Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NU 737 > Module 3: Postoperative Principles > Flashcards

Module 3: Postoperative Principles Flashcards

1
Q

Admission to ICU

A
  • 15% surgical procudures requires ICU
  • Decision made by surgeon & anesthesiologist
  • **Elderly patients or significant comorbidities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Delivery of care

A

**Accurate Data collection: **
* Surgical Procedure
* Patient positioning
* Unexpected Events
**Efficient Among surgeon, Anesthesiologists & Intensivist: **
* Typically informal
Brief and Incomplete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Continue Medications

A

Eye drops (Glycoma)
Antiseizure
Bronchodilators
Thyroid Replaceement

DM agent: add Sliding Scale; levemir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hold Medications

A

*** Glucorticoids **
* Should be given before Surgery
* Avoid Stress dosing:
* To Avoid : Hyperglycemia, Increased Infection Risk, and wound complications
* Talk to surgen ( ok to Hold )

  • Hold CCB, Diuretics, ACE : untile hemodynamically stable post up
  • Long Standing Insulin ( lantus or Levimir) , Metoforming, Glyburide: Hold Addd sliding scale SQ or IV, or Levemir
  • Maintain Glucose <180 mg/dl
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Goal for Blood Surgar Post Up

A

< 180 mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Opiate Management :
**Fentanyl **

A

For Mechanically Vented Patients.
Analgesia Properities, Rapid Onset, short Sedation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Opiate Management :
Other opiods

A

Morphine, Dilaudid, Oxycodone, MS Contin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Non-Opiate Management

A

Ketamine
Robaxin
Toradol (check Kidney Function)
Acetaminophed
and/or Gabaptin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Quantifying Pain and Sedation

A

*** Richmond Agitation Sedation Scale (RASSS) **
- Universal language to achieve adequite Sadation
* **Confusion Assessment Methord for the ICU (CAM-ICU) **
- check for delirium

Those scale help to avoid delirium, and shorter stay in ICU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Opiate Risk

A
  • Dependance and Withdrawal
    if on medication for > 7 days
  • Lethargy
  • Depressed Respitory Efforst
  • Vomiting and Ileus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Equivalent Dose

A

**Morphine **
Dose: 10 mg
Duration 4 to 5 HRS

**Dilaudid **
Dose: 1.5 mg
Duration : 4 to 5 hrs

**Fentanyl **
0.1 or 100 mcg
1 to 1.5 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Fentanyl

A
  • Full-mu receptor agonist
  • High Potency, short duration of action, Rapid onset of action
  • Lipohilic- ideal drug for transdermal and transmucosal administration
  • Biovailability - 50 %
    > **25 mcg/hour trasdernal Fentanyl patch = 1mg/1 hour IV Morphine **
  • Ideal for childern and incooperative adults

Super POtent ( only in ICU )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Morphine

A

*** GOLD Standard - For Treatment of Moderate to Severe Pain **
* Full mu-receptor agonist
* Bioavailability: 30 % (PO: IV dose is 3: 1)
Easilty available is wide range of preparations
Most widely used opioids analgesic
CAVEAT : BID /TID : Active Morpphine metabolites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hydromorphone

A

Semisynthetic opioid, Hydrogenated, of morphine
Full, Potent
Short duratio n

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Oxycodone

A
  • **Most Utilized opiod worldwide **
  • *** IR and ER **
  • sustained Release Preperatio of Oxycontin : has 2 phase Release (Immediate and EXtended the the same pill)
    Chronic pain management
    Keep off IV madications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hypothermia
Risk for ?

A

< 36 C
Riks of deloping
* Coagulopathy and
Hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mild Hypothermia

A
  • 32 to 36C or 89.6 to 96.8
  • **Passive External Rewarning **: warm Blankets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Moderate Hypothermia:

A

28 to 32 C or 82.4 to 89.6F
Active External Rewarning
Air Warming system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Severe Hypothermia

A

< 28 C
Active **core **rewarming
Warm IV fluids (Crystolids )
Do not warm Blood

20
Q

Assessemtn of Volume status

A
  • **Post Up (I/O ) **
    **Crystalloids : 0.9% +LR (keep eye on Na) **
    Change to NSS
    **MAP >65 **
    **UO >/= 0.5 mg/kg **

*** Echocardium : ** monitor resuscitatio efforts
**Maintenance Fluids : D5 1/2 NS (To prevent Catabolism) **

21
Q

Rapid Shallow Breathing (RSBI)

A

Predicts successful extubation and suctain off vent
GOAL : < 105 Value ( TV Devided by RR rate )

22
Q

Mechanical Vent

A

RR 12 to 16
PEEP: 5
FIO : 100% to 40%

**Tidal Volumes: 6ml/kg **

ARD: Neuro blockag (paralize; prone)

