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Block 4 - CritCareSurg > Clin Lab - Surg Dx > Flashcards

Clin Lab - Surg Dx Flashcards

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1
Q

Are there any diagnostics considered required prior to all surgeries?

A

NO

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2
Q

What is preop evaluation based on?

A

patient parameters

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3
Q

When is preop evaluation usually not necessary?

A

low-risk surgeries like elective ortho surgeries

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4
Q

What are considered high risk surgeries?

A
  • anything intraabdominal
  • near the neck, spine, brain
  • anything that cracks the chest
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5
Q

What is considered whether preop evaluation is needed?

A

comorbidities & patient Hx

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6
Q

List the preop diagnostics or screenings.

A
  • CBC
  • BMP
  • PT/INR & PTT
  • EKG
  • CXR
  • UA
  • MRSA nasal screening
  • COVID testing
  • Pregnancy test
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7
Q

Guidelines for CBC preoperatively & reasons

A

65+ yrs old / any age - major surg

  • checking for underlying anemia
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8
Q

Guidelines for BMP preoperatively & reasons

A

50+ yrs / intermediate or major surg; no indication for LFTs unless liver dz

  • Intermediate surgeries: Gallbladder surg
    CMP–> known liver dz, MASH, or cirrhosis
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9
Q

Guidelines for PT/INR & PTT preoperatively

A

only if significant RFs or surg where bleeding would be damaging (brain)

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10
Q

Guidelines for EKG preoperatively & reasons

A

50+ yrs / if pt has RFs of cardiac issues or known dz

  • Also, if they have unTx HTN–> LVH–> arrhythmias
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11
Q

Guidelines for CXR preoperatively & reasons

A

no age recommendation / significant lung dz

  • Known COPD, known interstitial fibrosis
  • Ask do they get SOB wheezing w/ normal activity, if yes–> CXR
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12
Q

Guidelines for UA preoperatively & reasons

A

no age recommendation / if hardware implanted

  • Screening before & At the time of surgery–> UTI infx can get seeded on the hardware
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13
Q

Guidelines for MRSA nasal screening preoperatively & reasons

A

open chest / if hardware implanted

  • Nasal swab – many ppl are colonized w/ MRSA
  • Tx: Nasal mupirocin & Chlorhexidine shower
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14
Q

Guidelines for COVID testing preoperatively & reasons

A

ongoing changes to recommendations

  • Not as big of a problem, but if they are symptomatic don’t recommend surg
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15
Q

Guidelines for pregnancy test preoperatively

A

any woman of child-bearing age

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16
Q

What other possible tests can be ran preop?

A
  • Echo
  • Cardiac stress test
  • Exercise tolerance test
  • PFTs / spirometry
  • Nicotine, cotinine, anabasine
  • Albumin
  • Cholinesterase
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17
Q

When would you order an echo?

A
  • SOB w/ normal activity
  • Sleeping in recliner
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18
Q

When would you order a cardiac stress test?

A

Angina/chest pain while doing normal activities

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19
Q

Describe an exercise tolerance test & why they are ordered?

A

Bike or treadmill, changes resistance–> gives metabolic tolerance
The better on the exercise tolerance test–> the better they will recover after surg

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20
Q

When would you order PFTs/spirometry?

A

wheezing &/or SOB

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21
Q

Describe what is assessed about nicotine/cotinine/tobacco product exposure

A
  • Active use vs passive exposure
  • Cotinine – metabolite w/ longer half life
  • Anabasine – found in tobacco but not in nicotine replacement products
22
Q

Does Cotinine pick up vaping?

A

YES

23
Q

Does Anabasine pick up vaping?

A

NO

24
Q

What affect does smoking have on the patient after surgery?

A

impaired wound healing

25
Q

Why would albumin be evaluated preop?

A

Some studies show correlation b/t lower levels & worse outcomes

26
Q

Why are albumin levels so important before surgery?

A

If body isn’t making PRO it can lead to worse outcomes b/c it can impair healing

27
Q

What is Cholinesterase?

