Pre- and Postop Care Flashcards
if a patient is over 50 what should they get before surgery
EKG
if a person is on blood thinners or has liver disease what should you get on the day of surgery
Coags
What does AMPLE stand for ?
Allergies Meds Past med hx Last meal Events prior to admission
preop beta blockers are shown to _____ mortality, so they should still take them the day of surgery.
decrease
There should be no elective surgery within ____ months of a MI/stroke
6
Before elective surgery, those with unstable angina should have what?
CABG or PTCA
Prosthetic heart valves may require anticoagulation up to the _________
day of surgery
someone on _____ is at a much higher risk of bleeding, and it isn’t reversible.
Plavix
If FEV1 is <__%, there is major pulmonary risk
50%
about 1 out of three postop mortality is ____ in nature
pulmonary
Pts with Chronic Renal Insufficiency (CRI) present problems with
electrolyte balance,
volume management,
acid-base balance,
bleeding risk
High BUN has an ______ effect
anticoagulation
Surgery should try to be scheduled ____ after dialysis
as soon as possible (day after)
people with cirrhosis have a huge _____ risk
mortality (due to infection from acsities)
Malnutrition predisposes to poor (or non-) (3 things)
wound healing, immunosuppression, resp insufficiency
are skinny people the only malnourished people?
No, alcoholics also commonly malnourished
what are alcoholic commonly deficient in?
thaimine
folate
Albumin below what is a sign of malnutrition
3
what is a better depiction of malnourishment in the past 3 days
prealbumin
a prealbumin below what is considered malnourished?
18
what is prealbumin?
Transthyretin
Pts with steroid use (typically more than just inhalers) within last year are at risk for ________ __________ ___________.
postop adrenal insufficiency.
If a patient is on chronic steroids and needs surgery what should you do to help them heal better?
leave staples in longer
hydrocortisone 100 mg IV TID then 50 mg IV tid for a day
diabetes insipidus is usually caused by what?
a head injury (turn off ADH from pituitary)
high sugars in general lead to ____ and ________
immunosuppression and poor wound healing
Diabetes patients are at a high risk or _________ coma
hyperosmolar
who are hypercoaguable
cancer obese trauma prolonged cases (stasis) known clotting disorders
What is an acronym for Post op care?
ADC
VAANDIMIL
What does ADC VAANDIMIL stand for?
(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
What is IS
incentive spirometry
What is IS used for?
prevent pneumonia or other pulmonary complications
when should postop DVT prophylaxis be given?
anyone inpatient for more than 24 hours post op
when should you give postop abx?
elective colon surgery
Fluid collections in red, painful wounds are called what?
abscesses
What must you treat and abscesses with?
Drainage
Generally most wounds can be undressed and left open after ____ hours
48
When should staples be taken out?
POD 7
when should you leave staples in longer?
if immunocompromised, malnourished, etc.
Fluid collections in painless wounds are typically
seromas (will resolve over time, can drain if symptomatic)
what is a pneumonic to remember sources of post op fevers?
Wind
Water
Wound
Walk
If POD 1 what is the likely cause of the post op fever?
wind (lungs)
atelectasis
If POD 3 what is the likely cause of the post op fever?
water (UTI)
If POD 5 what is the likely cause of the post op fever?
Wound infection or abdominal abscess
If POD 7 what is the likely cause of the post op fever?
Walk (DVT)
when should foleys be removed?
48 hours or less (unless still needed)
what would you suspect if POD 1 high fever with “dirty dishwater” fluid leaking from a surgical wound.
Necrotizing fasciitis
how do you treat necrotizing fasciitis?
get back to OR IMMEDIATELY
when should you suspect C Diff colitis
very high WBC or copious diarrhea
Important things with HPOTN
low volume (most common) give saline
bleeding
septic shock
MI (get EKG)
common causes of low urine output
Hypovolemia
bleeding
clogged foley
renal failure (usually from hypovolemia)
common causes of N/V post op
drugs from anesthesia
use antiemetic drugs
give NGT if drugs aren’t doing the trick
any GI surgery should be expected to have what?
postop ileus
Does the SB ever have an ileus?
No
does the stomach have an ileus?
usually not
what is a great alternative pain med but not good for people with renal insufficiency and elderly
Toradol
Toradol doses shouldn’t span more than how many hours?
72 hours
what do pain balls do?
placed intraop
local meds, decrease need for opioids post op
3 things you shouldn’t suprise a surgeon with
transfusion
antibiotics
diet changes (b/c surgeons fear change)
