Post OP Problems

1. Mrs.Rosy, A 48-year-old woman had a TAH and BSO to remove an ovarian tumour and is seen on the ward round on day 2. She had a poor night with abdominal pain and bloating and has just started vomiting. On examination: she looks pale and sweaty; the abdomen is distended with minimal bowel sounds and generalised tenderness; temperature is 36.8°C; pulse rate is 100 bpm; BP is 120/65 mmHg; respiratory rate is 14 breaths/min; BMI is 36.

2. Mrs. Sweetie , A 30 year-old woman underwent an uncomplicated  Diagnostic laparoscopy and dye test to investigate primary sub Fertility.  Uterus is normal and the fallopian tubes were patent. 6  hours after the operation the woman is experiencing a lot of pain requiring increased PCA. The abdomen is very tender around the secondary port site in the right  iliac fossa is slightly distended; oozing blood-stain fluid, despite a pressure dressing. Observations: pulse rate is 110 bpm; BP is 140/75 mmHg; temperature is 36.5°C; respiratory rate is 18 breaths/min

3. A 75-year-old woman, with a BMI of 24 and who is a non-smoker, had a laparotomy through a mid-line surgical incision for an abdominal and pelvic mass 3 days ago and the tumour was deemed to be inoperable. She has developed some central and right-sided chest pain and is feeling unwell and breathless and has become restless. On examination: abdomen is soft and non-tender; wound satisfactory; chest dull to percussion both bases and poor air entry with some crepitations that clear with coughing. Observations: pulse rate is 96 bpm; BP is 110/60 mmHg; temperature is 38.7°C; respiratory rate is 21 breaths/min

4. Ms. Lucy John /45 year underwent total abdominal hysterectomy on 21/02/2018 for multiple fibroid uterus. NO INTRAOP r post op complications. She developed pulmonary embolism on 23/02/ 2018 at 1.30pm She was immediately shifted to HDU and her recovery has been un eventful She is fit to go home. Pre operative period – her risk assessment for DVT done and her score was 3 (Obesity, major procedure and varicose veins ) according to trust guildelines her DVT prophylaxis -LMWH 60mg once daily Unfractionated heparin 8000units thrice a day was given Her medication charts has been enclosed.

The reason for her  pulmonary embolism is

5. SBAR is one of the most important risk management tool for  effective management of patients. Its party of patient safety culture. Very vital too in managing emergencies. All are contents of SBAR Except.

6. The NPSA NHS ‘5 Moments’ resource is an essential toolkit for all healthcare professionals who come into direct contact with patients. All are correct regarding except

7. Ms. Hazel, 24-year-old woman had an epidural for analgesia in labour. She had an emergency caesarean section for delayed progress in first stage. You go to see her the next day to debrief her, when she complains of a headache, which is more infrontal area its relived by lying down and severe while sitting & walking . Her BMI is 40kg/m2, blood pressure is 130/85mm of Hg. What is the reason for  her headache?

8. Mrs. lucy, 48year old underwent  total abdominal hysterectomy with BSO for abnormal uterine bleeding. On 7th day after surgery she presents with abdomen distension & persistent vomiting. On examination pulse-100bpm Blood pressure -100/70mm of Hg. Saturation 94%, RR-18bom Temperature is 37.2c Abdomen -soft, distention -present bowel sounds-absent, no guarding or rigidity. Her Erect abdomen x ray is enclosed. What is your most probable diagnosis?

9. Mrs. lucy, 48year old underwent  total abdominal hysterectomy with BSO for abnormal uterine bleeding. On 7th day after surgery she presents with abdomen distension &persistent vomiting. On examination pulse-100bpm Blood pressure -100/70mm of Hg. Saturation 94%, RR-18bom Temperature is 37.2c Abdomen -soft, distention -present bowel sounds-absent, guarding and rigidity is present. Her Erect abdomen shows small bowel obstruction. How would you treat her ?

10. Paralytic ileus is one of the commonest complication in postoperative period. All are correct regarding paralytic ileus  are true except

11. Rebecca, 46 year old and then again in the gynaecology ward. Her respiratory rate is suppressed; she is drowsy and has pinpoint pupils. What medication would you give to reverse this potential morphine overdose?