Labs for the Surgical Pt and F/u in Primary Care Flashcards
List of common Pre-Op labs
- CBC (40+ yo for sure!)
- BMP, Mg, Phos (40+ yo for sure! Mg and Phos = must add separately not included)
- LFTs
- Urinalysis
- Coags
- Tumor Markers
Why do we order pre-op labs?
- Used to screen for asymptomatic dz that may have surgical consequences.
- Appraisal of diseases that may contraindicate elective surgery or require treatment prior to sx
- To evaluate the nature and extent of metabolic or septic conditions
- To evaluate stability of previously diagnosed dz
Radiographic General Testing Guidelines
Patients over 50 yo: CXR, EKG
Patients undergoing sx for Cancer: CXR
Normal value for a WBC, and which lab panel is a WBC located?
4.5-11 cell/microL; CBC
Normal value for a Hb, and which lab panel is a Hb located?
15 g/dl; CBC
Normal value for a Hct, and which lab panel is a Hct located?
45%; CBC
Normal value for a Plt, and which lab panel is a Plt located?
150-450 cell/microliter; CBC
Normal value for a Na, and which lab panel is a Na located?
135-145 meq/L; BMP
Normal value for a K, and which lab panel is a K located?
3.5-5.1 meg/L; BMP
Normal value for a Cl, and which lab panel is a Cl located?
98-106 meq/L; BMP
Normal value for a CO2, and which lab panel is a CO2 located?
22-29 mmol/L; BMP
Normal value for a BUN, and which lab panel is a BUN located?
8-20 mg/dl; BMP
Normal value for a Creat, and which lab panel is a Creat located?
0.6-1.2 mg/dL; BMP
Normal value for a Glu, and which lab panel is a Glu located?
70-115 mg/dL; BMP
Normal value for a Ca, and which lab panel is a Ca located?
8.4-10.2 mg/dL; May or may not be in BMP (if it’s not you have to order it separately)
Normal value for a Mg, and which lab panel is a Mg located?
1.3-2.1 meq/dL; On its own (have to order separately)
Normal value for a Phos, and which lab panel is a Phos located?
2.7-4.5 mg/dL; On its own (have to order separately)
Normal value for a Total Protein, and which lab panel is a Total Protein located?
6-8 g/dL; LFTs
Normal value for a Alb, and which lab panel is a Alb located?
4 grams/dL^3; LFTs
Normal value for a Total Bilirubin, and which lab panel is a Total Bilirubin located?
0.3-1 mg/dL; LFTs
Normal value for a Direct Bilirubin, and which lab panel is a Direct Bilirubin located?
0-0.2 mg/dL; LFTs
Normal value for a Alk Phos, and which lab panel is a Alk Phos located?
Varies with age but 30-120 units/L^3; LFTs
Normal value for a LDH, and which lab panel is a LDH located?
100-210 IU/L; LFTs
Normal value for a AST, and which lab panel is a AST located?
7-40 U/L; LFTs
Normal value for a ALT, and which lab panel is a ALT located?
7-40 U/L; LFTs
What are you checking for in a Urinalysis?
- Specific Gravity (estimates the Urine Osmolality)
- Leukocyte Esterase (LE)
- Nitrites
- WBC
- Bacteria
- Casts
- RBS
- Urine Drug Screen (added on)
- FeNa (Added on)
What is the point of using a PTT (Partial Thromboplastin Time)?
- Evaluates intrinsic clotting cascade
- Increased HeparIN (Antithrombin III)
What is the point of using a PT (Prothrombin Time)?
- Evaluates Extrinsic Clotting Cascade
- Increased by Coumadin (Factors II, VII, IX, X, Protein S and C)
What is the point of using an INR (International Ratio)?
It is a standardized/universal marking of how the bleeding is. Normal should be 0.9-1.1.
Common Tumor Markers
- CEA (Carcinoembryonic Antigen) – Colon Cancer
- CA 19-9 – Pancreatic Cancer
- AFP (Alpha Fetal Protein) – Testicular and Hepatocellular Cancer
- PSA (Prostate Specific Antigen) – Prostate Cancer
What is important to note about tumor markers?
Tumor markers are SCREENING not Diagnostic
Things to think about with pre-op and post-op labs?
- Who is undergoing surgery (Age, PMH, Meds, Bleeding Hx)?
2. What Sx will they be undergoing? (Level of invasiveness, Pre-op tumor markers for post-op monitoring)
What is a rule of thumb to think about with Post-Op orders?
You are essentially re-admitting them to the hospital!
That being said, what do you order? (ADCVANDIML)
Admit Dx Condition Vitals Activity Nursing (i/o, drains, resp, monitors, dressings, accucheck) Diet IV Fluids Meds Labs Others
This is the pressure of blood in the thoracic vena cava, near the right atrium of the heart. It reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system.
Central Venous Pressure
What things should be monitored pre/post op?
- TPRBPO2 - Telemetry and/or Pulse Oximetry
- CVP (want to see if there is a large blood loss or fluid shifts)
- Intraventricular Catethers
What are drains used for?
- Used to prevent or treat an unwanted accumulation of fluid
- Prophylactic drains are placed in a sterile area
- External portion of the drain must be handled with aseptic technique
What are the two types of Drains?
- Closed (preferable) – Connected to a suction device. MOST COMMON = Jackson Pratt (JP) drain
- Open – open to air
- Pleur-Evac (Also very common)
- Vacuum Drain – common in rehab facilities. Usually for “ugly” wounds.
What are the types of Post-Op Analgesia?
- Patient Controlled Analgesia
- Parenteral Opioids
- Nonopioid Parenteral Analgesics
- Oral Analgesics
What is a patient controlled analgeia (PCA)?
- Patient controls the boluses
- Sometimes has a basal rate (usually a narcotic)
- Has a “timeout” to prevent OD (if you fall asleep, you can’t press it)
- Patient must be awake to push the button
What are parenteral Opioids?
- Direct effect on opioid receptors
- Stimulation of descending brain stem system that contributes to pain inhibition
- The mainstay of therapy for post-op pain.
***Commonly what is in your PCA
What are non-opioid parenteral analgesics?
NSAIDS
- Ketorolac potent analgesic and moderate anti-inflammatory
- Only IV NSAID, but is prone to causing GI bleeding
What are oral analgesics?
Usually used several days post-op (depending on severity of surgery)
Primary Care Follow Up!
ALL Post-Op patients should see their PCP! For basic knowledge, medication checks, wound checks, etc.
If there is an issue, then they’ll go back to the surgeon.