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Med Procedures - Final > Pre and Post-Op Management > Flashcards

Pre and Post-Op Management Flashcards

1
Q

How to evaluate a patient’s risk for a procedure?

A
  • Nature of procedure
  • Overall health of the pt
  • What risks can we control?
  • Which risks can we NOT control?
  • How can we reduce risk?
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2
Q

If risk is high and benefit low:

A

Reconsider surgery

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3
Q

When is surgery deemed appropriate for a patient?

A

When benefit is high and risk is low

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4
Q

What does the pre-op evaluation consist of?

A

Complete medical history

  • Allergies
  • Meds
  • Prior surgeries, problems w/anesthesia
  • Family hx of anesthesia problems
  • ROS
  • Physical exam
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5
Q

What are pre-op red flag disorders?

A
  • Cardiac, lung, DM
  • Bleeding, liver, renal
  • Seizures, infections, pregnancy
  • Substance abuse
  • HIV
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6
Q

How should diabetes patients be prepped pre-op?

A
  • NPO
  • Hold or reduce hypoglycemic agents
  • Better if glucose is higher rather than low
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7
Q

What should a surgical patient receive if they are on steroid treatment?

A

Pre and post-op solumedrol (IV)

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8
Q

Why does a patient on steroids require pre and post-op solumedrol (IV)?

A
  • Chronic steroids can suppress endogenous steroid production
  • During times of stress (aka surgery), the adrenals may not respond appropriately
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9
Q

How are labs ordered for the pre-op evaluation?

A

Fine tuned to the nature of the surgery as well as age/health of patient

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10
Q

Which pre-op labs are necessary only if indicated?

A
  • Clotting studies
  • LFTs
  • EKG
  • CXR
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11
Q

When is a pre-op EKG indicated?

A

If patient is over 40 yo OR has cardiac history

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12
Q

Effects of general anesthesia

A
  • Increases cardiac irritability

- Decreases: systemic vasc resistance, myocardial contractility, stroke volume

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13
Q

What type of anesthesia carries the least risk?

A

Local

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14
Q

What type of anesthesia carries the most risk?

A

General

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15
Q

Describe post-op MI

A

50% mortality risk

related to age and pre-existing conditions

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16
Q

What are considered major cardiac risks to surgery?

A
  • Unstable coronary syndrome
  • Decompensated CHF
  • Significant arrhythmia
  • Severe valvular disease
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17
Q

What are considered intermediate cardiac risks to surgery?

A
  • Mild angina
  • Previous MI
  • Compensated or prior CHF
  • DM
  • Renal insufficiency
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18
Q

What are considered minor cardiac risks to surgery?

A
  • Advanced age
  • Abnormal echo
  • Rhythm other than sinus
  • Prior hx of stroke
  • Uncontrolled HTN
  • Low cardiac functional capacity
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19
Q

What makes a surgery high risk and what are examples?

A
  • Over 5% chance of MI or death
  • Emergent surgery in elderly
  • Aortic surgery
  • Peripheral vascular
  • Procedures w/prolonged blood loss
20
Q

What makes a surgery intermediate risk and what are examples?

A
  • 1-5% chance of MI or death
  • Carotid endarterectomy
  • GU and uncomplicated abd
  • Ortho
  • Head and neck
  • Thoracic
21
Q

What makes a surgery low risk and what are examples?

A
  • Less than 1% chance of MI or death
  • Cataracts
  • Endoscopy
  • Superficial procedures
22
Q

Purpose of pre-op testing for cardiac risk patients

A
  • To measure functional capacity and predict risk

- Identify existing or potential myocardial ischemia

23
Q

Cardiac pre-op tests

A
  • EKG
  • Dobutamine stress ECHO
  • Dipyridamole thallium imaging
  • Coronary angiography
  • Exercise stress testing not always used
24
Q

What decreases the absolute cardiac risk of surgery by 15%?

A

Beta blockers started 1 week pre-op

25
Q

What is the result of starting Beta Blockers 1 week pre-op?

A

Reduces absolute cardiac risk by 15%

26
Q

How does post-op cardiac ischemia present?

A

Asymptomatic in up to 90% of cases

27
Q

When does post-op cardiac ischemia present?

A

NOT during surgery, but post-op day 1 and 2

28
Q

What are the % risks of cardiac ischemia pre-op, intra-op, and post-op?

A
  • Pre-op risk = 20%
  • Intra-op risk = 25%
  • Post-op risk = 55%
  • Highest risk of cardiac ischemia AFTER surgery
29
Q

The MC post-op complication is ____ in origin

A

Pulmonary

atelectasis and PNA

30
Q

Risk factors for pulmonary post-op complications?

A

Age
Obesity
Smoking
COPD, asthma, sleep apnea

31
Q

Risk of pulmonary post-op complication in smokers?

A

2X higher even if they don’t have COPD

32
Q

Ways to reduce pulmonary post-op complications?

A
  • Stop smoking more than 8 wks prior

- Delay elective surgery for poorly controlled COPD pts

33
Q

How to prevent post-op atelectasis?

A
  • Deep breathing
  • Incentive spirometry
  • Pre-op teaching
  • Avoid supine positioning
34
Q

When does oxygen delivery diminish?

A

HCT under 30

35
Q

HCT under 30 causes:

A

Reduced oxygen delivery

36
Q

What can intra-operatively lower HCT?

A

IV hydration

37
Q

HCT under ___ will increase MI risk

A

28

38
Q

HCT under 28 will increase:

A

MI risk

39
Q

Which surgeries carry higher infection risk?

A

Oral
Trauma
Bowel
Vaginal

40
Q

When are proph abx used for surgical patients?

A

If risk is over 2%

41
Q

How often should a diabetic surgical patient’s blood glucose be measured?

A

Every 6 hours

42
Q

What doses of prednisone (and hydrocortisone) can be suppressive?

A
  • Prednisone 7.5 mg/day

- Hydrocortisone 30 mg/day

43
Q

How long may partial adrenal insufficiency last after d/c chronic steroids?

A

As long as 9 months

44
Q

What are the 5 Ps for post-op patients?

A
  1. Pain control
  2. Prevent pus (post op abx)
  3. Pillow (sleeper PRN)
  4. Poop
  5. Previous meds
45
Q

Mobilization of a post-op patient

A

Get pt out of bed and ambulating ASAP to avoid pressure sores, PNA, DVT, etc.

46
Q

How often should post-op wound be checked?

A

At least QD or QOD

47
Q

What does a pre-op note consist of?

A
  • Date of planned procedure
  • Pre-op diagnosis
  • Name of procedure
  • Consent obtained/risks discussed
  • Lab results including EKG
  • Confirmation of blood in blood bank

Med Procedures - Final (1 decks)

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