Pre and Postop Care Flashcards
What do you document for informed consent
The procedure was explained
Risks, Benefits, and alternatives were explained
When to do an EKG preop
Over 50
What test should be done on any female of childbearing age?
HCG
When should you order a type and screen (T&S)?
Anemia or Significant blood loss
What lab should be ordered preop if the pt is on blood thinners or has liver disease and when?
Cag pannel on DOS
Why is past surgical Hx important?
preop planning b/c of scar tissue, expected adhesions
What does AMPLE stand for?
Allergies, Meds, Past med hx, Last meal, Events prior to admission
When is AMPLE used?
In the setting of emergency surgery
What has been shown to decrease mortality with heart disease if given preop?
Beta Blockers
No elective surgery within how long of an MI/Stroke?
6 months
What should pts with unstable angina ideally have before surgery?
CABG or PTCA
What should be given up until DOC with prosthetic heart valves?
Anticoagulation
What finding on PFT would signify major pulmonary risk?
FEV1 <50% expected
What pulmonary risks should be discussed with the patient?
Atelectasis, postop pneumonia, prolonged ventilation
What proportion of postop mortality is pulmonary related?
1/3
What complications are associated with chronic renal insufficiency?
Problems with electrolyte balance, volume management, acid-base balance, bleeding risk (high BUN has an anticoag effect)
What electrolytes should be avoided in fluids given to pts on dialysis?
K Mg Phos
When should surgery be scheduled in relation to pts dialysis?
Shortly after
What should be excluded from dialysis treatment before surgery?
Heparin
What mortality is associated with Child’s A cirrhosis?
10-15%
What mortality is associated with Child’s B cirrhosis?
25-30%
What mortality is associated with Child’s C cirrhosis?
> 50%
What complications is malnutrition associated with?
Poor wound healing, immunosuppression, respiratory insufficiency
What are laboratory signs of malnutrition?
Albumin <18, low total protein
Pts who have been on steroids during the past year are at a risk of what?
Postop adrenal insufficiency
If postop adrenal insufficiency caused by steroid use is untreated what can it lead to?
Vascular collapse
How is post op adrenal insufficiency treated?
Hydrocortisone IV 100 mg IV tid for one day then 50 mg IV for one day
What are diabetics high-risk for if their blood sugars are high at the onset of surgery?
Hyperosmolar coma
Hyperglycemia in general leads to:
Immunosuppression, poor wound healing
For what conditions do you keep on lovenox until DOS?
Mechanical heart valves and a fib
Risk of clot is greater with arterial clot within how much time?
6 months
Risk of clot is increased with DVT within how much time?
3 months
When is DVT prophylaxis given if the patient is still in the hospital post-op?
within 24 hrs
When are postop abx given?
Elective colon surgery
When can wounds be undressed and left open?
After 48 hours
How will an abscess in a wound present?
fluid collection in red, painful wounds
What can an abscess not be treated without?
Drainage
When can staples be removed in a normal patient?
POD 7
What is a seroma?
Fluid collection in a painless wound
How is a seroma treated?
It will resolve on its own or can be drained if it is symptomatic
When do postop fevers generally occur?
Wind (1) Water (3) Wound (5) Walk (7)
What does wind stand for in wind/water/wound/walk?
Atelectasis
When should C diff be suspected for a post op fever?
Very high WBC and copious diarrhea
What is the classic setup for necrotizing fasciitis?
POD 1, high fever, “dirty dishwater” drainage from wound
How is nec fasc treated
Surgical emergency
What are common causes of post op hypotension
Hypovolemia, bleeding, septic shock, MI
What are common causes of low urinary output?
hypovolemia, bleeding, clogged foley, renal failure
How long is a small bowel ileus?
SB ileus does not occur
How long does a stomach ileus last?
Maybe one day
How long does a large bowel ileus last?
3-5 days
How do you manage pain if pt is NPO?
IV or PCA narcotics
What are precautions in Toradol?
Elderly, renal insufficiency
How long can a pt be treated with Toradol?
Minimal doses for no more than 72 hours
