Exam 3 Review NUR 644 Questions and
Correct Answers
Complications of colorectral surgery ✅Colorectal surgery can have various
intraoperative and postoperative complications, including bleeding, bowel injury, wound
infection, anastomotic leakage, ileus, and adhesions1.
Postoperative complications can be classified using the Clavien-Dindo classification
system, which is based on the type of therapy needed to correct the complication1.
Factors that can increase the risk of complications include age, gender, emergency
surgery, and pre-existing medical conditions like hypertension, pulmonary disease, and
coronary artery disease1.
Improving surgical techniques, such as the increased use of laparoscopic approaches,
as well as standardizing perioperative care, can help minimize complications
Risk factors for complications in colorectal surgery ✅Non-modifiable risk factors
include age, gender, and prior abdominal surgery1.
Modifiable risk factors that can be addressed preoperatively include nutrition status,
comorbidities, and surgeon experience.
Emergency surgery and higher ASA classification (III+IV) also increase the risk of
adverse events in elderly patients1.
Prevention of complications in colorectal surgery ✅Identifying and addressing
modifiable risk factors before surgery is crucial to minimize complications1.
Improving surgical techniques, such as increased use of laparoscopic approaches, and
standardizing perioperative care can also help reduce complications1.
Surgeon training, hospital volume, and learning curves are becoming increasingly
important to maximize patient safety and outcomes
Causes of compartment syndrome ✅Acute Compartment Syndrome
Severe injuries, such as car accidents, broken bones (especially tibial fractures), and
crush injuries124
Complications from surgery, such as tight bandages or casts
Chronic (Exertional) Compartment Syndrome
Frequent, intense exercise and repetitive motions that put repeated stress on the same
muscle compartments
Possible factors include:Excessive muscle enlargement during exercise Inflexible fascia
(tissue) surrounding the muscle compartment. High-impact activities like running
The underlying mechanism for both acute and chronic compartment syndrome is an
increase in pressure within a confined muscle compartment, which restricts blood flow
and causes pain, swelling, and potential tissue damage. Certain factors can increase
the risk, such as having a blood disorder like hemophilia or participating in physically
demanding jobs or sports. However, anyone can develop acute compartment syndrome
due to sudden injuries.
,Treatment of compartment syndrome ✅Acute Compartment Syndrome
Immediate surgical treatment is required, usually in the form of a fasciotomy124
The surgeon makes an incision to cut open the skin and fascia covering the affected
compartment to relieve the dangerous pressure buildup124
Other supportive treatments include:Keeping the affected limb elevated1Providing
supplemental oxygen4Intravenous fluids1Pain medication1
Chronic (Exertional) Compartment Syndrome
Nonsurgical treatments may include:Avoiding the activity that caused the
condition25Physical therapy and stretching25Anti-inflammatory medications25Orthotics
or shoe inserts25Switching to lower-impact exercises25
If conservative treatments fail, surgical fasciotomy may be an option25This involves
making an incision to release the pressure in the affected compartment25Surgery is
typically an elective procedure, not an emergency like acute compartment syndrome2
The key difference is that acute compartment syndrome requires immediate surgical
intervention, while chronic compartment syndrome can often be managed initially with
conservative treatments before considering surgery
When do you operate on compartment syndrome? ✅Acute Compartment Syndrome
Acute compartment syndrome is a medical emergency that requires immediate surgical
treatment, usually within 6-12 hours of symptom onset.
The standard surgical treatment is a fasciotomy, where the surgeon makes incisions to
release the increased pressure within the affected compartment.
Delaying surgical decompression can lead to permanent muscle and nerve damage, so
a low threshold for intervention is needed.
Chronic (Exertional) Compartment Syndrome
For chronic compartment syndrome, surgery is typically an elective procedure, not an
emergency.
Initial treatment is usually non-surgical, such as activity modification, physical therapy,
and anti-inflammatory medications.
If conservative treatments fail to relieve symptoms, then surgical fasciotomy may be
considered45.
The timing of surgery for chronic compartment syndrome is less urgent compared to
acute cases, as the condition is not immediately life-threatening.
In summary, acute compartment syndrome requires immediate surgical decompression,
often within 6-12 hours, to prevent permanent tissue damage. For chronic compartment
syndrome, surgery is an elective option if conservative treatments are unsuccessful
What are the 5 Ps of compartment syndrome? ✅Pain - Severe, persistent, and
disproportionate pain in the affected limb or area
Paresthesia - Numbness, tingling, or pins and needles sensation in the affected limb
Pallor - Pale or discolored skin in the affected area
Pulselessness - Decreased or absent pulses in the affected limb
Paralysis - Weakness or loss of function in the affected muscles
How to measure intra-abdominal pressure ✅Measuring Intra-Abdominal Pressure
, The most common and recommended method for measuring IAP is the indirect bladder
pressure technique:
A 3-way Foley catheter is used, with the irrigation limb connected to a saline-filled
pressure monitoring system12.
The bladder is filled with 50 mL of saline to ensure a constant volume, and the pressure
is measured at the level of the pubic symphysis2.
This allows the bladder pressure to reflect the pressure in the abdominal cavity, as the
bladder is an intra-abdominal and extra-peritoneal organ12.
Other indirect methods include measuring pressure in the stomach, rectum, or inferior
vena cava, but the bladder technique is preferred as it is simple and minimally
invasive2.
What are High or Worrisome Intra-Abdominal Pressure Levels? ✅High or Worrisome
Intra-Abdominal Pressure Levels
Normal IAP is considered 0-5 mmHg, or up to 7 mmHg in critically ill patients.
Intra-Abdominal Hypertension (IAH) is defined as a sustained IAP ≥ 12 mmHg.
Abdominal Compartment Syndrome (ACS) is a severe form of IAH, defined as a
sustained IAP > 20 mmHg with new organ dysfunction.
IAH and ACS can lead to significant morbidity and mortality if not recognized and
treated, as they can impair perfusion to abdominal organs.
Therefore, any IAP measurement above 12 mmHg should be considered high and
worrisome, requiring close monitoring and potential intervention
What are signs and symptoms of worsening abdominal pressure? ✅Signs and
Symptoms of Worsening Abdominal Pressure
Sustained intra-abdominal pressure (IAP) ≥ 12 mmHg, which is considered Intra-
Abdominal Hypertension (IAH)
IAP > 20 mmHg with new organ dysfunction, which is defined as Abdominal
Compartment Syndrome (ACS)
Decreased urine output
Hypoxemia (low blood oxygen levels)
Decreased cardiac output
Derangement of renal, pulmonary, and cardiovascular systems
Organ dysfunction and potential multi-organ failure if not recognized and treated
promptly
What is difference between intra abdominal hypertension vs abdominal compartment
syndrome? ✅IAH is defined as a sustained intra-abdominal pressure (IAP) above 12
mmHg.
ACS is defined as an IAP above 20 mmHg with evidence of organ failure.
Severity
IAH is a less severe condition, where the pressure in the abdomen is elevated but has
not yet caused organ dysfunction.
ACS is a more severe condition, where the elevated abdominal pressure has led to
impaired blood flow and organ failure.
Outcomes
