Examkin

Soru

Zorluk: KolayPreoperative and Postoperative Care

A 68-year-old woman is examined on the fourth day of her recovery following an elective low anterior resection for rectal cancer. She reports experiencing new-onset lower abdominal discomfort over the past 12 hours. The patient has had an indwelling urethral catheter in place since the operation to prevent postoperative urinary retention. Her temperature is 38.4°C (101.1°F), blood pressure is 118/76 mm Hg, heart rate is 92/min, and respiratory rate is 16/min. Physical examination shows a soft abdomen with mild tenderness localized to the suprapubic region. The midline abdominal surgical incision is well-approximated, dry, and lacks any surrounding erythema or induration. The patient's lungs are clear to auscultation bilaterally, and there is no edema or tenderness in her lower extremities. Which of the following is the most appropriate next step in the management of this patient's fever?

  1. Urinalysis and urine cultureCevap
  2. B
    Immediate initiation of empiric intravenous broad-spectrum antibiotics
  3. C
    Bilateral lower extremity venous duplex ultrasonography
  4. D
    Computed tomography angiography of the chest
  5. E
    Bedside removal of surgical sutures and wound exploration

Cevap

Urinalysis and urine culture
The correct answer is Urinalysis and urine culture because the patient's presentation of fever on postoperative day 4 with an indwelling urinary catheter and suprapubic pain is highly indicative of a urinary tract infection. The classic '5 Ws' mnemonic for postoperative fever places urinary tract infections ('Water') typically in the day 3 to 5 timeframe. Proper protocol dictates obtaining a urinalysis and urine culture to confirm the diagnosis and identify the causative organism before initiating any targeted antimicrobial therapy.

Adım Adım Çözüm

1
Analyze the timing of the patient's postoperative fever.
The fever occurs on postoperative day 4.
The postoperative day helps narrow the differential diagnosis according to the classic '5 Ws' (Wind, Water, Walking, Wound, Wonder drugs). Day 3-5 fevers are typically associated with 'Water' (urinary tract infections).
2
Correlate the timing with the patient's physical examination and history.
The patient has an indwelling urinary catheter and new suprapubic tenderness, without respiratory symptoms, calf pain, or wound erythema.
Suprapubic tenderness in the presence of a Foley catheter strongly points to a catheter-associated urinary tract infection.
3
Determine the most appropriate initial management step.
A diagnostic workup with a urinalysis and urine culture is indicated.
Before initiating any antimicrobial therapy, it is essential to confirm the source of infection and obtain cultures to guide targeted treatment.

Anahtar Kavram

Catheter-associated urinary tract infections are a common cause of postoperative fever occurring typically between days 3 and 5 ('Water' in the 5 Ws mnemonic), and initial management requires urinalysis and culture before antibiotics.
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Preoperative and Postoperative Care

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