23
Q

***Nutrition Requirment

A
  • 25 to 30 kcal /kg/day
    1.2 to 2.5 g/kg/day of protein
    24 to 48 hrs nurtrition
24
Surgical Complications Hemorrhage Overwiew
* **Frequent cause for ICU admission ** * **Persistent Postoperative Hypotension**: ( early sigh for bleeding ) * Early Identification can prevent : Prevent multi Organ Failure Hemodynamic monitoring
25
Surgical Complications **Hemorrhage** Treatement Plan
* blood * Fluid: Isotonic Crystalloids (Avoid * Hypovolic Shock ; MAP >65)
26
Surgical Complications: Pulmonary Embolus Manifestation Hemodynamic Instability
* Origin: Femoral, Iliac, Popliteal Veins **Manifestation: ** * SOB, chest pain, ST. DVT (s/s ) * Altered Ventilation Perfusion RAtio * **Hemodynamic Instability **: - Blockage of main or major branch of PA --> Resulting - in Increase PVR (Increase Pulmonary Vascular Resistance) -Leads to RT Heart Dialation leading to -LV Dysfunction - Rt Heart comprase Left Heaert --> decrease Preload and Decrease CO
27
DX : PE
*** D-Dimer : Will be elevated post-up ** * **DD is protein fragment of blood clot that been dissolved in a body. ** Therefore, D-D elevated with present of PE. CTA (Gold Standard DX for PE ) **VQ Scan : Miss Match * For pt Kidney Issues; or Allergy to Diy * VQ Not Reliable in ICU pt with Disorders: ( COPD, Cystic Fibrosis, Bronchiectasis, Interstadial Lung Diseas) **ECHO **
28
TX PE
Heparing ( PTT 60 to 90 seconds): ICU Lovenoz 1mg/mg BID NOAC IVC Filter (if down leg)
29
Surgical Complications **Anastomotic Leak**
Most Devistating Surgical Complication Result in Mortality and Morbility
30
**Anastomotic Leak Clinical Findings:**
*** fever, ** **Elevated WBC, ****ST, ****Hypotension * Enteric Contents in Perianastomotic drain
31
Anstomotic Leak **Diagnosis : **
*** CT W/PO Or IV contrast** (not Always ask colorectal Surgery ) * Identify leak * Detect other Pathologies
32
Anatomotic Leak Treatment Plan
**Septic shock and Generalized Peritonitis ** Surgical Revision **Hemodynamically Stable** * **Antibiotics and Percutaneous Drainage (zosy +Microfungil (Antifungal ) ** * Endoscopy with Stent Depoyement * Consult: ID, GI, Surgery
33
Intraabdominal Compartment Syndrome Causes
* Severe Abdominal TRauma * Abdominal Surgery * Deep Burns * Obesety * Intraabdoninal or Retroperitoneal Hemorrhage * Excessive Crystalloid or Blood Products **
34
Intraabdominal Hypertension (IAH)
Intraabdominal Pressure > 12mmHG
35
Abdominal Compartemetn Syndrome (ACS)
Incraabdonial Pressure > 20 New or Worseing organ Dysfunction
36
Intraabdominal Compartment Syndrome Clinical Findings
* Tense and distended abdomen * Increased peak airway pressure * or Decrased Tidal Volume * Postoperative persistent** metabolic Acidosis and Shock: Suggest Bowel Ischemia
37
Intraabdominal Compartment Syndrome Diagnosis
CT scan or endoscopy Abdominal pressure measurement
38
Intraabdominal Compartment Treatment : IAH or early ACS?
* N0n Surgically * Decreasing volume resuscitation * Sedation and Neuromuscular blockage
39
Intraabdominal Compartment: ACS
Surgical Decompression via **Celiostomy ** Negative Pressure dressing
40
Surgical Complications Acute Kidney Injury
Increases mortality and Morbidity Emergen or high-risk surgeries
41
Surgical Complications Acute Kidney Injury: **Prerental AKI **
****Hypovolemia d/t bleeding I****mpaired cardiac Function * Cardiac Renal Syndrome
42
Surgical Complications Acute Kidney Injury: **Intrarenal **
**Acute tubular necrosis: ** * Hypovolemia * Shock * nephrotoxic agents
43
Postrenal AKI
**Obstruction to urine Flow Damage to ureters Urinal drainage obstruction ** ****non obstructive **** Have urge cannot go enlarge Prostate : Flomax
44
Surgical Complication Malignant Hyperthermia (MHS_ ) **Overview **
* Severe reaction to anesthesia * Genetic Mutation (Autosoma Dominant : one gene from parent to be affected 50% chanses * Fatall if not treated Promptly
45
Surgical Complication **Malignant Hyperthermia ** Clinical Manifestations
* High body temperature (crasy high) * Rigid muscles or spasms * Tachycardia * Rhabdomyolysis * Acute renal failure * Coagulation issues (clotting and bleeding )
46
Surgical Complication **Malignant Hyperthermia ** Risk Factors :
**Inherited Gene Affected ** Malignant Hyperhtermia Susceptibiltity (MHS) ****RYR1 Mutation: RYR 1 mutation ** **Rarely affected genes **: CACNA1S and STAC 3
47
Surgical Complication Malignant Hyperthermia (MHS) Diagsosis
* Genetic Testing * Muschle Biopsy ** (Tissue subjected to triggering Chemicals )
48
Surgical Complication Malignant Hyperthermia (MHS) Treatment
**Dantrolene ** * 2.5 mg/kg IV bolus TO 10 mg/kg PRN **maintenace OPtion: ** * 1mg/kg IV Q 4 to 6 hrs 0.25 mg/kg /hr IV infusion Oxygen IV fluids x body cooling

NU 737 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions