Examkin

Question

Difficulty: EasyPreoperative and Postoperative Care

Approximately 24 hours following an uncomplicated open appendectomy, a 34-year-old man is noted to have an elevated temperature. He has no significant past medical history and takes no routine medications. He currently complains only of expected mild pain at the surgical site. Vital signs show a temperature of 38.2°C (100.8°F), a heart rate of 90/min, blood pressure of 124/78 mm Hg, and a respiratory rate of 16/min. Oxygen saturation is 96% on room air. Auscultation of the chest demonstrates diminished breath sounds at the bilateral lung bases. Examination of the abdomen shows a dry, intact surgical dressing with no surrounding erythema or induration. Which of the following is the most appropriate next step in the management of this patient?

  1. Encourage incentive spirometry and early ambulationAnswer
  2. B
    Obtain blood cultures and start broad-spectrum intravenous antibiotics
  3. C
    Perform lower extremity compression ultrasonography
  4. D
    Remove the surgical dressing and probe the incision site
  5. E
    Administer a dose of intravenous furosemide

Answer

Encourage incentive spirometry and early ambulation
The most appropriate next step in management is to encourage incentive spirometry and early ambulation. This patient's presentation of a low-grade fever within the first 24 to 48 hours after surgery, combined with diminished breath sounds at the lung bases, is the classic presentation of atelectasis. Atelectasis is a very common postoperative complication caused by shallow breathing and impaired cough mechanics secondary to pain or anesthesia. It is considered a non-infectious cause of early postoperative fever. The standard treatment is pulmonary toilet, encompassing early ambulation, deep breathing exercises, and incentive spirometry, which help to re-expand collapsed alveoli.

Step-by-Step Solution

1
Analyze the patient's timeline
The patient is 24 hours (postoperative day 1) status post open appendectomy.
The timing of postoperative fever is the most critical factor in determining its etiology.
2
Evaluate the clinical signs and symptoms
The patient has a low-grade fever, diminished breath sounds at the bases, normal oxygen saturation, and no wound abnormalities.
Physical exam findings correlate with the expected physiologic changes, specifically alveolar collapse (atelectasis).
3
Determine the appropriate management
Identify atelectasis as the diagnosis and select non-pharmacologic respiratory interventions.
Atelectasis is managed and prevented effectively with pulmonary toilet, which includes incentive spirometry, deep breathing, and early ambulation.

Key Concept

Postoperative fever on days 1-2 is most commonly caused by atelectasis, which is managed preventatively and therapeutically with incentive spirometry and early ambulation.
Rate this question

Topics

Preoperative and Postoperative Care

More questions from this topic