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3. E Med & Surgery > 4- Intro to Surgery/ the PA Role > Flashcards

4- Intro to Surgery/ the PA Role Flashcards

1
Q

What was the goal of the 7 project guidelines of the Surgical Care Improvement Project (SCIP) Protocol?

A

Prevent avoidable/ infection-related deaths

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2
Q

What is used to indicate preoperative health/ operative risk?

A

ASA classifications I-VI

(I- healthy, VI- brain dead)

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3
Q

What is the Mallampati score used for?

A

Assess for ability to intubate, class I-IV

I- complete visualization of soft palate

II- complete visualization of uvula

III- visualization of only base of uvula

IV- soft palate not visible

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4
Q

What pre-op study should be ordered for a healthy pt who is older than 50 yo or has hx of cardiac/ pulm disease?

A

CXR

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5
Q

When should you obtain a pre-op 12-lead ECG?

A

Men > 45 yo

Women > 55 yo

Hx of cardiac disease, DM, HTN, diuretic use

Major surgery

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6
Q

What is the #1 RF for pulmonary complications during surgery?

A

Cigarette smoking/ vaping

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7
Q

If pt has hx of myocardial infarction, what is the protocol for elective surgeries?

A

Postpone until > 6 months post-MI

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8
Q

What cardiac specific RFs place pts at a greater risk for peri-operative MI? (2)

(want < 10 pts when evaluating RFs)

A

MI in previous 6 mos

S3 gallop/ JVD

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9
Q

When evaluating for coagulation abnormalities, what specific medication use should be noted? (2)

A

NSAIDs

Anti-coagulants

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10
Q

Pre-op elevations in glucose or A1C levels in pt w/ DM are a/w what?

A

Increased risk of post-op infections

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11
Q

What adjustments should be made for pt w/ DM prior to surgery?

A

NPO after midnight- adjust insulin regimens, hold oral agents in a.m.

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12
Q

What post-op management is included in a pt with DM?

A

Follow blood sugar q 6 hrs, maintain between 150-200

Restart insulin/ oral agents when resume eating

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13
Q

What precaution should be taken for surgery if adrenal insufficiency?

A

Additional steroids peri-operatively

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14
Q

What is the meaning of -pexy?

A

Fixation

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15
Q

What is the meaning of -rrhaphy?

A

Suturing

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16
Q

What is the use for a McBurney incision?

A

Appendectomy only

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17
Q

What is the most important part of positioning the pt for surgery?

A

Protect the patient

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18
Q

What type of positioning is most commonly used for general surgery (from diaphragm to pelvis)?

A

Supine

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19
Q

What type of positioning allows for increased exposure to pelvic organs and is used when placing central lines?

A

Trendelenburg

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20
Q

What type of positioning allows for enhanced exposure to upper abdominal viscera?

A

Reverse Trendelenburg

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21
Q

What type of positioning is used for craniotomies of the posterior fossa and cervical spine surgery?

A

Sitting

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22
Q

What type of positioning is used for urologic procedures, gynecologic procedures, and rectal surgery?

A

Lithotomy

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23
Q

What type of positioning is used for spinal surgery?

A

Prone

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24
Q

What type of positioning is used for thoracotomies, nephrectomies, and retroperitoneal approaches?

A

Lateral

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25
Q

What type of gas is used to insufflate the peritoneum in laparoscopic surgery?

A

CO2 (better solubility in blood)

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26
Q

What is an adverse effect a/w laparoscopic surgery?

A

Post-op referred shoulder pain

(due to CO2 on diaphragm and diaphragm stretches)

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27
Q

Which operations are commonly done laparoscopically? (4)

A

Cholecystectomy

Appendectomy

Inguinal/ ventral hernia repair

Nissen fundoplication

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28
Q

What is included as part of post-op daily rounds?

A

Check wounds daily

Vital signs/ I+O

  • I+O q 4-6 hrs POD 1
  • Fever POD 3-5, r/o infection

Advance diet/ control blood sugar

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29
Q

Meds, blood products, and malignant hyperthermia are most likely causes of post-op fever after how long?

A

Immediate (hours)

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30
Q

Nosocomial infections, UTI, and aspiration pneumonia are most likely causes of post-op fever after how long?

A

Acute (first week)

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31
Q

SSI, infection from central venous catheters, abx associated diarrhea are most likely causes of post-op fever after how long?

A

Subacute (1-4 weeks)

32
Q

Infection/ abscess is the most likely causes of post-op fever after how long?

A

Delayed (> 1 month)

33
Q

What diagnostic work-up is indicated if fever is noted 48 hrs post-op or > 102 deg?

(aside from looking at the pt)

A

[CBC, UA, cultures] x 2

CXR

34
Q

What is the most common cause of fever in the first 48 hrs after surgery and what is the tx?

A

Atelectasis

Tx: incentive spirometry, cough/ deep breathing, ambulation

35
Q

What is the tx for post-op fever 0-48 hrs if due to wound infection (group A strep)?

A

Open wound + abx

36
Q

What is the tx for post-op fever 0-48 hrs if due to leakage of bowel anastomosis?

A

Back to OR

37
Q

What is the tx for post-op fever 0-48 hrs if due to aspiration pneumonia?

A

Pulmonary toilet + abx

38
Q

What common complications are a/w fever POD #3-5?

A

Wound infection

Intra-abdominal abscess

39
Q

Although DVT can occur anytime, it usually presents w/ fever at POD #?

