceration: takpan ang mga organ ng sterile gauze na binasa sa sterile normal saline, ilagay ang pasyente sa low Fowler's na nakabaluktot ang mga tuhod para mabawasan ang tension, panatilihing NPO, huwag itulak pabalik ang anuman, at tawagan ang surgeon. Ang MALIGNANT HYPERTHERMIA ay nangyayari habang o pagkatapos ng anesthesia: tumataas na end-tidal carbon dioxide, paninigas ng kalamnan at tachycardia ang mauuna, bago ang mapanganib na temperatura; gamutin ng dantrolene at cooling.

FIRST 48 HOURS: ATELECTASIS and hypoventilation, shown by a low-grade fever, crackles and a falling saturation; prevent with the incentive spirometer 10 times an hour while awake, coughing with the incision splinted, and early ambulation. HEMORRHAGE and HYPOVOLEMIA: tachycardia, hypotension, cool pale skin, restlessness and low urine output; check the dressing and under the client. URINARY RETENTION: expect voiding within 6 to 8 hours; bladder scan if not. DAYS 3 TO 5: WOUND INFECTION with fever, redness, warmth and purulent drainage; PARALYTIC ILEUS with distention, no flatus and absent bowel sounds, treated with NPO status, a nasogastric tube and ambulation; DEEP VEIN THROMBOSIS with unilateral calf swelling and warmth, prevented with compression devices, early ambulation and prophylactic anticoagulants. DAYS 5 TO 10: DEHISCENCE (the incision separates) and EVISCERATION (organs protrude), often after a 'pop' with a gush of serosanguineous fluid in obese, diabetic or coughing clients. For evisceration: cover the organs with sterile gauze soaked in sterile normal saline, place the client in low Fowler's with the knees bent to reduce tension, keep NPO, do not push anything back in, and call the surgeon. MALIGNANT HYPERTHERMIA occurs during or soon after anesthesia: a rising end-tidal carbon dioxide, muscle rigidity and tachycardia come first, then a dangerous temperature; treat with dantrolene and cooling.

🏥 Sa totoong buhay

🫢 Sa ikaanim na araw pagkatapos ng operasyon, malakas na umubo ang pasyenteng may malaking abdominal incision, sinabing 'parang may bumigay', at nakita ng nurse ang isang loop ng bituka sa dressing. Tinakpan ng sterile gauze na binasa sa saline ang bituka, ibinaba ang kama sa low Fowler's na nakabaluktot ang mga tuhod, pinanatiling NPO ang pasyente, at tinawagan ang surgeon. Mas lalala sana ito kung itinulak pabalik ang bituka o pinaupo ang pasyente.

🫢 On post-op day six, a client with a large abdominal incision coughs hard, says 'something gave way', and the nurse finds a loop of bowel on the dressing. Sterile saline-moistened gauze goes over the bowel, the bed is lowered to low Fowler's with the knees flexed, the client is kept NPO, and the surgeon is called. Pushing it back or sitting the client up would have made it worse.

📌 Tandaan

  • 48 oras: atelectasis, hemorrhage, urinary retention48 hours: atelectasis, hemorrhage, urinary retention
  • Day 3 hanggang 5: wound infection, ileus, DVTDays 3 to 5: wound infection, ileus, DVT
  • Day 5 hanggang 10: dehiscence at evisceration; takpan, low Fowler's, NPO, surgeonDays 5 to 10: dehiscence and evisceration; cover, low Fowler's, NPO, surgeon

📖 Mga term sa araling ito

Evisceration: Paglabas ng mga organ sa nabukas na hiwa ng operasyon; takpan ng basang sterile gauze at tawagan ang surgeon.

Dehiscence: Paghihiwalay ng mga gilid ng hiwa ng operasyon, madalas sa paligid ng ikalima hanggang ikasampung araw.

Paralytic ileus: Isang bituka na tumitigil sa paggalaw pagkatapos ng operasyon, na may distention, walang utot at wala ang bowel sounds.

✅ Subukan ang sarili mo

Ang isang pasyente sa unang post-operative na araw ay may temperatura na 38.1 °C (100.6 °F), humihina ang breath sounds sa mga base at oxygen saturation na 92%. Ano ang pinakamalamang na sanhi?A client on the first post-operative day has a temperature of 38.1 °C (100.6 °F), diminished breath sounds in the bases and an oxygen saturation of 92%. What is the most likely cause?
  1. Deep vein thrombosis
  2. Urinary tract infection
  3. Wound infection
  4. Atelectasis

Sagot: D · Atelectasis

Ang maagang post-op na lagnat na may humihinang basilar breath sounds ay klasiko para sa atelectasis; mas huli lumilitaw ang wound infection at DVT.

Early post-op fever with diminished basilar breath sounds is classic for atelectasis; wound infection and DVT occur later.

Bumuka ang abdominal incision ng isang pasyente at nakikita ang bituka. Aling aksyon ang dapat unang gawin ng nurse?A client's abdominal incision has opened and intestines are visible. Which action should the nurse take first?
  1. Dahan-dahang itulak pabalik ang bituka at maglagay ng pressure dressingGently push the intestines back inside and apply a pressure dressing
  2. Ilagay ang pasyente sa high Fowler's na posisyonPlace the client in high Fowler's position
  3. Takpan ang bituka ng basang sterile gauzeCover the intestines with moist sterile gauze
  4. Painumin ang pasyente ng isang basong tubig para hindi ma-dehydrateGive the client a glass of water to stay hydrated

Sagot: C · Takpan ang bituka ng basang sterile gauze

Pinoprotektahan ng basang sterile gauze ang tissue. Pinananatiling NPO ang pasyente sa low Fowler's na nakabaluktot ang mga tuhod, at agad na tinatawagan ang surgeon.

Moist sterile gauze protects the tissue. The client is kept NPO in low Fowler's with knees flexed, and the surgeon is called immediately.

Alin sa mga post-operative na natuklasan sa day 4 ang dapat i-report ng nurse bilang posibleng paralytic ileus?Which post-operative finding on day 4 should the nurse report as a possible paralytic ileus?
  1. Nag-flatus at kaya ang clear liquidsPassing flatus and tolerating clear liquids
  2. Walang bowel sounds at walang flatusAbsent bowel sounds and no flatus
  3. Bahagyang sakit ng incision kapag gumagalawMild incisional pain with movement
  4. Dalawang malambot at hugis-dumi na pagdumi mula nang operahanTwo soft formed bowel movements since surgery

Sagot: B · Walang bowel sounds at walang flatus

Ang distention, walang bowel sounds at walang flatus ay nagpapahiwatig ng ileus; pinananatiling NPO ang pasyente at maaaring kailanganin ang nasogastric tube.

Distention, absent bowel sounds and no flatus indicate ileus; the client is kept NPO and a nasogastric tube may be needed.

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