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⚠️ Diminisyon Risk · Leson 2 sou 6 · 8 min

Jou 1 Jiska 10 Apre Operasyon: Sa Ki Mal Pase e Ki Lè

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

📆 Jou youn ak de: poumon, senyman ak vesi. Jou twa a senk: blesi, entesten ak kayo. Jou senk a dis: ensizyon an ka louvri. Konplikasyon apre operasyon yo swiv yon orè, epi egzamen an teste w sou kalandriye a.

📆 Days one and two: lungs, bleeding and bladder. Days three to five: wound, bowel and clots. Days five to ten: the incision might open. Post-op complications keep a schedule, and the exam quizzes you on the calendar.

💡 Ide prensipal

Poumon, senyman ak vesi nan premye 48 èdtan yo, apre sa blesi, entesten ak kayo nan jou 3 a 5, apre sa dehiscence nan jou 5 a 10. Evisceration: gaz esteril mouye, low Fowler's ak jenou yo leve, NPO, rele chirijyen an.

Lungs, bleeding and bladder in the first 48 hours, then wounds, bowel and clots at days 3 to 5, then dehiscence at days 5 to 10. Evisceration: moist sterile gauze, low Fowler's with knees up, NPO, call the surgeon.

🧠 Poukisa sa enpòtan

PREMYE 48 ÈDTAN YO: ATELECTASIS ak hypoventilation, ki parèt ak yon lafyèv lejè, crackles ak yon saturation k ap bese; anpeche l ak incentive spirometer la 10 fwa pa èdtan pandan w reveye, tous pandan w pwoteje ensizyon an, ak ambulation bonè. HEMORRHAGE ak HYPOVOLEMIA: tachycardia, hypotension, po frèt ak pal, ajitasyon ak pwodiksyon pipi ki ba; tcheke pansman an ak anba pasyan an. URINARY RETENTION: atann pipi nan 6 a 8 èdtan; fè bladder scan si se pa sa. JOU 3 A 5: WOUND INFECTION ak lafyèv, woujè, chalè ak drenaj purulent; PARALYTIC ILEUS ak distention, pa gen flatus ak bowel sounds absan, yo trete l ak estati NPO, yon nasogastric tube ak ambulation; DEEP VEIN THROMBOSIS ak anfleman ak chalè nan yon sèl molè, yo anpeche l ak aparèy compression, ambulation bonè ak antikoagilan prophylactic. JOU 5 A 10: DEHISCENCE (ensizyon an separe) ak EVISCERATION (ògàn yo soti deyò), souvan apre yon sansasyon li kase ak yon koule likid serosanguineous nan pasyan obèz, dyabetik oswa k ap touse. Pou evisceration: kouvri ògàn yo ak gaz esteril ki tranpe nan sterile normal saline, mete pasyan an nan low Fowler's ak jenou yo pliye pou diminye tansyon, kenbe NPO, pa pouse anyen rantre, epi rele chirijyen an. MALIGNANT HYPERTHERMIA rive pandan oswa touswit apre anestezi a: yon end-tidal carbon dioxide k ap monte, rigidité miskilè ak tachycardia vini anvan, apre sa yon tanperati danjere; trete ak dantrolene ak refwadisman.

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.

🏥 Nan lavi reyèl

🫢 Nan sizyèm jou apre operasyon an, yon pasyan ki gen yon gwo ensizyon nan vant touse fò, li di yon bagay te kase, epi enfimyè a jwenn yon bouk entesten sou pansman an. Yo mete gaz esteril ki mouye ak saline sou entesten an, yo bese kabann nan nan low Fowler's ak jenou yo pliye, yo kenbe pasyan an NPO, epi yo rele chirijyen an. Si yo te pouse l rantre oswa yo te chita pasyan an dwat, sa ta fè l pi mal.

🫢 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.

📌 Sa pou retni

  • 48 èdtan: atelectasis, hemorrhage, urinary retention48 hours: atelectasis, hemorrhage, urinary retention
  • Jou 3 a 5: wound infection, ileus, DVTDays 3 to 5: wound infection, ileus, DVT
  • Jou 5 a 10: dehiscence ak evisceration; kouvri, low Fowler's, NPO, chirijyenDays 5 to 10: dehiscence and evisceration; cover, low Fowler's, NPO, surgeon

📖 Tèm nan leson sa a

Eviserasyon (Evisceration): Ògàn ki soti atravè yon ensizyon chirijikal ki louvri; kouvri ak twal gaz esteril imid epi rele chirijyen an.

Deisans (Dehiscence): Separasyon bò yon ensizyon chirijikal, souvan ozalantou jou senk jiska dis.

Ileus paralitik (Paralytic ileus): Yon entesten ki rete deplase apre chiriji, ak distansyon, pa gen gaz ak son entesten absan.

✅ Teste tèt ou

Yon pasyan nan premye jou apre operasyon an gen yon tanperati 38.1 °C (100.6 °F), breath sounds diminye nan baz yo ak yon saturation oksijèn 92%. Ki kòz ki pi pwobab?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

Repons: D · Atelectasis

Lafyèv bonè apre operasyon ak breath sounds diminye nan baz yo se klasik pou atelectasis; wound infection ak DVT rive pi ta.

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

Ensizyon nan vant yon pasyan louvri epi entesten yo vizib. Ki aksyon enfimyè a ta dwe fè anvan?A client's abdominal incision has opened and intestines are visible. Which action should the nurse take first?
  1. Pouse entesten yo rantre dousman epi aplike yon pansman ak presyonGently push the intestines back inside and apply a pressure dressing
  2. Mete pasyan an nan pozisyon high Fowler'sPlace the client in high Fowler's position
  3. Kouvri entesten yo ak gaz esteril mouyeCover the intestines with moist sterile gauze
  4. Bay pasyan an yon vè dlo pou l rete idrateGive the client a glass of water to stay hydrated

Repons: C · Kouvri entesten yo ak gaz esteril mouye

Gaz esteril mouye pwoteje tisi a. Yo kenbe pasyan an NPO nan low Fowler's ak jenou yo pliye, epi yo rele chirijyen an imedyatman. Pouse entesten yo rantre dousman epi aplike yon pansman ak presyon pa bon paske reensere entesten ki ekspoze ka blese tisi epi entwodui enfeksyon.

Moist sterile gauze protects the tissue. The client is kept NPO in low Fowler's with knees flexed, and the surgeon is called immediately. Gently pushing the intestines back inside and applying a pressure dressing is wrong because reinserting exposed bowel can injure tissue and introduce infection.

Ki rezilta apre operasyon nan jou 4 enfimyè a ta dwe rapòte kòm yon paralytic ileus posib?Which post-operative finding on day 4 should the nurse report as a possible paralytic ileus?
  1. Li pase flatus epi li tolere likid klèPassing flatus and tolerating clear liquids
  2. Bowel sounds absan epi pa gen flatusAbsent bowel sounds and no flatus
  3. Doulè lejè nan ensizyon an lè l boujeMild incisional pain with movement
  4. De sèl ki mou epi ki fòme depi operasyon anTwo soft formed bowel movements since surgery

Repons: B · Bowel sounds absan epi pa gen flatus

Distention, bowel sounds absan ak pa gen flatus endike ileus; yo kenbe pasyan an NPO epi yo ka bezwen yon nasogastric tube. Li pase flatus epi li tolere likid klè montre entesten an ap travay ankò, kontrè ileus la.

Distention, absent bowel sounds and no flatus indicate ileus; the client is kept NPO and a nasogastric tube may be needed. Passing flatus and tolerating clear liquids show the bowel is working again, the opposite of an ileus.

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