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*OldSurgery > Pre- and Postop Care > Flashcards

Pre- and Postop Care Flashcards

1
Q

if a patient is over 50 what should they get before surgery

A

EKG

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2
Q

if a person is on blood thinners or has liver disease what should you get on the day of surgery

A

Coags

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3
Q

What does AMPLE stand for ?

A 
Allergies
Meds
Past med hx
Last meal
Events prior to admission
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4
Q

preop beta blockers are shown to _____ mortality, so they should still take them the day of surgery.

A

decrease

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5
Q

There should be no elective surgery within ____ months of a MI/stroke

A

6

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6
Q

Before elective surgery, those with unstable angina should have what?

A

CABG or PTCA

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7
Q

Prosthetic heart valves may require anticoagulation up to the _________

A

day of surgery

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8
Q

someone on _____ is at a much higher risk of bleeding, and it isn’t reversible.

A

Plavix

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9
Q

If FEV1 is <__%, there is major pulmonary risk

A

50%

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10
Q

about 1 out of three postop mortality is ____ in nature

A

pulmonary

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11
Q

Pts with Chronic Renal Insufficiency (CRI) present problems with

A

electrolyte balance,
volume management,
acid-base balance,
bleeding risk

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12
Q

High BUN has an ______ effect

A

anticoagulation

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13
Q

Surgery should try to be scheduled ____ after dialysis

A

as soon as possible (day after)

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14
Q

people with cirrhosis have a huge _____ risk

A

mortality (due to infection from acsities)

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15
Q

Malnutrition predisposes to poor (or non-) (3 things)

A

wound healing, immunosuppression, resp insufficiency

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16
Q

are skinny people the only malnourished people?

A

No, alcoholics also commonly malnourished

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17
Q

what are alcoholic commonly deficient in?

A

thaimine

folate

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18
Q

Albumin below what is a sign of malnutrition

A

3

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19
Q

what is a better depiction of malnourishment in the past 3 days

A

prealbumin

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20
Q

a prealbumin below what is considered malnourished?

A

18

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21
Q

what is prealbumin?

A

Transthyretin

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22
Q

Pts with steroid use (typically more than just inhalers) within last year are at risk for ________ __________ ___________.

A

postop adrenal insufficiency.

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23
Q

If a patient is on chronic steroids and needs surgery what should you do to help them heal better?

A

leave staples in longer

hydrocortisone 100 mg IV TID then 50 mg IV tid for a day

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24
Q

diabetes insipidus is usually caused by what?

A

a head injury (turn off ADH from pituitary)

25
Q

high sugars in general lead to ____ and ________

A

immunosuppression and poor wound healing

26
Q

Diabetes patients are at a high risk or _________ coma

A

hyperosmolar

27
Q

who are hypercoaguable

A 
cancer
obese
trauma
prolonged cases (stasis) 
known clotting disorders
28
Q

What is an acronym for Post op care?

A

ADC

VAANDIMIL

29
Q

What does ADC VAANDIMIL stand for?

A 
(A)dmit
(D)iagnosis 
(C)ondition
(V)itals
(A)llergies
(A)ctivity
(N)ursing – I&Os, foley, drain care, SCD’s, IS, wound care
(D)iet
(I)VF
(M)eds
(I)maging
(L)abs
30
Q

What is IS

A

incentive spirometry

31
Q

What is IS used for?

A

prevent pneumonia or other pulmonary complications

32
Q

when should postop DVT prophylaxis be given?

A

anyone inpatient for more than 24 hours post op

33
Q

when should you give postop abx?

A

elective colon surgery

34
Q

Fluid collections in red, painful wounds are called what?

A

abscesses

35
Q

What must you treat and abscesses with?

A

Drainage

36
Q

Generally most wounds can be undressed and left open after ____ hours

A

48

37
Q

When should staples be taken out?

A

POD 7

38
Q

when should you leave staples in longer?

A

if immunocompromised, malnourished, etc.

39
Q

Fluid collections in painless wounds are typically

A

seromas (will resolve over time, can drain if symptomatic)

40
Q

what is a pneumonic to remember sources of post op fevers?

A

Wind
Water
Wound
Walk

41
Q

If POD 1 what is the likely cause of the post op fever?

A

wind (lungs)

atelectasis

42
Q

If POD 3 what is the likely cause of the post op fever?

A

water (UTI)

43
Q

If POD 5 what is the likely cause of the post op fever?

A

Wound infection or abdominal abscess

44
Q

If POD 7 what is the likely cause of the post op fever?

A

Walk (DVT)

45
Q

when should foleys be removed?

A

48 hours or less (unless still needed)

46
Q

what would you suspect if POD 1 high fever with “dirty dishwater” fluid leaking from a surgical wound.

A

Necrotizing fasciitis

47
Q

how do you treat necrotizing fasciitis?

A

get back to OR IMMEDIATELY

48
Q

when should you suspect C Diff colitis

A

very high WBC or copious diarrhea

49
Q

Important things with HPOTN

A

low volume (most common) give saline
bleeding
septic shock
MI (get EKG)

50
Q

common causes of low urine output

A

Hypovolemia
bleeding
clogged foley
renal failure (usually from hypovolemia)

51
Q

common causes of N/V post op

A

drugs from anesthesia
use antiemetic drugs
give NGT if drugs aren’t doing the trick

52
Q

any GI surgery should be expected to have what?

A

postop ileus

53
Q

Does the SB ever have an ileus?

A

No

54
Q

does the stomach have an ileus?

A

usually not

55
Q

what is a great alternative pain med but not good for people with renal insufficiency and elderly

A

Toradol

56
Q

Toradol doses shouldn’t span more than how many hours?

A

72 hours

57
Q

what do pain balls do?

A

placed intraop

local meds, decrease need for opioids post op

58
Q

3 things you shouldn’t suprise a surgeon with

A

transfusion
antibiotics
diet changes (b/c surgeons fear change)

*OldSurgery (22 decks)

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