Peri and Post Operative Care Flashcards
What proportion of body weight is water
2/3
Of total body water what is the proportion in the intracellular compartment
Intracellular: 2/3
Of total body water, what proportion is extracellular
1/3
how can the extracellular compartment be divided
Interstitial and Intravascular
what proportion of extracellular fluid is interstitial
4/5
what proportion of extracellular fluid is intravascular
1/5
in resuscitation of a patient where is it important to have fluid
Intravascular
how much water should individuals be drinking per day
20ml/Kg/d
how much sodium should individuals have per day
1mmol/Kg/d
how much potassium should individuals have per day
1mmol/Kg/d
how much glucose should individuals have per day
50g/day
how does dehydration present on U+E
high urea to creatinine
why is malnutrition a big problem in surgical patients
- Poor wound healing
- Infection
- Skin breakdown
what tool is used to screen all patients in hospital for their malnutrition risk
MUST (Malnutrition Universal Screening Tool)
what are the 5 steps of the MUST score
- BMI
- Unplanned Weight Loss
- Acutely Unwell
- Calculate Score
- Manage
what score does a BMI of over-20 achieve
2
what score does a BMI of 18.5-20 achieve
1
what score does a BMI of under 18.5 achieve
0
what score does less than 5% weight loss in past 3-6 months achieve
0
what score does 5-10% weight loss in the past 3-6 months achieve
1
what score does >10% weight loss in the past 3-6 months achieve
2
explain acutely unwell score
If patients have been unwell for 5d or unlikely to have had food intake they are given a score of 2
what score is a low-risk must score
0
what score is a moderate-risk must score
1
what score is a severe-risk must score
2
how are low-risk (0) patients managed
Repeat screening at a later date
how are medium-risk (1) patients managed
Document oral intake for 3-days
how are high-risk (2) patients managed
Refer to dietician
if malnutrition is identified prior to surgery what is given
Nutritional support - to improve operative outcomes
what are rules with nutrition
Always try to use oral first
if individuals have dysphagia or are unable to intake sufficient calories orally, what is offered
NG Tube
if oesophagus is blocked, what is offered
PEG or RIG
If delayed gastric emptying what may be used
NJ Tube
if intestinal failure or jejunal inaccessible, what method is used
Parental
what guidelines governs nutrition after surgery
enhanced recovery after surgery (ERAS)
what are 5 things the enhanced recovery after surgery state should be done prior to surgery to optimise outcomes
- Reduced NBM (2-hours)
- Pre-Op Carb Loading
- Minimally invasive
- Minimising drains and NG tube
- Rapid re-introduction/ Feeding post-surgery
- Early mobilisation
what did ERAS state should be done following surgery
- Feed within 24h
what is post-op pyrexia
> 37.5
if post-op pyrexia happens 1-2d after what is the likely cause
Respiratory
if post-op pyrexia happens 3-5d after what is the likely cause
UTI
if post-op pyrexia happens 5-7d after what is the likely cause
Surgical Site
when may post-op pyrexia due to IV lines occur
Any time-frame
Define pyrexia of unknown origin
Recurrent fever >38, persisting for >3W, with >1W of inpatient investigaitons
what is wound dehiscence
fail of wound to heal causing it to re-open
when is wound dehiscence more common
abdominal surgery
what are the two types of wound dehiscence
- Superficial
- Full-thickness
what is superficial dehiscence
Skin re-opens
what is full-thickness dehiscence
Rectus sheath fails to heal causing it to re-open and bowel to protrude through
what is the most common cause of wound dehiscence
Infection
what patient factors increase risk of wound dehiscence
Male Age Smoking Corticosteroids Obesity Malnourished
what intra-operative factors increase of wound dehiscence
Emergency Prolonged operative time GI surgery Wound infection Poor technique
what post-operative factors increase of wound dehiscence
Blood transfusions
Coughing
Radiotherapy
Ventilation
how does wound dehiscence present clinically
Visible opening of the wound
how does full-thickness wound dehiscence present
Bulge from the wound with an increase in discharge
when should full-thickness dehiscence be considered
If there is an increase in discharge from the wound
how is superficial wound dehiscence managed
Pack with saline-soaked gauze and leave to heal by secondary intention
what can aid superficial dehiscence
Negative pressure dressing
how is full dehiscence managed
IV antibiotics
IV Fluids
Cover wound with saline soaked gauze and immediate return to surgery
how can haemorrhage in surgery be divided
Intra-operative
Reactive
Secondary
what is intra-operative
Bleeding during the operation
define reactive bleeding
Bleeding within 24h of the operation
what usually causes reactive bleeding
Missed vessel or slipped ligature
why may vessels be missed intra-operatively
Patient’s are often hypotensive - which can lead to vasoconstriction. However, post-op when BP resotres bleeding may occur
define secondary bleeding
Bleeding 7-10d post-op
what causes secondary bleeding
Infection causes erosion of a vessel
what is a major RF for secondary bleeding
Contaminated wound closed primarily
what is one of the most sensitive signs to haemorrhage
Increase RR
what is the problem with using BP as a sign of haemorrhage
BP is typically a late sign
what operation may post-op bleeding present as airway obstruction
Thyroidectomy
what artery is susceptible to injury from operative ports
Inferior epigastric
what are indications for surgical drains
- Drainage of space (abscess)
- Monitor output
- Detection bleed