A

7-10

40
Q

Fever due to UTI most commonly occurs after POD#?

A

3

41
Q

What local factors affecting wound healing are a/w increased rate of infection and would dehiscence?

A

Hematoma/ seroma

42
Q

Epinephrine can be used to control bleeding but should be avoided where?

A

Areas where distal ischemia may occur- fingers, toes, ears, nose, penis

43
Q

Irrigation w/ saline removes gross contaminates but does NOT do what?

A

Sterilize

44
Q

How long should a wound dressing be left in place for a clean surgical wound?

A

48 hrs to allow for epithelialization

45
Q

What type of wound dressing is used for contaminated wounds?

A

Packed open to promote hemostasis/ drainage

(wet to moist changes q 8-12 hrs)

46
Q

Infection accounts for 1/2 of all post- op complications and is most common 3-7 days after surgery. IF within 1-2 days, what are the likely causative agents?

A

Claustridia, group A strep

47
Q

What is the management for expanding hematomas vs small hematomas?

A

Expanding hematomas - evacuated and control bleeding

Small hematomas- may be left alone

48
Q

Sudden drainage of pink, serosanguineous, salmon-colored peritoneal fluid noted at 5-8 days post-op is suspicious for what type of wound complication?

A

Fascial would dehiscence

Back to OR

49
Q

What is the biggest source of surgical infection?

A

The patient

50
Q

What is the optimal time for admin of parenteral abx for prophylaxis?

A

30-60 min prior to incision

D/c after 24 hrs post-op

51
Q

What abx satisfy the criteria for most operations and are used prophylactically?

A

1st and 2nd gen Cephalosporins

52
Q

What pulmonary complication is seen in the elderly and in pts with decreased mental status, and is often a/w NG feedings?

A

Aspiration

(tx: elevate HOB- 30 deg, NG suction, nasotracheal suctioning)

53
Q

Pt w/ indwelling cath, urinary retention, and stasis is at risk for what surgical complication and what is the tx?

(PE = cloudy urine, fever)

A

UTI

Tx: abx, remove indwelling cath → intermittent cath q 4-6 hrs

54
Q

Surgical complications can lead to what intra-abdominal infections? Suspected etiology?

A

Abscess, peritonitis

E.coli, enterobacter, bacteroides

55
Q

What is included in evaluation if suspicious for bacteremia?

(fever, chills, tachycardia, leukocytosis, hypotension)

A

Check IV sites (redness, tenderness, palpable cords, gross purulence)

Blood cultures x 2

56
Q

What is the management for bacteremia? (4)

A

Change IV lines q 3 days

Make sure lines are properly sealed

Abx

I+D/ vascular consult if suppurative vein

57
Q

What type of debridement uses the body’s own enzymes to liquify necrotic debris and maintain a moist wound environment and when can it NOT be used?

A

Autolytic

NOT used for infected wounds

58
Q

What type of debridement uses chemical enzymes to turn necrotic tissue into slough, causes minimal/ no damage to surrounding tissue and when is it best used?

A

Enzymatic

Hard/ large amounts of eschar

59
Q

What type of debridement includes a wet to dry dressing or hydrotherapy, is painful, and can cause maceration/ risk of exposure to waterborne pathogens?

A

Mechanical

60
Q

When is sharp surgical debridement best used?

A

Large amounts of necrotic tissue, especially in infected wounds

61
Q

How long are disinfected fly larvae placed in a wound for maggot debridement therapy (MDT) and what is the primary disadvantage?

A

2-3 days

Highly perishable (use w/i 24 hrs of delivery)

62
Q

What is included in the management of wound exudate?

A

Maintain moisture (add moisture if dry)

Absorb excess drainage (foam, negative wound pressure)

AVOID wet to dry

63
Q

What tool is used to create sub-atmospheric pressure in the wound bend to enhance granulation and increase perfusion to the wound bed?

A

Negative pressure wound therapy (NPWT)

64
Q

The following are contraindications to what type of wound therapy?

Necrotic tissue, untreated osteomyelitis, fistula to body cavity, malignancy in wound, exposed artery/ vein

A

Negative pressure wound therapy

65
Q

What should be suspected if a wound isn’t healing/ worsens, if exudate/ pain increases, or if odor develops?

A

Infection

66
Q

What type of suture is a/w increased risk of infection but is less apt to tear?

A

Braided

(silk, vicryl)

67
Q

What type of suture reduces risk of infection, and can expand w/ tissue swelling?

A

Non-braided

(prolene, monocryl)

68
Q

The larger the suture number, the smaller the what?

A

Suture/ needle

69
Q

What size suture is used on abdominal muscle and fascia?

A

1.0-2.0

70
Q

What size suture is used for skin closure, NOT on face?

A

3.0-4.0

71
Q

What size suture is used on the face?

A

5.0-6.0

72
Q

What size suture is used on vessels (microsurgery) and anastamoses?

A

> 7.0

73
Q

What type of suturing is good for all types of wounds, and allows for selective removal in case of infection?

A

Interrupted

74
Q

What type of suturing is used for clean wounds, fast to sew, easy to remove, and a/w compromised wound integrity if secondarily infected?

A

Continuous

75
Q

What type of wound closure is a 2 person job, and you must approximate skin edges/ do not invert skin edges?

A

Staples

(surgeon preference to use)

3. E Med & Surgery (19 decks)

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