Mod 3 - Post-op Care 8/29

Question 1

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

Answer 1

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

Question 2

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

Answer 2

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

Question 3

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

Answer 3

False

Question 4

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

Answer 4

FALSE - hypersensitivity 3 reactions occur - use dog albumin!

Question 5

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.

Answer 5

True

Question 6

what is the equation to calculate IV fluids for maintenance?

Answer 6

(BW (kgs) x 30) + 70

Question 7

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

Answer 7

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

Question 8

1 L water = ? kg

Answer 8

1

Question 9

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

Answer 9

1. maintenance
2. dehydration
3. losses

Question 10

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

Answer 10

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

Question 11

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

Answer 11

metabolic rate

Question 12

what are the 2 formulas you use for RER?

Answer 12

(BW (kg) x 30) + 70

(BW (kg)^0.75) x 70

Question 13

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

Answer 13

2.5 kg to 25 kg

Question 14

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

Answer 14

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

Question 15

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

Answer 15

False - better to feed sooner rather than later

Question 16

T/F - nutrients are more important than ingredients.

Answer 16

True

Question 17

What are 3 benefits of enteral nutrition?

Answer 17

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

Question 18

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

Answer 18

True

Question 19

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

Answer 19

1. antiemetics
2. prokinetics
3. alterations in feeding prescription

Question 20

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

Answer 20

True

Question 21

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

Answer 21

1. 25-50%
2. 2-3 days

Question 22

what are 2 reasons to start slow with RER quantity?

Answer 22

1. reduce incidence of feed intolerance
2. refeeding syndrome

Question 23

how does refeeding syndrome occur? (5)

Answer 23

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

Question 24

what is a full shock dose for a dog?

Answer 24

90 mL/kg

Question 25

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

Answer 25

False - give 25% of shock dose, then reassess

Question 26

what are the 4 views with aFAST?

Answer 26

1. diaphragmatic-hepatic 2. splenorenal 3. cystocolic 4. hepatorenal

Question 27

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

Answer 27

1. diaphragmatic-hepatic 2. cystocolic 3. splenorenal 4. hepatorenal

Question 28

why do we utilize FAST scans in ER medicine?

Answer 28

quick check for free fluid

Question 29

if we have peritoneal fluid, what should we do?

Answer 29

abdominocentesis

Question 30

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

Answer 30

1. capillary pressure 2. interstitial fluid oncotic pressure

Question 31

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

Answer 31

1. plasma oncotic pressure 2. interstitial fluid pressure

Question 32

how can we classify peritoneal fluid? (2)

Answer 32

1. cell count # 2. protein level

Question 33

when discussing cell count # & protein level, define: 1. exudate 2. protein-rich transudate 3. protein-poor transudate

Answer 33

1. high cell count, high protein 2. low cell count, high protein 3. high cell count, low protein

Question 34

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

Answer 34

1. lactate 2. glucose

Question 35

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

Answer 35

to avoid poking the spleen

Question 36

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

Answer 36

False - NOT reliable in post-op patients!

Question 37

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

Answer 37

False - intracellular only

Question 38

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

Answer 38

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

Question 39

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

Answer 39

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

Question 40

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

Answer 40

3-5d post surgery

Question 41

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

Answer 41

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