9: Surgical Pt

Question 1

When does NPO begin for Sx pts?

Answer 1

Before midnight

Question 2

What are the cardiovascular effects seen during Sx? How do you Tx this?

Answer 2

Dec. BP + contractility; Vasodilation;

Tx with IV fluids + vasopressors

Question 3

Hoarseness, dislocated arytenoid, vocal cord granuloma, SOB, and dislocated hyoid call all result from what procedure

Answer 3

Intubation

Question 4

What can you have secondary to Rxs?

Answer 4

Urinary retention

Question 5

What is atelectasis?

Answer 5

Partial or total collapse of lung due to hypoventilation

Question 6

Airway collapse is caused by what?

Answer 6

Inflammation (will see in increase in temp)

Question 7

Fluid overload is usually transient and result in what problems?

Answer 7

CHF and edema

Question 8

Third spacing of fluid after trauma should resolve in what time frame?

Answer 8

24-48 hours

Question 9

Contraction ileus and urinary retention can result from what Rx?

Answer 9

Chlonergic m. relaxants like glycolpyrrolate and atropine; secondary to inc. parasympathetics

Question 10

Benadryl can cause the previous effect in what populations?

Answer 10

Kids and old ppl

Question 11

When does increased sympathetic tone happen?

Answer 11

After anesthesia wears off: resets Co2 r’s and apneic threshold

Question 12

Hypercarbia post anesthesia will cause what to be released?

Answer 12

Catecholamines __> low grade fever

Question 13

4 W’s of Post Op

Answer 13

Wound (infection)
Water ( bladder problems)
Wind (lungs)
Walking (DVT)

Question 14

What usually is causing back pain in the post op pt?

Answer 14

Extended sacrum

Question 15

What is an dynamic ileus?

Answer 15

Diminished or absent motility secondary to inhibition of neuromuscular apparatus

Can be secondary to appendicitis, peritonitis, Sx manipulation, anastomotic leakage, pancreatitis, stones sepsis, electrolyte imbalance, and most importantly OPIOIDS

Question 16

What is a spastic ileus?

Answer 16

Contracted bowel musculature (inhibits propulsive motility); rare; usually secondary to organophosphates, heavy metal poisoning, porphyria, and occasionally uremia.

Question 17

What happens in a vascular occlusion ileus?

Answer 17

Sx emergency; it’s a dead or ischemic bowel!

Question 18

What can cause shoulder pain post oP?

Answer 18

Diaphragmatic irritation referral pain from insufflation gas

Question 19

What is the innervation of the shoulder?

Answer 19

Suprascap n.; Upper subscap. n; Axillary C5-6

Question 20

What GI plexus controls motility?

Answer 20

Auerbach plexus

Question 21

What GI plexus controls secretions and blood flow?

Answer 21

Meisner plexus

Question 22

Increased IgA levels from OMT might lead to the prevention of what lung condition?

Answer 22

URTI

Question 23

What can you do to quickly return pt to baseline FVC and FEV1?

Answer 23

Normalize thoracic lymphatic drainage

Question 24

OMT can do what for the post op pt?

Answer 24

Reduce incidence of ileus; reduced rate and length of stay; and required less morphine