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Pre, Peri and Post-Operative Care > Peri and Post Operative Care > Flashcards

Peri and Post Operative Care Flashcards

1
Q

What proportion of body weight is water

A

2/3

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2
Q

Of total body water what is the proportion in the intracellular compartment

A

Intracellular: 2/3

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3
Q

Of total body water, what proportion is extracellular

A

1/3

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4
Q

how can the extracellular compartment be divided

A

Interstitial and Intravascular

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5
Q

what proportion of extracellular fluid is interstitial

A

4/5

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6
Q

what proportion of extracellular fluid is intravascular

A

1/5

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7
Q

in resuscitation of a patient where is it important to have fluid

A

Intravascular

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8
Q

how much water should individuals be drinking per day

A

20ml/Kg/d

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9
Q

how much sodium should individuals have per day

A

1mmol/Kg/d

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10
Q

how much potassium should individuals have per day

A

1mmol/Kg/d

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11
Q

how much glucose should individuals have per day

A

50g/day

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12
Q

how does dehydration present on U+E

A

high urea to creatinine

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13
Q

why is malnutrition a big problem in surgical patients

A
  • Poor wound healing
  • Infection
  • Skin breakdown
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14
Q

what tool is used to screen all patients in hospital for their malnutrition risk

A

MUST (Malnutrition Universal Screening Tool)

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15
Q

what are the 5 steps of the MUST score

A
  1. BMI
  2. Unplanned Weight Loss
  3. Acutely Unwell
  4. Calculate Score
  5. Manage
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16
Q

what score does a BMI of over-20 achieve

A

2

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17
Q

what score does a BMI of 18.5-20 achieve

A

1

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18
Q

what score does a BMI of under 18.5 achieve

A

0

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19
Q

what score does less than 5% weight loss in past 3-6 months achieve

A

0

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20
Q

what score does 5-10% weight loss in the past 3-6 months achieve

A

1

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21
Q

what score does >10% weight loss in the past 3-6 months achieve

A

2

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22
Q

explain acutely unwell score

A

If patients have been unwell for 5d or unlikely to have had food intake they are given a score of 2

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23
Q

what score is a low-risk must score

A

0

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24
Q

what score is a moderate-risk must score

A

1

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25
Q

what score is a severe-risk must score

A

2

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26
Q

how are low-risk (0) patients managed

A

Repeat screening at a later date

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27
Q

how are medium-risk (1) patients managed

A

Document oral intake for 3-days

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28
Q

how are high-risk (2) patients managed

A

Refer to dietician

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29
Q

if malnutrition is identified prior to surgery what is given

A

Nutritional support - to improve operative outcomes

30
Q

what are rules with nutrition

A

Always try to use oral first

31
Q

if individuals have dysphagia or are unable to intake sufficient calories orally, what is offered

A

NG Tube

32
Q

if oesophagus is blocked, what is offered

A

PEG or RIG

33
Q

If delayed gastric emptying what may be used

A

NJ Tube

34
Q

if intestinal failure or jejunal inaccessible, what method is used

A

Parental

35
Q

what guidelines governs nutrition after surgery

A

enhanced recovery after surgery (ERAS)

36
Q

what are 5 things the enhanced recovery after surgery state should be done prior to surgery to optimise outcomes

A
  • Reduced NBM (2-hours)
  • Pre-Op Carb Loading
  • Minimally invasive
  • Minimising drains and NG tube
  • Rapid re-introduction/ Feeding post-surgery
  • Early mobilisation
37
Q

what did ERAS state should be done following surgery

A
  • Feed within 24h
38
Q

what is post-op pyrexia

A

> 37.5

39
Q

if post-op pyrexia happens 1-2d after what is the likely cause

A

Respiratory

40
Q

if post-op pyrexia happens 3-5d after what is the likely cause

A

UTI

41
Q

if post-op pyrexia happens 5-7d after what is the likely cause

A

Surgical Site

42
Q

when may post-op pyrexia due to IV lines occur

A

Any time-frame

43
Q

Define pyrexia of unknown origin

A

Recurrent fever >38, persisting for >3W, with >1W of inpatient investigaitons

44
Q

what is wound dehiscence

A

fail of wound to heal causing it to re-open

45
Q

when is wound dehiscence more common

A

abdominal surgery

46
Q

what are the two types of wound dehiscence

A
  • Superficial

- Full-thickness

47
Q

what is superficial dehiscence

A

Skin re-opens

48
Q

what is full-thickness dehiscence

A

Rectus sheath fails to heal causing it to re-open and bowel to protrude through

49
Q

what is the most common cause of wound dehiscence

A

Infection

50
Q

what patient factors increase risk of wound dehiscence

A 
Male 
Age 
Smoking 
Corticosteroids 
Obesity 
Malnourished
51
Q

what intra-operative factors increase of wound dehiscence

A 
Emergency 
Prolonged operative time 
GI surgery 
Wound infection 
Poor technique
52
Q

what post-operative factors increase of wound dehiscence

A

Blood transfusions
Coughing
Radiotherapy
Ventilation

53
Q

how does wound dehiscence present clinically

A

Visible opening of the wound

54
Q

how does full-thickness wound dehiscence present

A

Bulge from the wound with an increase in discharge

55
Q

when should full-thickness dehiscence be considered

A

If there is an increase in discharge from the wound

56
Q

how is superficial wound dehiscence managed

A

Pack with saline-soaked gauze and leave to heal by secondary intention

57
Q

what can aid superficial dehiscence

A

Negative pressure dressing

58
Q

how is full dehiscence managed

A

IV antibiotics
IV Fluids

Cover wound with saline soaked gauze and immediate return to surgery

59
Q

how can haemorrhage in surgery be divided

A

Intra-operative
Reactive
Secondary

60
Q

what is intra-operative

A

Bleeding during the operation

61
Q

define reactive bleeding

A

Bleeding within 24h of the operation

62
Q

what usually causes reactive bleeding

A

Missed vessel or slipped ligature

63
Q

why may vessels be missed intra-operatively

A

Patient’s are often hypotensive - which can lead to vasoconstriction. However, post-op when BP resotres bleeding may occur

64
Q

define secondary bleeding

A

Bleeding 7-10d post-op

65
Q

what causes secondary bleeding

A

Infection causes erosion of a vessel

66
Q

what is a major RF for secondary bleeding

A

Contaminated wound closed primarily

67
Q

what is one of the most sensitive signs to haemorrhage

A

Increase RR

68
Q

what is the problem with using BP as a sign of haemorrhage

A

BP is typically a late sign

69
Q

what operation may post-op bleeding present as airway obstruction

A

Thyroidectomy

70
Q

what artery is susceptible to injury from operative ports

A

Inferior epigastric

71
Q

what are indications for surgical drains

A
  • Drainage of space (abscess)
  • Monitor output
  • Detection bleed

Pre, Peri and Post-Operative Care (4 decks)

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