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Zorluk: KolayPreoperative and Postoperative Care

A 45-year-old woman is evaluated on her second day of recovery following an uncomplicated open abdominal hysterectomy. Her temperature is 38.3∘C38.3^\circ C (100.9∘F100.9^\circ F), blood pressure is 122/78122/78 mmHg, heart rate is 88/min88/min, and respirations are 18/min18/min. Oxygen saturation is 95%95\% on room air. Physical examination reveals decreased breath sounds at the bilateral lung bases without crackles or wheezes. The surgical incision is clean, dry, and intact with no surrounding erythema or induration. The patient's calves are soft and non-tender. Which of the following are the most appropriate next steps in management? (Select two)

  1. Encourage frequent incentive spirometryCevap
  2. Promote early patient ambulationCevap
  3. C
    Initiate empiric intravenous broad-spectrum antibiotics
  4. D
    Obtain a computed tomography pulmonary angiogram
  5. E
    Perform a bedside exploration of the surgical wound

Cevap

The most appropriate next steps are to encourage frequent incentive spirometry and promote early patient ambulation.
The correct interventions directly address postoperative atelectasis, which is the most likely cause of a low-grade fever and decreased basilar breath sounds on postoperative days 1 and 2. Incentive spirometry and early ambulation encourage deep breathing and alveolar recruitment, treating the underlying alveolar collapse.

Adım Adım Çözüm

1
Analyze the timing of the postoperative fever.
The patient is on postoperative day 2 with a low-grade fever.
Postoperative fevers occurring within the first 48 to 72 hours (postoperative days 1-2) are most commonly due to atelectasis or a normal physiologic response to tissue trauma (the 'Wind' in the '5 Ws' mnemonic).
2
Evaluate the clinical signs and symptoms.
The patient has decreased breath sounds at the lung bases, a clean surgical incision, and no calf tenderness.
These findings support the diagnosis of atelectasis and make other causes like surgical site infection or deep vein thrombosis highly unlikely.
3
Select the appropriate non-pharmacologic interventions.
Incentive spirometry and early ambulation are selected.
These interventions expand the lungs, recruit collapsed alveoli, and improve secretion clearance, effectively managing atelectasis.

Anahtar Kavram

The most common cause of fever on postoperative days 1 and 2 is atelectasis, which is managed preventatively and therapeutically with incentive spirometry, deep breathing exercises, and early ambulation.
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Preoperative and Postoperative Care

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