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TOPICS:
● Pre-op and Post-op Counseling and Management (Dr. Crisostomo)
● Hyperandrogenism (Dr. Dichoso)
● Infertility (Dr. Dichoso)
● Primary & Secondary Amenorrhea/ Precocious Puberty/ Hypeprolactenemia (Dr. Dichoso)
QUESTIONS RATIONALIZATION
Vesicovaginal Fistula
● Allows the continuous involuntary discharge of
urine into the vaginal
11. Immediately after surgery, the patient’s vital signs are ANSWER: B
monitored in the recovery room every:
Post-operative Period
A. 1 minute 1st phase - Perioperative Stabilization (24-48 hours)
B. 15 minutes ● resumption of normal physiologic function of the
C. 1 hour respiratory, cardiovascular and neurologic
D. Nurse’s shift (8 hours) ● recovery from anesthesia and stabilization of
hemostasis with resumption of oral intake
● when we put patient in the recovery room, they will
say monitor vital signs q 15 for the 1st 1 to 2 hours.
Take BP, HR, temp, RR, and UO
2nd phase - Post-operative Recovery (1-4 days)
● hospital or at home
● regular diet, ambulation shift from parenteral to oral
meds
● post-operative complications become apparent
3rd phase - Return to Normalcy (1-6 weeks)
● out-patient setting
● increase in strength, back to normal activity
● minor surgery – 2 weeks
● major op – about 6 weeks
12. Post operatively, the patient developed ileus. The next ANSWER: C
step to do would be any of the following EXCEPT:
Ileus
A. Placing patient on NPO ● arrest and disorganized gastrointestinal motility
B. Fluid and electrolyte replacement ● refers to an impairment of intestinal motility
C. Exploratory laparotomy ETIOLOGY/RISK FACTORS
D. Insertion of NGT ● opening of abdominal cavity
● aggressive manipulation of intestinal tract and
prolonged surgical procedure
● infection
● electrolyte imbalance
SIGNS AND SYMPTOMS
● abdominal distention
● belching
● cramping and pain
● decreased bowel sounds
● nausea and vomiting
● could resolve within 2-3 days (relative ileus) or
continue past several days post operation
You have to put the patient on NPO and insert NGT, since
the GIT is dysfunctional, the food cannot pass through the
tract properly. Give fluids and electrolytes to serve as
nutrition.
15. The most common cause of late post-operative fever is: ANSWER: B
18. The patient is placed on NPO (nothing per orem) for 8 ANSWER: D
hours before surgery primarily to prevent:
ASPIRATION PNEUMONIA
A. Fluid overload ● chemical pneumonitis due to aspiration of gastric
B. Post-operative ileus fluid leading to destructive inflammatory response
C. Hyperglycemia leading to adult respiratory distress syndrome
D. Aspiration pneumonia ● RISK FACTORS
○ older women
○ obese
○ hiatal hernia
○ emergency surgery done on patient with
full stomach – hindi na prepare for surgery.
This is also the reason why we put the
patient on NPO prior to surgery
● PREVENTION
○ early removal of nasogastric suction
○ antacid ingestion
○ H2 blockers during perioperative period
○ NPO prior to surgery
● TREATMENT
○ antibiotics
○ ventilator support