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VM 580 - Vet Surgery & Anesthesia > Mod 3 - Post-op Care 8/29 > Flashcards

Mod 3 - Post-op Care 8/29 Flashcards

1
Q

what are 4 things you should check during your daily PE (at the minimum)?

A
  1. hydration status
  2. “ins & outs” - bowel movement, urination, nutrition
  3. pain control
  4. FAST scan (U/S)
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2
Q

what are 5 things you need to reassess at least daily?

A
  1. IV fluids
  2. pain meds
  3. nutrition
  4. antibiotics?
  5. recumbent care/physical rehab
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3
Q

T/F - all of Kirby’s Rule of 20 apply to every patient every day.

A

False

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4
Q

T/F - you can use human albumin for treatment in dogs.

A

FALSE - hypersensitivity 3 reactions occur - use dog albumin!

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5
Q

T/F - if you try to use plasma to replenish albumin in a patient, it would take A LOT of plasma to inc. albumin 0.5-1 value. Therefore, it’s not feasible.

A

True

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6
Q

what is the equation to calculate IV fluids for maintenance?

A

(BW (kgs) x 30) + 70

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7
Q

Dehydration is always an estimate. What is the range for % of dehydration? Why?

A

5-12%
- anything <5% is undetectable on PE
- anything >12% is not compatible with life

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8
Q

1 L water = ? kg

A

1

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9
Q

what are the three components that you must consider when starting IV fluid therapy?

A
  1. maintenance
  2. dehydration
  3. losses
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10
Q

what are 4 considerations you have to think about when starting pain meds?

A
  1. route of administration
  2. MOA
  3. side effects
  4. anxiolytics vs. pain meds
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11
Q

resting energy requirement (RER) is based on resting ?.

A

metabolic rate

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12
Q

what are the 2 formulas you use for RER?

A

(BW (kg) x 30) + 70

(BW (kg)^0.75) x 70

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13
Q

You use (BW (kg) x 30) + 70 for calculating RER for what weight range?

A

2.5 kg to 25 kg

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14
Q

You use (BW (kg)^0.75) x 70 for calculating RER for what weight range?

A

outside the range of 2.5 kg to 25 kg
- you can use this equation for every patient if you want

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15
Q

T/F - it’s better to withhold food post-surgery or procedure.

A

False - better to feed sooner rather than later

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16
Q

T/F - nutrients are more important than ingredients.

A

True

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17
Q

What are 3 benefits of enteral nutrition?

A
  1. maintenance (GI structure, integrity, function)
  2. immune function support
  3. reduced risk of bacterial translocation & sepsis
18
Q

T/F - do NOT force feed your patient, as this could cause aspiration or a conditioned food aversion.

A

True

19
Q

how can you manage a patient that has nausea, is vomiting, or is regurgitating? (3)

A
  1. antiemetics
  2. prokinetics
  3. alterations in feeding prescription
20
Q

T/F - RER equation is the same as the fluid maintenance equation.

A

True

21
Q

With RER, you should start at 1% and work up. The goal is to get to full RER in 2 days if possible.

A
  1. 25-50%
  2. 2-3 days
22
Q

what are 2 reasons to start slow with RER quantity?

A
  1. reduce incidence of feed intolerance
  2. refeeding syndrome
23
Q

how does refeeding syndrome occur? (5)

A
  1. period of severe starvation - body utilizes ketone bodies, FA, and muscle protein (instead of carbs)
  2. sudden intake of carbs = large insulin release
  3. rapid intake of glucose intracellularly w/K+, Mg++, and P
  4. hypoK+, hypoMg+, hypoP, thiamine deficiency, NaCl & H2O retention
  5. refeeding syndrome
24
Q

what is a full shock dose for a dog?

A

90 mL/kg

25
Q

T/F - you should give the full shock dose of balanced isotonic crystalloids and then reassess.

A

False - give 25% of shock dose, then reassess

26
Q

what are the 4 views with aFAST?

A
  1. diaphragmatic-hepatic
  2. splenorenal
  3. cystocolic
  4. hepatorenal
27
Q

Which aFAST view is:
1. cranial
2. caudal
3. patient’s left side
4. patient’s right side

A
  1. diaphragmatic-hepatic
  2. cystocolic
  3. splenorenal
  4. hepatorenal
28
Q

why do we utilize FAST scans in ER medicine?

A

quick check for free fluid

29
Q

if we have peritoneal fluid, what should we do?

A

abdominocentesis

30
Q

which of the Starling’s forces are pushing fluid OUT of the vascular space?

A
  1. capillary pressure
  2. interstitial fluid oncotic pressure
31
Q

which of the Starling’s forces are pulling fluid IN to the vascular space?

A
  1. plasma oncotic pressure
  2. interstitial fluid pressure
32
Q

how can we classify peritoneal fluid? (2)

A
  1. cell count #
  2. protein level
33
Q

when discussing cell count # & protein level, define:

  1. exudate
  2. protein-rich transudate
  3. protein-poor transudate
A
  1. high cell count, high protein
  2. low cell count, high protein
  3. high cell count, low protein
34
Q

what 2 quick, diagnostic tests can help you determine if your patient with peritoneal fluid has septic abdomen?

A
  1. lactate
  2. glucose
35
Q

if you are doing a blind abdominocentesis, why should you always have the patient lay in left lateral?

A

to avoid poking the spleen

36
Q

T/F - you can use lactate and glucose diagnostic tests for diagnosis of a septic abdomen in both pre-op and post-op patients.

A

False - NOT reliable in post-op patients!

37
Q

T/F - we are looking for either intracellular or extracellular bacteria on a fluid cytology to confirm a septic abdomen.

A

False - intracellular only

38
Q

Septic peritonitis is a surgical emergency. What are the 3 mainstays of tx for any case of sepsis?

A
  1. early antibiotic administration
  2. timely source control (surgery)
  3. cardiovascular support (restore/maintain perfusion)
39
Q

what changes in drain fluid production could indicate a problem in your patient? (4)

A
  1. inc. fluid production volume
  2. serosanguineous –> turbid, brown
  3. non-degenerate –> degenerate neutrophils
  4. presence of intracellular bacteria
40
Q

what time frame is most crucial for monitoring for intestinal dehiscence?

A

3-5d post surgery

41
Q

A patient’s fluid production drops each day in hospital - on day 5, you measure 5 mL/kg/day total fluid production.

Is it appropriate to remove the drain?
A. No, 5 mL/kg/day is still too high
B. Yes, volumes <10 mL/kg/day are safe
C. Volume doesn’t matter; pull regardless on day 5
D. Not enough info to answer

A

B. & D.
- we care about both volume AND fluid characteristics!

VM 580 - Vet Surgery & Anesthesia (11 decks)

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