A

Rare genetic def can cause significant & extended period of apnea when given succinylcholine

28
Q

Why is knowing if a person has Cholinesterase so important?

A
  • Can make it more difficult to wean a person off the ventilator
29
Q

What is another rare condition that would make surgery more difficult?

A
  • Rare anesthesia related hyperthermia
30
Q

What is an alternative to general anesthesia?

A

spinal anesthesia

31
Q

Why is neuromonitoring used intraoperatively?

A

to assess integrity of brain/cord/periph nerves during surgery

32
Q

What common surgeries have neuromonitoring?

A
  • intracranial
  • spine
  • neck
  • aorta/carotid
33
Q

Common modalities for neuromonitoring?

A
  • EEG
  • EMG
  • Evoked potentials
    –> Somatosensory – most common
    –> Motor
    –> Auditory
34
Q

What must be assessed/assigned postoperatively?

A
  • ICU vs non-ICU
  • Telemetry or no telemetry (med/surg)
  • Vital signs
  • Intake/output
  • No labs are considered absolutely necessary
    – Commonly ordered labs
    –> CBC or Hgb/Hct
    –> BMP or CMP
35
Q

Describe the decision b/t ICU vs non-ICU

A

can they wean off vent

36
Q

Describe the decision b/t Telemetry or no telemetry (med/surg)

A
  • If they go into Afib in PACU, arrhythmia during surg–> telemetry
  • Most postop pts go the med/surg
37
Q

Describe the measuring of vital signs post op.

A

First 15 mins after, every 30 mins, every 1hr for 4hrs, then back to regular

38
Q

Why measure intake/output?

A
  • Intraabdo – intestinal surg or if worried about their kidneys
  • To keep up w/ fluid losses, diet management
39
Q

Why is a CBC or Hgb/Hct ordered post op?

A
  • there is postop Hgb drop b/c pt gets fluids
    –> Loss blood & replace w/ just fluids–> will cause Hgb to drop
    –> If <7 Hgb = blood transfusion
    –> If cardiac Hx/ischemia <8 = blood transfusion
40
Q

Why is a BMP or CMP ordered post op?

A
  • electrolyte monitoring b/c continued losses, drains, didn’t eat the day before procedure
  • K+ & Mg
  • Pain response–> secrete ADH inappropriately–> so Na+ will drop causing Hyponatremia
41
Q

Postop Evaluation: Complications/Evaluation Includes

A
  • Delirium
  • Chest pain
  • Abdomen:
    –> N/V
    –> Diarrhea
    –> Constipation
    –> Abdo pain
  • Fever
  • Low urine output
42
Q

What is Delirium, assessment tool used & types?

A
  • acute decline in cognitive function - CAM assessment tool
  • Agitated or Hypoactive
    **Ask family about pt’s baseline
43
Q

Why is chest pain important postoperatively

A

during surg we drop BP b/c you bleed less,
- but this can cause problems on back end b/c you aren’t getting blood to heart if blockage–> can lead to ischemia

44
Q

What causes N/V postoperatively

A

anesthesia & pain meds

45
Q

Which is less common postoperatively: diarrhea or constipation

A

diarrhea

46
Q

Why is the passing of gas so important postoperatively?

A

Gas is the first sign that the bowels are working after surg

47
Q

What might constipation occur postoperatively?

A
  • Bowels are paralyzed during anesthesia
  • Regimen of: Colace, Senna or MiraLAX
    if they haven’t pooped worried about forming an Ileus
48
Q

Reasons of abdominal pain postoperatively

A
  • Obstructions (could be an ileus)
  • anastomotic leak–> peritonitis
  • Get an abdo Xray–> looking for air fluid levels
49
Q

Describe a fever postoperatively.

A
  • Common to have a fever (99-100.2) & leukocytosis 1st day post op
  • Drug rxn or DVTs can cause a fever
    –> PE: Homer’s sign, one leg might be bigger, does one leg hurt more?
  • Get US
    NO D-dimer b/c they just had surgery & body will be forming clots
50
Q

What does low urine output mean postoperatively?

A

1st indication that they may be going into AKI

Block 4 - CritCareSurg (2 decks)

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