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1. Exams - Semester 3 > MP&S - Pre/Post Op Management > Flashcards

MP&S - Pre/Post Op Management Flashcards

1
Q

When do you choose surgery?

A

– Re-think surgery → high risk & low benefit

– Surgery → High benefit & low risk

– Operate → Even if risk is high, the risk of not operating is certain death

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2
Q

What are some RED FLAGs for surgery?

A
  • Cardiac/Vascular/Lung/Liver/ Endocrine Dz
  • Bleeding d/o
  • Infection
  • DM
    • (NPO pre op –> hold or reduce hypoglycemic agents – better if the glucose is high rather than low)
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3
Q

What labs should you order before Surgery?

A
  • CBC/BMP (lytes/BUN/Creat/glucose)
  • LFT’s (in older pts or when indicated)
  • CXR if indicated
  • Surgical Consent
  • Clotting studies (only if indicated)
  • EKG (pts w/ cardiac Hx or > 40yo)
  • Type & Cross PRN (should include number of units & should be >2unit min)
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4
Q

What is the Difference between T&C vs T&S?

A
  • T & C (Type & Cross):
    - Determines blood type & blood is made available before the surgery begins
  • T & S (Type & Screen):
    - Determines blood type, but blood is not made available, it as to be ordered after.
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5
Q

What are some of the risks of GENERAL Anesthesia?

A
  • ↓Sys vascular resistance
  • ↓Myocardial contractility
  • ↓Stroke volume
  • ↑Cardiac irritability
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6
Q

What the key difference between general and local anesthesia?

A

Local anesthesia carries the least risk

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7
Q

What is the most problematic Post-Op Cardiac Risk?

A

Post-op MI carries a 50% mortality risk

  • Related to age & pre-existing conditions
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8
Q

What are some HIGH Post-Op Cardiac Risks?

A
  • Emergent surgery in elderly pt,
  • Aortic surgery,
  • Periph vascular surgery,
  • Procedures w/prolonged blood loss

> 5% risk of MI or death

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9
Q

What are some INTERMEDIATE Post-Op Cardiac Risks?

A
  • Carotid endarterectomy,
  • GU
  • Ortho
  • Uncomplicated abd
  • H&N
  • Thoracic surg
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10
Q

What are some MINOR Post-Op Cardiac Risks?

A
  • Cataracts
  • Endoscopy
  • Superficial procedures
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11
Q

Cardiac tests prior to Surgery?

A
  • EKG
  • Dobutamine → stress echo
  • Dipyridamole thallium imaging
  • Coronary angiography
  • Exercise stress testing not always used
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12
Q

What group of drugs can reduce Absolute risk of cardiac event Po-Op by ~15%?

A

BB

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13
Q

What is dangerous about post op Ischemia?

A

It can be asymptomatic in up to 90% of cases

It usually occurs 1-2 days post-op

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14
Q

What is THE MC Post-Op complication?

A

Pulm Complication

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15
Q

What ARE MC Pulm Post-Op complicates?

A

Atelectasis & PNA

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16
Q

What IS MC Pulm Post-Op complicates?

A

Atelectasis

- MC post-op complication in pts who have received GENERAL anesthesia

17
Q

What are some of the Post-Op Pulm Risk Factors?

A

o Age, Obesity
o Smoking/COPD/Asthma
o Sleep apnea
o Thoracic or upper abd surgery

*****2X higher in smokers even w/o COPD

18
Q

How do you reduce plum risks?

A

o Stop smoking > 8 wks prior to surgery
o Delay elective surgery in pts w/ poorly ctrl COPD

o Prevention of MC pulm complication (atelectasis)

   - Deep breathing
   - Incentive spirometry
   - Preoperative teaching
   - Avoid supine positioning
19
Q

Post-Op - Resp/Cardiac Status?

A 
o	Good pulmonary toilet
          - use of spirometer
o	Good cough/deep breathing techniques
o	D/C vents & ET tubes ASAP
o	Chest PT PRN
o	CXR PRN
          - r/o atelectasis, PNA
20
Q

Why is there a high risk of DVT Post-OP?

A

o Blood loss during surgery

o Combined w/ decreased activity

21
Q

How does Anemia cause complications during surgery?

A

Extensive blood loss & HCT < 28 will increase MI risk

→ might want to transfuse

22
Q

What surgeries carry higher risk of infection?

