Pre And Post Op Care Flashcards
Earliest indication of hypermagnesemia
Loss of deep tendon reflexes
What level and symptoms is symptomatic hyponatremia
120 mEq/L
HA, seizure, coma, ICP
How to treat hyponatrmia- moderate vs symptomatic
Mild- free water restriction
Symptomatic- hypertonic saline
Complication of jejunoileal bypass
Lose ileum–>calcium and oxalate can’t form insoluble compounds –> oxalate gets too absorbed –> hyperoxaluria
FENa less than 1 indicates
Prerenal etiology for oliguria
Magnesium deficiency symptoms
Potassium wasting by kidney
Functional hypoparathyroidism–> hypocalcemia
Prolonged qt, torsades
Hypocalcemia symptoms
Paresthesia
Hyperreflexia
Muscle spasm, tetany
Prolonged qt, heart blocks
When to give antibiotics to prevent surgical site infection in an elective procedure?
Single dose Pre-op no more than one hour before incision
What cardiac test should man with history of peripheral vascular disease and MI have before surgery?
Persantine thallium stress test and echo - assess need for stent and angiogram
Overdose of what can lead to tinnitus plus mixed metabolic acidosis-resp alkalosis
Aspirin
Treatment of Heoarin induced thrombocytopenia
Stop heparin plus start direct thrombin inhibitor and convert to warfarin when appropriate
bleeding post-op should first make you think of this etiology
bleeding blood vessel in surgical field
biggest risk factors for perioperative MI
**recent MI
CHF evidence
frequency of ectopic beats
diagnostic test of choice for acute mesenteric ischemia
angiography
suspected symptoms of actue mesenteric ischemia
sudden development of abdominal pain out of proportion of physical findings
systemic manifestations of arteriosclerotic disease or low CO states
treatment of acute mesenteric ischemia
emergent revascularization or resectional surgery
lapartomy if peritoneal signs
peritoneal signs include
acute abdominal pain, abdominal tenderness and abdominal guarding, which are exacerbated by moving the peritoneum, e.g., coughing (forced cough may be used as a test), flexing one’s hips,
Difficulty passing gas or pooping, fever, vomiting
diagnostic modality of choice for infrainguinal DVT
duplex US and heparin + warfarin (if not pregnant)
which bleeding disorder is indicated with elevated PTT and abnl bleeding time but normal PT?
von Willebrand (prevents inactivation of factor 8)
treatment of vWD and when given
desmopressin- activates receptors from storage sites to release vWF
only given before surgery or if severely injured
Systemic inflammatory response syndrome (SIRS) criteria
2 or more:
- temp over 38 (100) or below 36 (97)
- HR >90
- resp rate >20 or PaCO2 <32
- WBC >1,2,000 or <4000 or >10%immature PMNs
sepsis criteria
SIRS + documented infection
severe sepsis conditions
sepsis + organ dysfunction or hypoperfusion (lactic acdisos, oliguira, altered mental)
septic shock criteria
sepsis + organ dysfunction + hypotension (systole<90)
class IV hemorrhagic shock (loss of >40% blood volume) treatment
infusion of packed RBCs and early administration of frozen plasma and platelets before lab values
type of nutrition form that is recommended for patients with predicted prolonged recovery postop abdominal surgery
enteral nutrition within 24 hrs post op
(better than parenteral because decreased risk of infections, and better than oral because stomach is uncoordinated for 24 hours post op)
woman on heparin gets retroperiotoneal hematoma. treatment?
reverse heparin with antidote-protamine sulfate
indications for IVC filter
- failure or complciation of anticoagulation
- known free floating venous clot
- prior history of PE
complications of refeeding syndrome
hypophosphatemia, hypokalemia, hypomagnesemia (as insulin shifts electrolytes into cells)
hypoglycemia, hyperchloremic acidosis, volume overload –> HF
acute adrenal insufficiency signs
changing mental status, increased temp CV collapse hypoglycemia hyperkalemia
causes of adrenal insuff
severe stress
infection
trauma
cessation of chronic gluocorticoids
treatment of adrenal insuff
IV steroids
volume rescucitation
transusions of FFP to replenish vit K dep clotting factors should be administered when for patient with abnl coag factors going into surgery
on call to the operating room- transfusion complete prior to incision
most common post op nosocomial infection?
UTI
factors that predispose to fistula formation
FRIENDS
foreign body radiation inflammation epithelization of tract neoplasms distal obstruction steroids
hemolytic vs allergic nonhemolytic transfusion reactions
hemolytic: preexisiting antibodies against ABO incompatible blood
symptoms of hemolytic transfusion reactions
fever, chills, pain, redness along infused veins, oozing from IV sites, resp distress, anxiety, hypotension, oliguria
treatment for bleeding complication in surgery with someone with mild vs severe hemophilia A
mild: desmopressin (increases factor 8 and vWF)
severe: desmopressin plus e-aminocaproic acid (inhibits fibrinolysis)
when should you stop NSAIDs vs aspirin before surgery?
NSAIDs- 3-4 days before
aspirin: 7 days before
treatment of megaloblastic anemia post gastrectomy
IV vit B12 (cyanocobalamin) every 3-4 months for life
tests you could do post-op when you suspect a ureteral injury
pyelogram or nuclear medicine scan
treatment for mild vs severe hypocalcemia post thyroid surgery
mild: oral calcium gluconate
severe: continuous infusion of calcium gluconate for few days
which type of fluid is appropriate for replacing enteric losses?
ringer lactate solution
which med counteracts effects of potassium (cardio) without decreasing the amount of potassium?
calcium gluconate
which deficiency: alopecia, poor wound healing, night blindness or photophobia, anosmia, neuritis, skin rash
zinc
which deficiency: cardiomyopathy
selenium
molybdenum deficiency
encephalopathy- toxic accumulation of sulfur containing amino acids
chromium deficiency
difficult hypoglycemia,
peripheral neuroapthy
encephalopathy
commonly occurs in long term TPN
thiamine def
beri beri- encephalopathy, peripheral neuropathy
CV symptoms and HF
malignant hyperthermia antidote
dantrolene- stop the anesthetic
typical case of malignant hyperthermia
after induction of anesthesia
fever, shaking rigors, rhabdo (blood-tinged urine)
how to replace blood loss in jehovas witness
lactated ringers or normal saline in 3:1 ratio
whats a good solution for maintenance fluid?
0.45% normal saline with or without KCl (depends on kidney function)
early signs of sepsis
changing mental status tachypnea --> resp alkalosis flushed skin (dilated peripheral arteries)
treatment for non-anion gap metabolic acidosis
fluid replacement and stool bulking agents
treatment for transfusion reactions
stop transfusion. replace fluids
inducing diuresis to clear hemolyzed RBC membranes
alklanize urine to prevet Hgb clumping–>renal damage
do you use antidiarrheal agents for c dif?
no!
should you take in more or less calories post starvation?
less
how many calories should you increase (relative to baseline) in following situations:
- post routine operation
- multiple organ failure or severe injury
- more than 50% surface area burns
- post routine operation: 1.1
- multiple organ failure or severe injury: 1.5
- more than 50% surface area burns: 2.0
