A 34-year-old woman is evaluated on the surgical ward 30 hours after undergoing an elective laparoscopic myomectomy for symptomatic uterine fibroids. The nursing staff notifies the physician because the patient's temperature has increased to 38.4°C (101.1°F). She is resting comfortably in bed and reports mild soreness at the surgical port sites. Her blood pressure is 118/76 mm Hg, pulse is 82/min, and respirations are 16/min. Pulse oximetry shows 98% on room air. Physical examination reveals clear lungs bilaterally, normal active bowel sounds, and non-erythematous incisions without any discharge or induration. Which of the following are the most appropriate next steps in managing this patient? (Select exactly 2 options)
- Reassurance and continued routine observationCevap
- Encouragement of incentive spirometry and early ambulationCevap
- CInitiation of empiric broad-spectrum intravenous antibiotics
- DCollection of blood and urine cultures with a chest radiograph
- EOrdering a bilateral lower extremity venous Doppler ultrasound
Cevap
The correct steps are reassurance with continued observation, and encouragement of incentive spirometry and early ambulation.
Fevers occurring within the first 48 hours after surgery are most commonly physiologic, resulting from surgical tissue trauma and the subsequent release of inflammatory cytokines (such as IL-1, IL-6, and TNF-alpha). In a patient who is hemodynamically stable with a benign physical examination and no localizing signs of infection, extensive diagnostic testing is unnecessary. The standard of care includes reassurance, adequate pain control, and continued preventive measures. These preventive measures include early ambulation and incentive spirometry, which are vital to prevent complications like atelectasis and venous thromboembolism.
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Management of early postoperative fever (first 48 hours)
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