OpenHealth Q&A

Post-Appendix Surgery Complications in a 70-Year-Old Woman

Hello everyone, I am reaching out to seek guidance regarding my mother, who is in her early 70s. Prior to her emergency operation for a perforated appendix, she was completely self-sufficient and mentally sharp. Now, she finds herself in the hospital facing multiple challenges after the surgery. I would greatly appreciate any recommendations on what inquiries I should pose to her medical team. ## Primary Concerns: - **Delirium and Confusion**: My mother has been excessively drowsy, occasionally forgetful, and at times fails to recognize me. She struggles to recall how she arrived at the hospital and keeps questioning when her surgery will occur, despite it already having taken place. She is currently on a range of medications, including Zosyn (piperacillin/tazobactam), gabapentin, clonazepam, and Tylenol. She received Toradol for just two days but exhibited confusion even prior to that. Could her medications or the infection she’s battling be contributing to her cognitive impairment? - **Abdominal Distension and Discomfort**: Her abdomen appears hard and swollen. Two KUB X-rays indicated a potential obstruction; however, the surgeon suspects an ileus because she’s had watery stools. Should I advocate for further diagnostic procedures, such as a CT scan? - **Stool Concerns**: She has experienced frequent green, watery diarrhea. Is this a side effect of the antibiotics? Would it be appropriate to request a C. difficile stool test? - **Urinary Symptoms**: She mentions a burning sensation during urination. The nursing staff indicated that a urine test is unnecessary since she’s receiving antibiotics. Is this correct, or should I insist on getting a urinalysis or culture? - **Severe Lethargy**: She has been sleeping extensively throughout the day. Could this be attributed to her medication, her renal function (eGFR approximately 52-60), or an ongoing infection? - **Hemoglobin Levels**: Her hemoglobin dropped to 8.5 and has since risen to 9.8, with the doctors asserting that a transfusion isn’t required. Should I explore the possibility of iron supplements or alternate treatments? - **Dietary Needs**: She remains on a liquid diet, and lab results show low albumin and protein levels. There have been contradictory responses from the doctors regarding the progression of her diet. Would it be wise to request a consultation with a nutritionist or recommend supplements? - **Hydration Issues**: My mother appears weak and has not been drinking sufficient fluids. For several days, she was administered only IV antibiotics without continuous fluid support until I intervened. Lab results revealed low CO₂ and high chloride levels. How can I ensure she maintains adequate hydration? ## Additional Information: - Blood cultures have identified Bacteroides fragilis. - She is currently receiving IV Zosyn. - Although her fever has subsided, she is still experiencing significant weakness, bloating, and fatigue, about five days post-operation. ## Questions for the Community: 1. Are symptoms such as confusion, abdominal swelling, watery stools, painful urination, and excessive tiredness to be expected after a perforated appendix surgery and subsequent antibiotic treatment? 2. What potential complications should I ensure the medical team investigates before her discharge? 3. Is it necessary to press for further tests, like a repeat CT scan, urinalysis, a C. difficile stool test, or a nutrition consultation? 4. Could her current medication regimen (gabapentin, clonazepam, Toradol, Zosyn) be exacerbating her lethargy and confusion? 5. What topics should I address in discharge planning to ensure she might continue IV antibiotics at home safely? 🙏 I would greatly appreciate any assistance you can provide. My goal is to ensure that I am asking the appropriate questions and not overlooking anything critical.

Answers (1)

9/11/2025, 9:02:04 AM

OpenHealth AI

Thank you for sharing your mother’s situation; it sounds like a challenging time for both of you. After appendix surgery, particularly with complications like a perforated appendix, it’s common to face multiple post-operative issues, especially in older adults. Let’s break down your primary concerns and form some actionable questions for her medical team.

Key Concerns Overview

1. Cognitive Changes: Delirium and confusion can occur after surgery, particularly in older adults. This may stem from medications, the infection, or even the stress of surgery.
2. Abdominal Symptoms: The abdominal swelling and discomfort are significant and may be linked to an ileus or obstruction.
3. Stool Changes: The frequent watery stool may be related to antibiotics, but C. difficile infection is a valid concern.
4. Urinary Symptoms: A burning sensation during urination could suggest a urinary tract infection (UTI), warranting investigation.
5. Severe Lethargy: This may result from her medication, infection, or dehydration.
6. Hemoglobin Levels: Monitoring her hemoglobin is important, and exploring iron supplementation could be beneficial.
7. Dietary and Hydration Needs: Ensuring she gets enough nutrition and fluids is crucial for recovery.

Actionable Questions for the Medical Team

1. Cognitive Symptoms:

   • Could her medications (gabapentin, clonazepam) be contributing to her confusion and lethargy?
   • What steps can be taken to monitor and manage her cognitive status going forward?

2. Abdominal Distension and Bowel Function:

   • Given the recent KUB X-rays, what is the plan for her abdominal distension? Are further diagnostics like a CT scan warranted to rule out obstruction versus ileus?

3. Stool Concerns:

   • Considering her watery stools, should we perform a C. difficile stool test to rule out infection related to antibiotics?

4. Urinary Symptoms:

   • Is a urinalysis or urine culture appropriate given her urinary symptoms, despite being on antibiotics? What criteria are used to decide this?

5. Lethargy and Hydration:

   • What might be causing her severe lethargy? Can we monitor her renal function more closely? What hydration strategies are recommended to ensure she is drinking enough fluids?

6. Hemoglobin Levels:

   • Given her hemoglobin levels, what monitoring and treatment for her anemia is recommended? Could we discuss the feasibility of iron supplements or dietary changes?

7. Nutritional Support:

   • How long will she be on a liquid diet, and at what point will regular diet progression be considered? Should we consult with a nutritionist to optimize her recovery?

Additional Steps for Recovery

• Monitoring Fluid Intake: Ensure staff is aware of her hydration needs. Consider asking about specific daily fluid intake goals.
• Nutritional Supplements: If her diet progression is slow, asking for recommendations on protein supplements might help improve her albumin levels.
• Discharge Planning: Discuss with the team what home care will look like, especially regarding continuing IV antibiotics and monitoring signs of infection or complications at home.

Final Thoughts

Addressing these questions with her medical team will help clarify her condition and ensure she receives appropriate care. It's great that you're advocating for her; it truly makes a difference in patient recovery. If you have further questions or need more information as you gather insights from the doctors, feel free to reach out. Your proactive approach is commendable and essential for your mother’s recovery.