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Zorluk: KolayPreoperative and Postoperative Care

A 45-year-old woman is evaluated on postoperative day 1 following an uncomplicated open cholecystectomy. She reports mild pain at the incision site but otherwise feels well. Her temperature is 38.2°C (100.8°F), blood pressure is 122/78 mmHg, pulse is 88/min, and respirations are 16/min. Physical examination reveals decreased breath sounds at both lung bases. The surgical incision is clean, dry, and intact with no erythema, induration, or purulent drainage. The patient's calves are non-tender. Which of the following is the most appropriate next step in management?

  1. Incentive spirometry and early ambulationCevap
  2. B
    Blood cultures and empiric intravenous antibiotics
  3. C
    Computed tomography of the abdomen with contrast
  4. D
    Opening of the surgical wound at the bedside
  5. E
    Initiation of a therapeutic dose of low-molecular-weight heparin

Cevap

The most appropriate next step in management is encouraging incentive spirometry and early ambulation to treat postoperative atelectasis.
The correct answer is to encourage incentive spirometry and early ambulation. Postoperative fever in the first 24 to 48 hours is classically caused by atelectasis (the 'Wind' in the mnemonic for postoperative fever etiologies). The physical examination finding of decreased breath sounds at the lung bases further supports this diagnosis. Management is supportive and focuses on pulmonary toilet to expand the alveoli and clear secretions.

Adım Adım Çözüm

1
Analyze the timeline of the patient's fever.
The patient has a low-grade fever on postoperative day 1.
Timing is the most important clue for postoperative fever. Days 1-2 are classically associated with the 'Wind' etiology.
2
Correlate the timeline with physical examination findings.
Decreased breath sounds at the lung bases support a pulmonary etiology, while normal wound and calf exams decrease suspicion for infection or deep vein thrombosis.
This confirms the clinical suspicion of atelectasis.
3
Determine the appropriate management for the identified condition.
Supportive pulmonary care is indicated.
Atelectasis is managed with chest physiotherapy, deep breathing exercises (incentive spirometry), and early ambulation rather than pharmacologic or surgical interventions.

Anahtar Kavram

Fever in the first 24 to 48 hours postoperatively is most commonly caused by atelectasis, which is diagnosed clinically and managed with incentive spirometry and early ambulation.
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Preoperative and Postoperative Care

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