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Medicine II: Surgery > Labs for Surgical Patient > Flashcards

Labs for Surgical Patient Flashcards

1
Q

Why do we do Pre-Op labs?

A
  • To make sure the patient is ready for surgery and to get a base line for any adverse reactions.
  • Used to screen for asymptomatic disease that may have surgical consequences.
  • An appraisal of diseases that may contraindicate elective surgery or require treatment prior to surgery.
  • To evaluate stability of a previously diagnosed disease
  • To evaluate the nature and extent of metabolic or septic conditions
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2
Q

What Pre-Op labs do we run?

A 
CBC
BMP, Mg, Phos
LFTs
UA
Coags
Tumor markers
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3
Q

Patients over 40 should get which tests?

A

CBC, BMP, Mg, Phos

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4
Q

Patients over 50 should get which tests? Why?

A

CXR, EKG

Preventative

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5
Q

All patients under going surgery should get a CXR, Why?

A

To check for metastasis

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6
Q

If a patient has a history of bleeding gums what test would you want to look at?

A

Coag study

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7
Q

What do you get from a CBC? What are the norms?

A

WBC- 4.5-11
Hb- 15
Hct- 45%
Plt- 150-450

P-60%
Band- 0%
L- 25%
M- 5%
E- 2%
B- 1%
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8
Q

What do you get from a BMP? What are the norms?

A 
Na- 135-145
K- 3.5-5.1
Cl- 98-106
CO2- 22-29
BUN- 8-20
Creat- 0.6-1.2
Glu- 70-115

Ca- 8.4-10.2
Mag- 1.3-2.1
Phos- 2.7-4.5

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9
Q

What do you get from a LFT? What are the norms?

A 
Tot Prot- 6-8
Alb- 4
Tot Bil- 0.3-1
Dir Bil- 0-0.2
Alk Phos- 30-120 (varies with age)
LDH- 100-210
AST- 7-40
ALT- 7-40
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10
Q

What are you looking for in a UA?

A 
Specific gravity- estimate of urine osm
Leukocyte Esterase
Nitrites
WBC
Bacteria
Casts
RBC
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11
Q

Do you get a urine drug screen with a UA?

A

No it has to be ordered separately

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12
Q

With a UTI what are you looking for in a UA?

A

Nitrites and LE

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13
Q

What do you get from a Coag Test?

A

PT
PTT
INR

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14
Q

What is PT?

A

Prothrombin time, evaluates extrinsic clotting cascade

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15
Q

What increases PT?

A

Coumadin (factors II, VII, IX, X, Protein S & C)

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16
Q

What is PTT?

A

Partial Thromboblastin Time, evaluates intrinsic clotting cascade

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17
Q

What increases PTT?

A

Heparin (antithrombin III)

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18
Q

What is INR?

A

International ratio, normalized PTT (goal is 2-3; norm=1)

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19
Q

What must you ask a surgical patient about before the surgery?

A

History of bleeding

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20
Q

What are the tumor markers? What do they screen for?

A

CEA- (carcinoembryonic antigen): colon cancer
CA 19-9- pancreatic cancer
AFP (alpha fetal protien)- testicular cancer and hepatocellular cancer
PSA (Prostate specific antigen)- prostate cancer

21
Q

*What are thing that we need to think about for Pre- and Post- Op Labs?

A

Who is undergoing the surgery(age, PMHx/comorbidities, Meds, Bleeding Hx)

What surgery are they undergoing? (level of invasiveness)

22
Q

What test should you run on any woman of child bearing age?

A

HCG, it broadens what you think

23
Q

T/F: you must essentially readmit the patient to the hospital Post-Op.

A

True

24
Q

What goes into the Post-Op orders?

A 
ADCVANDIML
admit
diagnosis
conditions
vitals
activity
nursing
diet
IVF
Meds
Labs
Other- Call HO for....
25
Q

Who is the HO?

A

House officer

26
Q

What are things that we need to monitor with the patient?

A

VS
CVP ( if a pt has large blood losses or fluid shifts)
Intraventricular catheters

27
Q

What is CVP? What does it tell us?

A

Central venous pressure- describes the pressure of the blood in the thoracic vena cava, near the RA. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system

28
Q

What is CVP a good estimate of?

A

Right atrial pressure, a major determinant of RV and diastolic volume

29
Q

Why are drains used?

A

Used to prevent or treat an unwanted accumulation of fluid

30
Q

Where are prophylactic drains placed?

A

In a sterile area

31
Q

How do you handle the outside of the drain?

A

With aseptic technique

32
Q

What is a closed drain?

A

A drain connected to a suction device; preferred

33
Q

What is an example of a closed drain?

A

JP: jackson pratt, squeeze it then it refills

34
Q

What is an open drain?

A

a drain that is open to the air

35
Q

What is an example of an open drain?

A

Pen rose drain, used usually only for bartholins gland; needs to be removed soon

36
Q

What is a Pleur-Evac?

A

Uses a water seal, does not allow air to get back into the lungs (it should bubble)

37
Q

What is a vacuum drain?

A

keeps area from being moist, often used in bed sores

38
Q

What are the Post-Op analgesics?

A

Patient controlled
Paternal opiods
Nonopiod parental analgesics
Oral analgesics

39
Q

Patient Controlled Analgesics

A

Patient controls boluses
Sometimes also has a basal rate
Has a time out to prevent OD
Patient must be awake to push button

40
Q

Parental Opiods

A

Direct effect on opiod receptors
Stimulation of descending brain stem system that contributes to pain inhibition
Main stay therapy for post operative pain

41
Q

Nonopiod Parenteral Analgesics

A

NSAIDS
Ketorolac potent analgesic and moderate anti-inflammatory. Better for renal colic patients than opiods, but the concern is parenteral NSAIDS: GI bleeding, wound bleeding, and renal failure are contradictions

42
Q

Oral Analgesics

A

Usually used several days post operatively depending on severity of surgery

43
Q

Primary Care follow up

A

All post ops should see their PCP

44
Q

Why should post ops see their PCP?

A

Basic knowledge, medication changes, and wound checks

45
Q

Tumor marker: CEA-

A

(carcinoembryonic antigen): colon cancer

46
Q

Tumor marker: CA 19-9 -

A

CA 19-9- pancreatic cancer

47
Q

Tumor marker: AFP -

A

AFP (alpha fetal protien)- testicular cancer and hepatocellular cancer

48
Q

Tumor marker: PSA -

A

PSA (Prostate specific antigen)- prostate cancer

Medicine II: Surgery (14 decks)

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