A
  • Oral,
  • Trauma,
  • Bowel,
  • Vaginal
23
Q

How to prevent infection during surgery?

A

o Abx admin prior to surgery

o Prophylactic abx used if risk is >2%

24
Q

What RFs do pts w/ DM present Post-Op?

A

o ↑Risk for:

• Stroke, MI, Inf, DKA, Wound dehiscence

25
Q

How do you manage DM pts going to surgery?

A

NPO pre op
- Hold or reduce hypoglycemic agents – better if the glucose is high rather than low

  • Use of sliding scale rather than regular oral hypoglycemic agents or regular insulin dosing UNTIL pt is taking

BS – Q6H (post- prandial & HS)

26
Q

Liver Dz Post-Op complications?

A

o LFT’s
- pts w/hx of liver Dz or ETOH abuse

o Narcotics/sedatives metabolized in liver so consider that when ordering meds

o Coagulopathy occurs w/liver Dz

o Ascites

27
Q

How does Malnutrition/Drug Dependency effect Post-Op pts?

A

o Vit K def, Hepatic dys, Poor wound healing, lyte abnml’ties (tx Hyponatremia slowly – 3% Saline last resort)

o Poor social/family support often the case

o Pain relief in light of drug dependency

o Drug withdrawal

28
Q

How do Steroids effect Post-Op pts?

A

o Chronic steroid → suppress bodies’ endogenous steroid production

o Doses as small as 7.5mg Prednisone per day (or Hydrocortisone 30 mg/day) can be a suppressive dose

o Partial adrenal insufficiency may be present for these pts as long as 9 mos after d/cing

o Solution:

    - GIVE Solu-Cortef 100mg IV 
          - immediately pre-op & repeat that night and/or next AM
29
Q

Post-Op 5 P’s?

A

o Pain control
- PCA/Epidural/IM/IV/PO PRN

o Prevent Pus
- Post op abx prophylaxis

o “Pillow”
- Sleeper PRN

o “Poop”
- Narcotics + inactivity = constipation

o Previous Meds
- Co-morbidities

30
Q

Fever Post-Op?

A

o Common post op → often resolves spontaneously

o Fevers in 1st 24 hrs are rarely wound infections

o Can be caused by atelectasis

o If pt has Foley → check for UTI & Rx PRN

o Could be PE/PNM/drug induced

o C/S, blood cults, CXR, U/A & C/S

31
Q

Post-Op Mobilization?

A

o Get pt OOB & ambulating ASAP

o Get the pt moving any way you can → chair or cardiac chair if can’t ambulate

o Complications, → pressure sores, PNM etc

32
Q

Post-Op Oversedation/Confusion causes?

A

o Elderly pts
o Narcotics

o Multi factorial:

      - Polypharmacy, 
      - Sundowning, 
      - unfamiliar surroundings
33
Q

How do you reduce Post-Op infections?

A

o Prophylaxis of wound infection.
o D/C drains/tubes as soon as possible
o Higher risk w/implants or immuno-compromised pts

34
Q

Post-Op Pain Control?

A

o 5th vital sign → Pre-emptive pain ctrl reduces post op narcotic use most effectively

o Risk of over sedation/confusional states

o Narcotics can make you itchy (side effect) → not a true allergy unless rash forms

o Taper a pt appropriately & no worries about “addiction”

35
Q

Post Op - Wound Healing?

A

o Compromised in the

       - elderly, 
       - chronically ill, 
       - DM, 
       - immunocompromised.

o Check wound QD or QOD at least

o Remove stitches/staples when ready & steri strip wound PRN

o Watch for signs of infection

       - Redness
       - Calor
       - Drainage (esp purulent)
       - Dehiscence
36
Q

Post-Op Fluids/Electrolytes

A

o Check lytes, BUN, Creat PRN

o Older pts tend to be dehydrated when they come in

o Pts can lose fluid/blood intra-op → get a lot of fluids IV intra-op

o Daily weights/I & O PRN – QD weights can help Dx CHF / fluid retention

37
Q

Pt / Family Communication

A

o Maintain communication (i.e. phone #’s of family members)
o Prepare pre-op – avoid surprises
o Address family concerns even if you think they are minor
o Obtain informed consent from pt or legal guardian, family member etc

38
Q

What do you do when Brainscape tells you to take a break?

A

Fuck off

1. Exams - Semester 3 (21 decks)

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