Examkin

Soru

Zorluk: OrtaPreoperative and Postoperative Care

A 66-year-old man is evaluated on postoperative day 2 following an elective open ventral hernia repair with mesh placement. The nursing staff notes that he has developed new-onset tachypnea and a low-grade fever. His medical history is significant for ischemic cardiomyopathy, chronic obstructive pulmonary disease, and tobacco use disorder. Vital signs include a temperature of 38.2°C (100.8°F), blood pressure of 132/84 mmHg, heart rate of 94/min, and respiratory rate of 22/min. Oxygen saturation is 93% on room air. Physical examination reveals decreased breath sounds at the bilateral lung bases. There are no pulmonary crackles, expiratory wheezing, or jugular venous distention. The abdominal dressing is clean, dry, and intact. Which of the following are the most appropriate next steps in management? (Select two)

  1. Encourage frequent deep breathing exercises and mobilization out of bedCevap
  2. Obtain a portable anterior-posterior chest radiographCevap
  3. C
    Administer intravenous furosemide and closely monitor urine output
  4. D
    Commence empiric therapy with vancomycin and cefepime
  5. E
    Perform bilateral lower extremity venous duplex ultrasonography

Cevap

The most appropriate next steps are to obtain a portable anterior-posterior chest radiograph and to encourage frequent deep breathing exercises alongside mobilization out of bed.
The patient is experiencing a low-grade fever, tachypnea, and decreased bibasilar breath sounds on postoperative day 2. This clinical picture is highly characteristic of atelectasis, which is the most frequent cause of fever during the first 48 to 72 hours following abdominal surgery. The most appropriate immediate management includes obtaining a chest radiograph to confirm the diagnosis and rule out alternative causes like pneumonia or pleural effusion. Concurrently, initiating aggressive pulmonary toilet through deep breathing exercises and early mobilization is essential to physically open the collapsed alveoli and improve oxygenation.

Adım Adım Çözüm

1
Analyze the timing of the patient's postoperative fever and symptoms.
The low-grade fever and tachypnea are occurring on postoperative day 2.
Timing is crucial for diagnosing postoperative fever. Days 1 and 2 are classic for atelectasis ('Wind').
2
Evaluate the patient's physical examination findings against his medical history.
Decreased bibasilar breath sounds point to alveolar collapse. The absence of crackles, wheezing, and jugular venous distention argues against acute heart failure or a COPD exacerbation.
Correlating symptoms with physical findings isolates the respiratory system as the source without implicating his underlying chronic conditions.
3
Select the appropriate dual approach of diagnosis and therapeutic intervention.
A chest radiograph is selected to visualize the lung fields, and deep breathing with early mobilization is selected to physically expand the airways.
These concurrent steps establish the diagnosis, rule out complications like pneumonia, and actively treat the underlying atelectasis.

Anahtar Kavram

Atelectasis is the most common cause of fever on postoperative days 1 and 2. It is best managed with diagnostic imaging to rule out other pathology and proactive pulmonary toilet (such as incentive spirometry and mobilization) to expand collapsed alveoli.
Bu soruyu puanla

Konular

Preoperative and Postoperative Care

Bu konudan daha fazla soru