postop complications & pain management Flashcards

1
Q
  • highly sensitive to stretch, ischemia and inflammation
  • Ache, dull, crampy, diffuse, spastic, gnawing, constant
A

visceral nociceptive

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2
Q
  • stimulation of nociceptors in ligaments, tendons,
    bones, blood vessels, fascia and muscles
  • Broken bone, sprains
A

deep somatic nociceptive

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3
Q

well-defined and easily located activation of nociceptors in skin or other superficial structures

A

superficial somatic nociceptive

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4
Q

two pre-op local anesthetics

A

lidocaine
marcaine

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5
Q
  • Preferred mode of administering opioids for moderate/severe postop pain
  • easy and minimizes risk for OD
  • which 3 meds can be given like this?
A

Patient controlled analgesia (PCA)
hydromorphone, morphine, fentanyl

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6
Q
  • harder to dose bc of short half life but used in liver patients bc no first pass effect
  • synthetic derivative of morphine; 100x more potent
A

fentanyl

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7
Q

what anelgesia is MC used for epidurals vs spinals?

A

epidurals: fentanyl
spinals: bupivacaine (marcaine)

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8
Q

how are postdural HA treated? (3)

A

rest, IVF, blood patch

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9
Q
  • rapid onset; semisynthetic opioid agonist
  • IV meds
A

hydromorphone

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10
Q
  • IV med that reduces narcotic demand used for 48h postop
  • works as antipyretic
A

acetaminophen (ofirmev)

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11
Q
  • potent NSAID used with caution in renal pts/elderly
  • reduces narcotic demand
  • can only be dosed for 5 days d/t renal risk
A

ketorolac (toradol)

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12
Q
  • most commonly used oral meds
  • SE includes N/V, constipation, hypotension, sedation, respiratory dep, urinary retention
  • easy to withdrawal
A
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13
Q
  • Long lasting pain control
  • Patch stays on for up to 3 days
  • Transmits opioid transdermally
  • New adjunct to modern day pain contro
A

fentanyl/lidocaine patch

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14
Q
  • SE profile low
  • Helpful with neuropathic pain by binding to Ca+ channels to decrease impulse conduction which increases GABA synthesis (inhibitory pathway to pain transmission)
  • No ceiling drug – If pain not controlled, increase the dose
A

anticonvulsants

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15
Q
  • Produces pain relief by enhancing the descending pain inhibition pathway
  • Helpful with neuropathic and phantom pain
  • Can be helpful with insomnia and depression associated with pain
  • Concerns about toxicity
A

TCA (amitriptyline)

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16
Q
  • Helpful for sleep, anxiety disorders and muscle
    spasms
  • Can cause dependence, increased aggression
  • Caution with elderly
  • Avoid if possible
A

Benzos

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17
Q

should you stop the home dosing for people who take narcotics at home?

A

NO

18
Q

what are the 5 Ws of fevers

A
  • Wind: atelectasis vs pneumonia; first 24 to 48h
  • Wound: after post op day 3
  • Water: UTI; 24-72hrs
  • Walking: PE?
  • Wonder drugs: anytime
19
Q

3 causes of intraoperative or PACU fever

A
  • MH
  • infection
  • drug/transfusion reaction (often hypotension and rash)
20
Q
  • necrotizing wound infections (clostridia or streptococcus)
  • preexisting infection
A

fever w/in 24 hrs (infection)

21
Q

fever 2-3 days; what are 3 possible causes

A

UTI
pneumonia– XR, procalcitonin
IV related complications

22
Q

test to distinguish bacteria from other causes of infection or inflammation

A

procalcitonin

23
Q

fever 3days to 1 week what are 3 possible causes

A

infections, DVT/PE, drug fever

24
Q

how are deep surgical site infections diagnosed?

A

CT targeted at the site

25
Q
  • sick patient post op day 5-7; associated mortality
  • causes peritonitis and sepsis
  • requires emergent re-op to fix the leak
A

anastomotic leak

26
Q
  • inflammation/infection of the parotid gland from prolonged NPO/dry mouth
  • Associated with sialolithiasis
  • tx: abx plus sour lozenges to stimulate saliva
A

parotitis

27
Q
  • acute gallbladder infection from prolonged NPO status/acute illness.
  • Requires cholecystectomy or cholecystostomy tube
A

alcalculous cholecystitis

28
Q
  • associated with copious diarrhea and often profound leukocytosis.
A

C. diff

29
Q

usually associated with NG tubes

A

sinusitis

30
Q

____ rarely causes post op fever

A

malignancy

31
Q

when does major post op bleeding usually manifest?

A

within 24h postop

32
Q

H/H of what level should be allowed in healthy person

A

7/21– allow lower level

33
Q

FeNa under 1% vs above 2-3%?

A

under 1 is prerenal while above 2-3 is ATN or postrenal dz

34
Q

what two classes of meds are risk factors for urinary retention

A

narcotics or decongestants

35
Q

3 ways to monitor urinary retention

A
  • voided output
  • bladder scan if no void over 6hrs
  • straight cath to record residual volume
36
Q

3 ways to treat urinary retention

A
  • straight cath q 6h or sooner if uncomfy
  • foley if over 2 straight caths required (leave in 2-7days)
  • consider Flomax
37
Q

if someone is delirius what must be ruled out

A

post op CVA– get head CT if not going away after usual treatment

38
Q
  • neurogenic obstruction d/t inflammation, manipulation, peritonitis
  • distended, hypoactive BS, dilated bowel
  • NO PAIN!!!
  • tx: reduce oral intake (liquid or light meals), provide IV fluids
A

ileus

39
Q

mild permissive ____ glycemia ok because it’s a physiologic response to stress?

A

HYPER– treat if over 200mg/dl; can impair healing

40
Q
  • no sx or increased WOB or hypoxemia
  • managed with aggressive pulmonary toilet, suctioning PRN, supplemental O2 PRN
A

atelectasis

41
Q

wound infections usually appear how many days post-op

A

wound infection