“The 6 W’s” (chronologically)
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Details
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Wind (atelectasis)
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- occurs within the first 48hrs. post-op
- dyspnea, tachycardia, pyrexia, cyanosis, painful productive cough (sputum may be purulent)
- diminished chest movement & reduced air entry on affected side
- opacity of involved segment ± mediastinal shift on CXR
- chest PT & incentive spirometry may be beneficial
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Water (UTI)
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- irritative symptoms (FUND) – frequency, urgency, nocturia & dysuria
- incomplete emptying & incontinence
- investigations – urinalysis with C & S
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Wound (healing/infection)
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- risk factors – DM, immunosuppression, obesity, poor vasculature, contamination, long operating time, etc.
- signs – redness (rubor), swelling (tumor), heat & erythema (calor), increased pain (dolor) ± drainage
- Staph most common pathogen
- post-op infection rare until POD #4 unless pre-existing infection present
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Walking (DVT ? PE)
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- DVT -local swelling, tenderness and warmth, mild pyrexia, persistent tachycardia, + Homan’s sign
- Doppler ultrasound to confirm diagnosis
- PE – SOB, tachycardia, pleuritic CP, hemoptysis,
- spiral CT of chest to confirm diagnosis
- Tx. therapeutic Fragmin
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Wonder drug (drug rxn.)
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- many potential signs & symptoms
- consider possible rxn. to anesthetic
- D/C drug immediately & treat symptomatically
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Wein “vein” (thrombophlebitis)
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- painful and cord-like inflamed area is diagnostic
- infection may occur and spread rapidly up the vein resulting in the formation of an abscess or bacteremia
- tx. includes support (stocking + elevation) & anti-inflammatory drugs
- 1/4 of pts. may have an underlying DVT
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